Emedinews:Insights on Medicolegal Issues:Issuance of death Certificate by Doctor

Coma is a clinical symptom and not a cause of death

The certificate of death is always issued by doctor as an honor/respect to the deceased person without any fee. In accordance with the Registration of Births and Deaths Act 1969, the registration of deaths is now compulsory throughout India. The doctor must write his registration number in the Death Certificate and a register for such information should be maintained with his clinic/hospital and a copy/information of death must/mandatorily be sent immediately to the birth and death registration office. It is essential that the cause of death must be documented/determined before lawful disposal of the deceased body by the doctor. The death certificate also provides the exact cause of death for statistical purposes. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organization. Thus, the international medical Certificate of the Cause of Death consists of two parts:

• Part I: Records (a) the immediate cause, and (b) the morbid conditions, if any, giving rise to the immediate cause. Thus (a) must be due to (b). When (b) is due to other causes, it should be mentioned in (c). The basic pathological condition is that on the lower–most line and this is the one that is used for statistical purposes.
• Part II: records any other significant condition contributing to death, but not related to the immediate cause of death. The underlying cause of death is defined as the disease, which initiated the train of morbid events leading directly to death for instance; a patient may die primarily from myocardial infraction due to coronary artery disease. These should be placed in parts (a) and (b) of part I as the myocardial infraction due to coronary artery disease (or coronary insufficiency). Similarly, it can be certified that the patient died of cerebral hemorrhage due to hypertension.

However, if the patient also suffers from diabetes, it should be entered in part II as it does not have a direct contributing role to the immediate cause of death. It is incorrect to write ‘heart failure ‘or ‘cardiac failure’ or’ cardiopulmonary arrest’ without mentioning the underlying pathological cause, which might be’ coronary artery disease’ or ‘rheumatic valve lesions’ or’ senile myocardial degeneration’. It should be remembered that everyone dies of ‘cardiopulmonary arrest’ or’ heart failure’ or ‘cardiac failure’, which simply means cessation of circulation and respiration leading to somatic death.

The modes of death, e.g., cardiorespiratory failure, or asphyxia should not be recorded as the cause of death, unless qualified as explained here, for instance, ‘coma’ is a clinical symptom and not a cause of death. It should be used with proper cause such as crush injury of head or meningitis etc.

The terms like angina, cancer, tumor apoplexy congestion’,’ debility’, ‘asthenia,’ organic disease toxemia, sepsis and hemorrhage are sign/symptoms of the disease and not a pathological condition. It is pertinent for medical professional to note that a death certificate requires the underlying pathological cause and not clinical manifestations or modes of death.