Multiple alternatives listed on death certificate - is this a thing?

December 28, 2021 5:41 PM

Is this a common practice for a death certificate, to add in variations of likely culprits? Is there some sort of cause of death tally or record kept by the county so they want to cover all possibilities?

My elderly friend's death certificate listed multiple causes of death: Dementia, Vascular dementia, Parkinson's, Lewy Body Dementia, Alzheimer's disease, Mixed dementia, hypertension, heart disease, etc. So many diseases were listed that they were stacked 3 lines deep, which is what caught my attention.

My knowledge of his death is that he was diagnosed years prior with Vascular dementia and Parkinson's but not Lewy Body or Alzheimer's or the other variants. There was no autopsy, so of course we can't know for certain, but a listing of all of those diseases was unexpected and now I'm curious if someone might know the reason for the coroner's many, many listings?

posted by Ink-stained wretch to Health & Fitness (4 answers total)

Best answer: Typically the first cause will be the proximate cause of death, and everything else are contributing factors (ideally in order of importance but often just alphabetically). At least when I was a resident several years ago, there was a emphasis on being as comprehensive as possible, so as to accurately capture how sick a person was at the time of death. Hospitals get dinged for excess mortality rates, so there's something of a "kitchen sink" mentality to death certificates.
posted by basalganglia at 6:35 PM on December 28, 2021 [7 favorites]

Besides the obvious medical issues, there are, surprisingly, also legal considerations for listing additional causes of death on the death certificate.

A personal example: As a 100% disabled veteran (USA), if my death certificate lists cause of death as any of the health problems that the Veterans Administration has formally rated me as having, then my wife is eligible for a survivor's pension. If it doesn't list any of the VA conditions, then she is not. We've made sure my wife and my primary care provider know this, and it is one of the items on our estate/death planning checklist.
posted by seasparrow at 7:06 AM on December 29, 2021 [1 favorite]

My father's death certificate lists 7 causes of death, with a note to enter the "chain of events that directly caused the death". The first is listed as the Immediate Cause, and the others are "sequential conditions leading to the cause of death", with the Underlying Cause ("disease or injury that initiated the events resulting in death") listed last.

If nothing else, the list is a good source for the "did your immediate family members suffer from any of these diseases?" checklist at a doctor's office.
posted by alynnk at 8:36 AM on December 29, 2021

My husband died of a very obvious cardiac event, probably blood clot, and I declined an autopsy. His death certificate took me more than a month to get, and listed pneumonia as the first cause, though his last ER visit a week before his death had included an x-ray that found no pneumonia, and he had no symptoms of pneumonia in the intervening week. It has no mention of the blood clot that actually killed him, or the several non-pneumonia infections that he'd been treated for over the last few months including MRSA which we were still waiting on a blood test to see if it was gone. They did list his kidney transplant and diabetes as proximal cause.

I assume they just didn't want stats saying someone died of MRSA.
posted by buildmyworld at 7:06 PM on December 29, 2021