Medical certificates of death: First principles and established practices provide answers to new questions

• Published in: Canadian Medical Association journal (CMAJ) Vol. 188; no. 1; pp. 49 - 52
• Main Authors: Downie, Jocelyn, Oliver, Kacie
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Inc 05.01.2016; Joule Inc; CMA Impact, Inc; 8872147 Canada Inc
• Subjects: Analysis; Assisted suicide; Canada; Cause of Death; Death Certificates; Euthanasia; Health insurance; Humans; Insurance coverage; Insurance policies; Legislation; Life insurance; Physicians; Practice; Practice Patterns, Physicians; Privacy; Right to die; Suicide, Assisted; Vital statistics; Canada
• ISSN: 0820-3946; 1488-2329; 1488-2329
• DOI: 10.1503/cmaj.151130

Voluntary euthanasia became legal in Quebec in December 2015,1 although the legislation is currently the subject of litigation. In addition, physi cian-assisted death will become legal across Canada in February 2016,2 barring an extension on the deadline being given by the Supreme Court of Canada. There are many questions about how physician-assisted death should be regulated. One as-yet-unanswered question is "Should physician-assisted death be recorded anywhere on the medical certificate of death?" If so, a second question follows: "How should it be recorded - as manner and/or cause?" and if the latter, "Which category of cause: immediate, antecedent or underlying?" Although there is no uniform medical certificate of death in use across Canada, all 12 of the provinces and territories for which we were able to obtain a medical certificate of death ask for the "immediate cause of death" and "antecedent causes, if any, giving rise to the immediate cause ..., stating the underlying cause last." The underlying cause of death is "the cause selected for coding and tabulation of the official cause-of-death statistics."4 All 12 jurisdictions also ask for "other significant causes contributing to death" but "not causally related to the immediate cause," "not resulting in the underlying cause" and "not related to the disease or condition causing it." In addition, all 12 jurisdictions ask for the interval between the onset of each cause or condition and death. All 12 jurisdictions ask about variations on the "manner of death," and the respondent must check one from a list of possible answers, including "natural," "accident," "homicide," "suicide," "pending investigation," "pending finalized details of natural causes" and "undetermined." However, not all jurisdictions offer all of these options; for example, only half include "natural."