Causes of Death, Contemporary

The cause of death is a short statement that informs a reader as to the reason for an individual's death. Strictly speaking, it should be divided into the medical cause of death, or a short statement of an illness or medical condition that was responsible for the death of the individual, and the manner of death, which is a legal conclusion on the circumstances of an individual's death. While this appears to be straightforward, for many physicians, lawyers, and ethicists, this can be the most difficult issue with which they must deal.

Historical Developments

Death was defined historically and by “common law” to be the condition whereby the circulation (heartbeat) as well as the breathing of an organism had stopped. This was easily understood by all and required no medical training. Even so, medical doctors were frequently asked to attend a death and confirm that these physiological events had occurred.

This determination of death became more complex and controversial when the World Medical Association, at its assembly in Sydney in 1968, introduced and adopted the concept of brain death. This concept can be further divided into that of brainstem death, as adopted in the United Kingdom, and that of whole brain death, as adopted in the United States in 1980 with the Uniform Determination of Death Act.

The medical cause of death can be as variable or colorful as the individual doctor writing the statement. François Bossier de Lacroix is credited as the first person to propose a systematic classification of disease in the treatise Nosologica methodica. The statistical study of diseases for practical purposes had a century earlier been exemplified by the work of John Gaunt on the London Bills of Mortality. William Farr, a medical statistician with the General Register Office of England and Wales, along with Marc d'Espine, is credited with developing the first internationally applicable and uniform classification of the causes of death. This led to the Bertillon Classification of Causes of Death in 1893, a classification that was later developed into the International List of Causes of Death. Successive revisions and lists were introduced.

In 1948, the World Health Organization prepared the two-volume Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. In 1955 and then in 1965 the seventh and eighth editions, respectively, were published. The ninth edition followed in 1975, and the tenth edition was first introduced in 1989. Modifications to the classifications continue, and several new versions of the tenth edition have been promoted.

Determination of the Cause of Death

Under ideal situations, the following would be the background for the determination of a cause of death statement. A trained, qualified physician will attend the death of an individual wherever this may be. This doctor will make determinations to establish the fact of death and will then decide on the medical cause of death. In doing this, available medical records and charts are reviewed to determine if a disease or disease condition caused the death. If this was possible, some form of document containing the name of the deceased [Page 160]individual, the place of death, the time of death, and the medical cause of death can be issued, and this information can then be registered with a legal authority such as the registrar of death. Upon such registration, action can be taken to initiate funeral arrangements, death duties, and inheritance procedures.

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