Case Study: Death Certification Drama

The JMO was working on night shift when he was called to certify the death of a patient and complete the Medical Certificate of Cause of Death. The patient had been receiving palliative care for metastatic breast cancer. The death was expected and was not reportable to the Coroner. The JMO had never completed a death certificate before. He was in a hurry and was uncertain what to include under the various headings on the certificate. In his haste, he simply recorded "Metastatic cancer 2 years" under the heading "Disease or condition directly leading to the death". He did not make any notation under the other headings: "Antecedent causes" and "Other significant causes".

Several days later, the JMO received an angry phone call from the patient's husband. The husband had received a copy of his wife's death certificate. He was extremely upset that the certificate was not accurate. The husband told the JMO that his wife had been diagnosed with breast cancer 2 years earlier and she had developed liver metastases 6 months prior to her death. She also had insulin dependent diabetes mellitus which had not been recorded on the certificate. To make matters worse, the patient's name had been spelled incorrectly.

Accurate death certification is important to family members. It allows them to understand what caused the death and to be aware of conditions that may occur in other family members, now and in the future. The information is also coded by the Australian Bureau of Statistics (ABS) for use by the public health sector and medical researchers for evaluating and developing measures to improve the health of Australians generally.

The ABS has published a booklet which provides guidance on completing Medical Certificates of Cause of Death.

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