Cause of Death

Cause of death is a concept applied somewhat more strictly and precisely by

the medical examiner than by other physicians or the lay public.21 A number

of definitions of this term have been devised, but a simple one favored by the

author is “that disease, injury or event, but for which death would not have

occurred at the time it did.” In death certification, the first insult that begins

a cascading series of events leading to death is of primary interest. This is

referred to as the cause of death, or as the proximate cause of death. This is in

distinction to the subsequent resultant physiologic derangements caused by

this event. These derangements are often referred to as mechanisms of death

or the immediate causes of death.

For example, suppose an individual receives a gunshot wound that

injures the spinal cord and renders the victim quadriplegic. If, years later, he

or she succumbs to a urinary tract infection related to the paralytic bladder

caused by the spinal cord injury, the cause of death should be appropriately

certified as a “gunshot wound of the back,” or “urosepsis complicating

quadriplegia due to gunshot wound of back.” Many physicians, however,

would inappropriately list the cause of death as “urinary tract infection”

(a mechanism of death) without referencing the true cause of the condition,

the gunshot wound. The reasons for this are readily apparent, as most clinical

physicians are concerned with diagnosing and treating acute conditions that can be ameliorated by medical or surgical therapy. The medical examiner,

however, recognizes that the purpose of death certification is to provide statistical

information on primary causes of death, and that the lapse of time

between injury and death is of no importance in this documentation.