Death certification became a statutory obligation in England in the 1830s, and a state function in the US in 1844.1
Information on causes of death has been published in New Zealand since 1872 for Europeans, and 1920 for Maori.2
The completed certificate attests to the fact and cause of death. Death certificates now have additional functions:3-5
- to monitor trends and patterns in disease;
- to guide health promotion, resource allocation, service planning, priority determination;
- research and epidemiology; and
- settlement of estates, welfare and pension entitlements and insurance payments.
The consequences of erroneous information are significant, not only for families, but also for health planners and funders.
International reports of inaccuracies in death certificates range from 20–65%.6-9
Inaccuracies can emerge from the initial entry by the attending doctor or coroner, and the assignment of codes by coders. Attempts to improve accuracy have been through training certifiers, audit and review,3-5
re-design of the certificate and updated guidelines.10
Occasional reference has been made to the possibility that the attitude of medical practitioners influences inaccuracies.8,11,12
Bloor described death certification as one of a number of activities where ‘wide and largely unacknowledged variations in practice occur with each practitioner investing his or her own practices with moral worth’.12
Maudsley and Williams have indicated a need to go beyond the ‘traditional perspective’ to improve the quality of death certification.3
In New Zealand the Registrar General keeps the register of the causes of death as submitted on each death certificate or coroner's report. Approximately 11% of deaths have postmortem examinations and the subsequent reports are taken into consideration in stating the cause of death.2
The New Zealand Medical Certificate of Causes of Death has been designed in accordance with the World Health Organisation's recommended International Form of Medical Certificate of Cause of Death. This provides for international uniformity of the questions on the certificate.
How this fits in
Causes of inaccuracies in death certification are largely attributed to inadequate training and coding errors and, occasionally, to the attitudes of the certifiers. This study exposes uncertainty, the role of the family of the deceased, and cultural issues as factors influencing New Zealand GPs completing death certificates.
The doctor attending the patient during the final illness completes the death certificate. Under some circumstances the doctor must report a death to the coroner and the Coroners Act 1988 (Section 4) specifies the deaths that need to be reported. These include every death that appears to have been without known cause, or suicide, or unnatural or violent.
In New Zealand GPs complete approximately 30% of death certificates (R Smyth, personal communication, 29 Nov 1995). The aim of this study was to explore what New Zealand GPs consider influences them as they complete death certificates.