The state likes to know when someone is born, someone dies or a marriage occurs. The registrar of births, deaths and marriages keeps the local records. I am concerned with death certificates, on which is written the particulars of the dead person, including the cause of death.

If a patient has been under medical care for a natural disease and has seen a doctor within 14 days of death, then a doctor CAN write a death certificate. What is put as the cause of death (ie within the central box) need only be to the doctor’s best knowledge (ie it is not necessary for the doctor to have outside proof). Only someone on the medical register (held by the General Medical Council) can fill out the cause of death.

The cause of death is on 4 lines, labelled ‘1a’, ‘1b’, ‘1c’ and ‘2’. 1c must lead to 1b, which must lead to 1c. Somewhere among 1a, 1b and 1c there must be a DISEASE. MODES OF DEATH (such as ventricular fibrillation or heart failure) can figure, but must be qualified by a disease (ie the disease must appear in either 1b or 1c.

For instance, someone may go into ventricular fibrillation, but this is usually caused by coronary atheroma. Therefore, 1a Ventricular Fibrillation 1b Coronary Atheroma is acceptable to the Registrar of Births, Deaths and Marriages, but 1a Ventricular Fibrillation alone is not.

Under 2 are natural diseases that contributed to the death but which are unrelated to anything written under 1a, 1b or 1c.

Things that may not appear are abbreviations and unnatural causes (the latter deaths are referred to the Coroner). Section 2 is often used as a dumping ground for conditions, although I frown on this. ‘Old age’ is regarded as a legitimate disease process only in the very old (the goalposts are moving all the time).

The Medical Examiner acts as the referee, deciding what is reasonable and which cases to refer to the coroner.

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