The April 7th issue of the New Yorker has a fascinating article by Kathryn Schulz[1] on death certificates, a subject you never thought you would want to know about.
She says, “every dead body is a mystery. Death is an assassin with infinite aliases, and the question of what kills us is tremendously complex. . . . Today, ‘Why do we die?’ is one of the fundamental questions of epidemiology, and we have developed a vast and macabre bureaucracy to answer it.”
Only one half of the 50 million people who will die this year, she reports, will get a death certificate. The half who do not are in the world’s poorest places that do not have the infrastructure for such documentation.
The antecedent of the modern death certificate was the Bill of Mortality in early-sixteenth century England that recorded the weekly numbers of death by the plague.
In 1836 they were replaced in England by what would become the global prototype of the modern death certificate.
In 1893 the International List of Causes of Death was published by a committee headed by the French statistician and demographer Jacques Bertillon. That list after 10 revisions is still used today and now is managed by the World Health Organization. The latest version has over 8,000 ways to die.
Today the one-page death certificate has 250 pages of instructions on how to fill it out by physicians, funeral directors, medical examiners and coroners. Although 90% of the certificate can be filled out easily, the problem arises with the four lines for cause-of-death.
The certificates for deaths in hospitals typically are filled out by residents who have inadequate training for doing so. This results in errors that “overstate leading causes of death, obscure emerging ones, and distort the data we use to allocate funds for research, education, prevention and treatment.”
The author concludes that a death certificate “provides the pathological basis of death, determined by some combination of fact, convention, and guesswork, and described in terms that most non-doctors struggle to understand.” She adds, “The bureaucratization of death . . . has evolved over time into a massively complex checkpoint at the border between the living and the dead; Charon’s[2] T.S.A. [Transportation Security Agency].”
I now add the history of the death certificate to my prior post’s reflection on mortality.
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[1] Schulz is a journalist, author and book critic for New York Magazine. Her book Being Wrong: Adventures in the Margin of Error was described as a “funny and philosophical meditation on why error is mostly a humane, courageous and extremely desirable human trait.” She has spoken at TED on “Don’t regret regret” and “On being wrong.”
[2] In Greek mythology, Charon is the ferryman of Hades who carries souls of the newly deceased across the rivers Styk and Acheron that divided the world of the living from the world of the dead.
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