Editorial
Do we properly fill out death certificates? The importance of knowing the basic aspects involved in completing the certificates
¿Cumplimentamos bien los certificados de defunción? La importancia de conocer los aspectos básicos de su cumplimentación
G.J. Palacios García-Cervigón
Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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"apellidos" => "Albarrán Juan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519301651" "doi" => "10.1016/j.rce.2019.05.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301651?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301869?idApp=WRCEE" "url" => "/22548874/0000022000000004/v1_202004301501/S2254887419301869/v1_202004301501/en/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Do we properly fill out death certificates? The importance of knowing the basic aspects involved in completing the certificates" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "245" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "G.J. Palacios García-Cervigón" "autores" => array:1 [ 0 => array:3 [ "nombre" => "G.J." "apellidos" => "Palacios García-Cervigón" "email" => array:1 [ 0 => "goyo.palacios1975@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cumplimentamos bien los certificados de defunción? La importancia de conocer los aspectos básicos de su cumplimentación" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Filling out the medical certificate of cause of death is a legal requirement for physicians when the cause of death is natural. In contrast, when the death is violent (homicide, suicide or accident) or criminal intent is suspected (including sudden death), the death certificate is not signed. Instead, the courts will be informed so that a legal autopsy may be performed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The medical certificate of cause of death is a medical-legal document that has 2 main objectives. First, it facilitates the registration of the death in the registry office, allowing for burial or cremation of the body 24 h after the death certification. Second, it is an essential statistical document employed by the Spanish National Statistics Institute to determine the causes of death in Spain. The first of these objectives has legal importance because the law clearly mandates the documentation in the certificate of the deceased’s identity and the time and place of death.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although properly filling out the entire document is important, correctly documenting the identity, date and location is absolutely required and essential. Errors in these 3 pieces of information can lead to certain problems, including rejection of the document by the registry officer, the need to redo the document, a delay in the burial or cremation process and the consequent harm to the family of the deceased. No less importantly, an error in filling out the certificate could be interpreted as making false statements in a public document, an act that constitutes a criminal offense, although for it to be considered as such there needs to be an intent to falsify the documentation with the goal of achieving some benefit from this.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The new medical certificate of cause of death of the Professional Medical Association (PMA) emerged at the beginning of 2009,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A certificate that unified the old medical certificate and the statistical death bulletin and introduced a number of changes following the WHO recommendations.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Among these recommendations were the reporting of the sequence of diseases that led to the death and their respective progression times; the inclusion of fields for inserting data to make the information more legible; the incorporation of information on whether the cause of death was violent or accidental and whether a clinical autopsy was performed. In contrast, the certificate removed the option of certifying the identity of the deceased by other people if the deceased had no national ID or passport, and no space was provided to indicate the address where the death took place, as is required by law. Instead, the form provided only a field for indicating whether the death occurred in hospital, at home or at a residence.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Criticisms of the new certificate include the inability to accurately determine the sequence of diseases or pathophysiological disorders that led to the death (especially in the outpatient setting) and the times at which they occurred, often leaving these data blank. There is also no space to indicate the exact location of the death, an essential piece of information required by the civil registry law. There is no space to indicate the accreditation of the deceased by relatives, as appears in the older certificate, a situation allowed for by law when the deceased’s national ID is not available. There are also superfluous data that can result in confusion, such as the field indicating whether the death was accidental or violent, given that, by definition, a death certificate cannot be signed under these conditions; a legal autopsy needs to be performed in these cases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the general impression of physicians is that this new certificate is more complicated to fill out and thereby more prone to error, there are few studies that have analyzed the main problems in completing the certificate, the most common errors made and the consequences of these errors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The article by Pinto et al. is therefore of considerable importance. This observational descriptive study analyzed the completion of 531 death certificates in the municipality of Madrid, Spain, which included the 2 PMA certificates (before and after 2009) and other death certificates of a number of Madrid hospitals.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In this study, the most important completion errors were observed in those hospitals that submitted their own death certificates (a now unusual procedure), which had mistakes as severe as the incorrect identification of the deceased. These errors were practically absent in the official PMA certificates, although a significant proportion of the new submitted certificates had not filled out the address of the place of death due to the lack of a specific space for this information. Errors were also detected in filling out the time of death. All of these can be considered severe errors and reasons for rejecting the certificate for specifically failing to comply with civil registry legislation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">As expected, the authors observed severe errors in the filling out of epidemiological data, especially in the new death certificate, where the progression time of the patients’ various disease processes were often not filled out. The term “cardiopulmonary arrest” was also incorrectly used to refer to the fundamental cause of death.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, correctly filling out the death certificate in cases of natural death is a required task for physicians, and special care needs to be taken in correctly identifying the deceased and the time and place of death. The use of the PMA death certificate helps to properly fill out the information, but a specific space for indicating the place of death needs to be included. Simplifying the statistical data to fill out, especially the progression times of the patients’ diseases, would be advisable, given that its lack of completion in standard practice has been demonstrated. The fields for indicating whether the death was violent or accidental also seem unnecessary and can cause confusion given that a death certificate cannot be filled out if the death has occurred under these circumstances.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Understanding the legal obligations in our clinical practice is an unavoidable responsibility. Training in medical-legal aspects should be included in the training programs during the medical residency and as part of the continuing medical education of all practitioners. This specifically includes knowing exactly how and when to formalize medical-legal documents, not only death certificates but also injury reports, health and disease certificates and legal documents. Work groups on ethical and legal aspects within the various specialties is of considerable importance for this objective.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-18" "fechaAceptado" => "2019-08-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Palacios García-Cervigón GJ. ¿Cumplimentamos bien los certificados de defunción? La importancia de conocer los aspectos básicos de su cumplimentación. Rev Clin Esp. 2020;220:244–245.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Decreto de 14 de noviembre de 1958 por el que se aprueba el Reglamento de la Ley del Registro, Civil. art 274. 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