[vertex-four]

The point here is that the proximate medical cause isn’t actually the complete cause. While medical records are useful, they don’t explain the circumstances that led to someone’s death, and are therefore heavily missing information in many cases. The person who died of pneumonia because they couldn’t afford to go to hospital - all that gets listed on their certificate is that they died of pneumonia, and so we’re lacking in information that might be just as useful (or more) as that a person died of pneumonia.

If we actually understood that people literally died of not having enough money, or of lack of willpower to deal with a bureaucracy, or of homelessness, or of their mental state, there’s every chance that something might change.

[dingbat]

> If we actually understood that people literally died of not having enough money, or of lack of willpower to deal with a bureaucracy, or of homelessness, or of their mental state, there’s every chance that something might change.

if you actually understood the implications of following your logic, please take a moment to explain:

why do people not have enough money?

do some people waste away whatever time and money they have?

do some people fail to develop any marketable skills?

are some people just incapable of rendering valuable labor or service to anyone?

what percentage of those without money fit into that hopeless category?

what should be done about those people?

why does money exist in the first place?

how do we ensure that everybody will "have enough money"?

why do people lack willpower?

why do bureaucracies exist and what is the alternative?

why does homelessness exist?

do people in dire straits often reject help?

do people in dire straits often make things worse for themselves?

how do we force people to stop doing that?

why do people have differing mental states?

that's just for a start. then answer those questions in context of each individual life and death. but that won't be necessary if one thinks that all homeless are just "the homeless", or that all poor people are just "the poor".

but that would be oversimplification and "heavily missing information" in many cases, don't you think?

[nkozyra]

> The point here is that the proximate medical cause isn’t actually the complete cause.

I understand the spirit of this, but it's entirely subjective and way too open for interpretation.

I think by and large people do understand these things contribute to illness & death, they are just able to separate themselves from that reality on a day-to-day basis.

[simonh]

That's all true, but are not the job of the death certificate or the responsibility of a doctor. It has to be as objective as possible, not a matter of interpretation, that would be an appropriate role for an inquest.

[vertex-four]

Only because we have defined the role of a death certificate as containing the immediate medical cause of death. You’re arguing that something should be the way it is because that’s the way it is.

[deong]

But that's the only practical thing it could be. Suppose you shoot yourself in the head. What's the doctor supposed to put down as the cause of death? All he knows is that a bullet destroyed part of your brain. He doesn't know if you were depressed. Hell, he doesn't even know if it was intentional. Was it the girlfriend that left you last month, or that promotion you thought you were going to get that went to someone else?

What do you put down for a drug overdose? Was he chasing the next good time or escaping the pain of being molested as a child?

[vertex-four]

I think that the death certificate should either just say "yep, this person's dead", or it should list the actual reasons how and why a person died. In most cases, hopefully that'll be "this person lived out their life, and this happened to be the end of it", and that'll be self-evident because the person died of natural causes and received appropriate treatment for any illness at the appropriate stages. In others, it might require investigation. Whether it's a doctor's job to do that or a multidisciplinary team's is irrelevant to the question of what it should contain.

[simonh]

So either:

Doctors would also be responsible for performing inquests into non-medical circumstances of a death, for which they are not trained and don't have any powers to gather evidence or take statements. I can't see that being popular with doctors.

Doctor would not be able to sign a death certificate until a Judge had completed an inquest into the non-medical circumstances. In which case the Judge would have to do so without the benefit of a medical certification as to the medical cause of death, which would have to remain open until the end of the inquest. In which case, I don't see how the inquest can reasonable be completed without a certification as to the medical facts, which is all a death certificate is.

Neither of those make any sense, so I'm sure those aren't what you are suggesting. How do you see this working?

[hyperbole]

while a death cause graph database might be an interesting research tool, the big glaring problem in death certificates is mislabeled death ultimately caused by medical error. When a patient dies via a heart failure because they were given the wrong medication what is written on the death certificate isn't medical error its died due to heart failure. research funding is based around these statistics. Causes of death one of which is medical error doesn't rise as close to the top as it should.

http://freakonomics.com/podcast/bad-medicine-part-3-death-di...