Facts (and Lies) On Death Certificates

causes of death How about a few thoughts on one of the most (least) popular items on your after-death to-do list?

Death certificates are among the most dismal of reading materials. But they are essential for the “business” after a loved one’s death. Since it takes time to order and acquire certificates, it’s better to purchase multiple copies. Tucking several extras into a file is likely better than scrambling to request more in the future.

On a practical note, the mortuary will probably handle the death certificate. Depending on the county, prices for certificates run the gamut from cheap to are-you-kidding! expensive. In the United States, official copies are obtained from a county clerk’s office*.

Insurance companies, banks, and similar institutions requiring proof of death frequently want the legal certificate issued with the county’s seal. However, with my parents’ estate, the companies that requested an official certificate versus those only needing a copy were never predictable.

After getting the certificate, you will confirm the facts are accurate: date and place of birth, full name, his or her “usual occupation,” location of the grave, and what is . . .

The cause of death

Will death’s cause surprise you? My father’s certificate proved unsettling. According to the form, Dad died from “Heart Failure.” Really? There was more. The “underlying cause” was Sinus Bradycardia. Huh? Soon, I was scouring the web for definitions. Thank you, Mayo Clinic website:

Bradycardia is a slower than normal heart rate. The hearts of adults at rest usually beat between 60 and 100 times a minute. If you have bradycardia (brad-e-KAHR-dee-uh), your heart beats fewer than 60 times a minute. Bradycardia can be a serious problem if the heart doesn’t pump enough oxygen-rich blood to the body . . .

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In a recent patient care meeting at the hospice where I work I scanned the list of our patients. Several had the same terminal illness: atherosclerosis. Back to Mayo:

Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow.

Like Dad, the patients were elderly, ranging from the late 80s to near the century mark. Like Dad, this tongue-twisting disease may be an “underlying cause” on many death certificates. However, I don’t think Dad died of “heart failure.” Yes, his heart ceased beating. And yes, the underlying cause of sinus bradycardia involved a “slower than normal heart rate . . .”

On his certificate, there is also a box with the category of “other significant conditions contributing to the death.” It contains one word that I think caused his death: dementia.

Wasn’t it really dementia that slowly killed him, crushed his spirit, and caused dis-ease in the family? Referring to dementia as an “underlying cause” is too damn polite. And misleading.

I don’t think certificates can use “old age” or “natural causes” as reasons for the death. But isn’t that often closer to the truth for those in their late 80s and beyond? A heart is a muscle, and the arteries supplying the body’s vital pump eventually clog. With age, it’s inevitable. The body’s electrical impulses slow or become erratic. With age, it’s inevitable.

And yet how can I—the kid who got to play a thousand games of catch with Dad—only see my father’s heart as a muscle?

I can’t help but think that some have died of broken hearts. What if an eighty-something spouse who was married while still a teenager dies? What if a few months later her husband also dies, with his death certificate identifying sinus bradycardia—or another nasty noun—as the official reason? The form’s facts aren’t lying, but could a broken heart at her loss could be the real reason for his death?

There are many ways and lists for how humans die. In 2015 the Center for Disease Control published an odd map (see above) of the United States showing which “distinctive” cause of death occurred in each state. It’s fascinating and literally morbid. When patients enter hospice care, a disease “label” is always linked to her or his name. For those ignorant of medicalese like me, reasons like evil cancer or despicable AIDS are “easy” to understand. But there are so many arcane words about dying that cause me to search the web or to ask a friendly nurse colleague for help.

When reading about those with sinus bradycardia or atherosclerosis in a hospice meeting, I now know what they mean. And though still struggling to pronounce them, I’m sure they will eventually appear on death certificates somewhere underneath “heart failure.” But even more I believe, for the caregiver and the hospice patient, for the family member and the beloved with a terminal illness, for the ones grieving the ones who have died, every heart will fail because they are all broken.

Death certificates are recorded facts, but they rarely reflect our deepest hurts and truths.


(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

By the way, find the explanations about the odd map at the top: here.

* I currently reside in Fresno, and once lived near Madison, Wisconsin (in Dane County). Here are two examples of how to acquire a death certificate in places I’m familiar with:

But please note that there are over 3,000 counties in the United States! Don’t assume one is like another.

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    • Thanks for your comments, James.

      I think, since the decisions about the content of death certificate are made at county and/or state levels, there will likely always be differences. Some may include a new line like you seem to be suggesting, but others? Maybe not . . .

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