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Cause of Death

Donald T. Reay, MD; Corinne L. Fligner, MD
JAMA. 1987;258(22):3253. doi:10.1001/jama.1987.03400220052017.
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To the Editor.—  The July 17, 1987, issue of JAMA contained an article by Kircher and Anderson1 concerning the proper completion of the death certificate. The dissemination of this information is long overdue and the authors are to be commended. However, their choice of examples to illustrate accurate death certification in trauma victims would have been more causally specific if the authors had not included "automobile accident" and "slipped and fell in bathtub" in the cause of death section. In our view, the authors have mixed etiology and manner of death with the cause of death, which should reflect either a disease or injury. This could have been avoided with a more appropriate choice of proximate cause. The appropriate proximate cause in both of these instances is "blunt impact" or "blunt force" to the specified body area. The authors listed "automobile accident" and "slipped and fell in bathtub" as the


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