Even if extensive information is available to the certifier, causes of death may be difficult to determine, so the certifier may indicate uncertainty by qualifying the causes on the death certificate. While the death certificate is a legal document used for legal, family, and insurance purposes, it may not be the only record used, because, in some cases, the death certificate may only be admissible as proof of death. Optimally, a certifier will be able to provide a simple description of the process leading to death that is etiologically clear and to be confident that this is the correct sequence of causes. However, realistically, description of the process is sometimes difficult because the certifier is not certain. Causes of death on the death certificate should not include terms such as senescence, old age, infirmity, and advanced age because they have little value for public health or medical research.
Age is recorded elsewhere on the death certificate.
When malnutrition is involved, the certifier should consider if other medical conditions could have led to malnutrition. In other instances, conditions listed in Part II of the death certificate may include causes that resulted from the underlying cause but did not fit into the sequence resulting in death. If any potentially lethal medical conditions are known but cannot be cited as part of the sequence leading to death, they should be listed as other significant conditions. Infant Deaths Maternal conditions may have initiated or affected the sequence that resulted in an infant death. Most certifiers will find themselves, at some point, in the circumstance in which they are unable to provide a simple description of the process of death.