AIDS ON THE DEATH CERTIFICATE - THE FINAL STIGMA
AIDS ON THE DEATH CERTIFICATE - THE FINAL STIGMA
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DOI：
10.1136/bmj.298.6675.734
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发表时间：
1989-03-18
影响因子：
--
通讯作者：
KING, MB
中科院分区：
文献类型：
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作者：
KING, MB
在英格兰和威尔士，出生、死亡和婚姻的记录已经有几个世纪了。第一次尝试保持记录的整个国家的日期从时间的亨利八世，甚至在都铎时代的努力，开始了一个中央登记。“主要的推动力来自于一种愿望，即婚姻需要得到民事当局适当程度的宣传和正规化，以及年龄、合法性和血统的文件证明。世纪早期的改革者如埃德温·查德威克是第一个意识到中央登记处在监测社会状况和健康方面的优势的人。查德威克向政府施压，要求在死亡登记册中列入死亡原因，部分原因是出于对婴儿死亡率的兴趣，因为婴儿死亡率是社会状况的敏感指标。因此，登记成为1836年的宪法法律，从此医生就被恳求准确记录死亡原因。虽然这一系统在法律的和医学意义上被证明是有价值的，但死亡证明的准确性一直受到激烈的争论，特别是在这个世纪，在欧洲和美国的医学杂志上。对记录的审查显示，临床诊断不正确，文书错误，3英尺5英寸高，死亡”方式”与死亡”原因”混淆，导致不准确和延误亲属。愤世嫉俗者甚至将死亡证明的统计数据描述为”垃圾进垃圾出“。“7虽然尸检结果增加了医疗信息的准确性，8但病理解剖学和组织病理学结果可能与致命结果没有直接联系。3事实上，通常未经医学训练的死因裁判官签发的死亡证明书，载有病态解剖发现的摘要，可能掩盖与实际死因有关的最大错误。9
Births, deaths, and marriages have been recorded for centuries in England and Wales. The first attempt to keep a record for the whole nation dates from the time of Henry VIII, and even in the Tudor era efforts were made to start a central registry.'The main impetus arose from a desire formarriage to be accredited a proper degree of publicity and regularisation by a civil authority as well as for a source of documentary proof of age, legitimacy, and ancestry. Reformers in the early nineteenth century such as Edwin Chadwick were the first to realise the advantage of a central registry for monitoring social conditions and health. Chadwick pressed the government for a cause of death to be included in the death register, partly out of interest in infant mortality, which was known to be a sensitive indicator of social conditions.Accuracy of certification Registration thus became constitutional law in 1836, and physicians have been entreated ever since to accurately record the cause of death. Although the system has proved worth while in a legal and medical sense, 2 the accuracy of death certification has been vigorously debated, particularly in this century in medical journals in Europe and the United States. Scrutiny of records has revealed incorrect clinical diagnosis, clerical errors, 3'5 and confusion of" mode" of death with" cause" ofdeath, resulting in imprecision and delay for relatives. Cynics have even depicted the statistical data from death certification as" rubbish in-rubbish out." 7 Although findings at necropsy increase the accuracy of medical information, 8 morbid anatomical and histopathological findings may have no direct connection with the fatal outcome. 3 Indeed, death certificates issued by coroners who are not usually medically trained which contain a summaryof morbid anatomical findings may conceal the greatest number of errors in relation to the actual cause of death. 9