Background: The insufficient quality of external post-mortem examination of the corpse as well as the documentation of death certificates (DCs) have long been the subject of controversial discussions in the literature. Frequently criticized are faulty or implausible causal chains and a falsely attested natural mode of death.
Objective: It was investigated which type of death was attested by the responsible physician in the case of an unknown or inexactly determined cause of death and how often an autopsy at the institute for forensic medicine was carried out in these cases.
Method: The confidential and non-confidential parts of all DCs in the second quarter of 2013 of the city of Munich were screened in a standardized manner and statistically analyzed.
Results: The study comprised a total of 3228 DCs. Out of all cases, 900 DCs (27.9%) were classified under Ia and 462 cases (14.3%) under Ic as an unknown or inexactly determined cause of death. Despite being certified as an unknown cause of death, 4,0% of these cases were assigned a natural death. Autopsies were performed far more often for cases with unknown cause of death (Ia: 52.0% and Ic: 52.1%, respectively) than in cases with an inexactly determined cause of death (Ia: 5.2% and Ic: 7.5%, respectively).
Discussion: In most cases, the responsible physician attested the correct manner of death in the case of an unknown cause of death (96.0%) but in 4.0% they also falsely certified a natural manner of death at the same time. This has far-reaching consequences, especially in terms of criminal proceedings, since if a natural death is reported, the investigating authorities are not notified with the aim of clarifying the circumstances of the death. At this point, there is a risk of a recording gap for non-natural deaths.
