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lected cause is a trivial condition unlikely to cause death and a more serious condition is reported, reselect the underlying cause as if the trivial condition had not been reported. If the death was the result of an adverse reaction to treatment of the trivial condition, select the adverse reaction" (ICD-10, 2: 45). Derrida (1980) reminds us that it is through what is excluded as trivial that we can frequently understand systems of thought by pointing directly at what is important. Similarly, this opening of the door to an undetermined attribution of triviality is one significant moment, hidden in the third volume of a massive classification system, where the work of reifying current categories is done. Only certain causal chains will be permitted at the moment of classification. This in turn naturally affects the interpretation at the other end of "raw data" in the form of epidemiological statistics: "The expression 'highly improbable' has been used since the sixth revision of the ICD to indicate an unacceptable causal relationship. As a guide to the acceptability of sequences in the application of the general principle and the selection rules, the following relationships should be regarded as 'highly improbable'" (ICD-10, 2: 67). After this passage, there follow a series of unacceptable chains. For example, a malignant neoplasm can not be reported as due to any other disease than HIV; hemophilia cannot be due to anything, and no accident can be reported as due to any other cause, except epilepsy (ICD-10, 2: 68). |
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An acceptable string of classifications in a death certificate is one that fits into an internally consistent chain that reflects current medical knowledge. In the process of crafting such a chain, all qualifiers should be removed: "Qualifying expressions indicating some doubt as to the accuracy of the diagnosis, such as apparently, presumably, possibly, etc., should be ignored, since entries without such qualification differ only in the degree of certainty of the diagnosis" (ICD-10, 2: 88). In the process of achieving this certainty, multiple causality must often be arbitrarily collapsed into unicausality, here by a principle of first come first served: "If several conditions that cannot be coded together are recorded as the 'main condition,' and other details on the record point to one of them as the 'main condition' for which the patient received care, select that condition. Otherwise select the condition first mentioned" (ICD-10, 2: 106). Any working classification system will have such rules of thumb attached. Such rules are theoretically interesting for several reasons. First, the ICD developers have explicitly recognized that it is not enough to control the classification (the name of the disease) they also must attempt to exercise control over the lan- |
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