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standardize death certificates. "A cause of death is a morbid condition or disease process, abnormality, injury or poisoning leading directly, or indirectly, to death. Symptoms or modes of dying, such as heart failure, asthenia, etc. are not considered to be statistical causes of death" (WHO archives, 455-3-4, 31/3/48). The committee proposed a uniform death certificate with several blanks to be filled in for causes and symptoms. |
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It is clear that standard forms are essential for the ICD to work and that these standard forms cannot be overprecise or people will not be able to use them. That is the fault of this death certificateit attempted to make the determination of the real cause of death at the time of certification. This entailed asking busy doctors to do work they had no interest in doing nor often any ability to do. It entailed making choices that were more historically contingent than the ICD itself, which allowed a deal of flexibility by not itself making any causal claims. Standardization procedures must be tailored to the degree of granularity that can be realistically achieved (Fujimura 1987, Star 1991). As Harvey (1997, p. 1) states, "Standards are good. Quality is better." |
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Using the ICD: Links between Design and Practice in the Organizational Infrastructure |
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It is clear that there are many unsettled arguments about the design of the ICD; let us look for a moment at the practices associated with its use by people certifying death and illness. None of this will come as a particular surprise to social scientists involved with quality control and practical survey research methods. For many years they have been exploring the gap between representations and codes, and the practices of filling out forms. Cicourel's (1964) ground-breaking critique of methods in survey research in the early 1960s is one example; Bitner and Garfinkel's (1967) exploration of "'Good' Organizational Reasons for 'Bad' Clinical Records'" extends the analysis, as does the work of Suchman and Jordan (1990). Our favorite is a lovely and extraordinarily honest participatory observation article, by sociologist Julius Roth, that explores some of the practices of coders in survey research: |
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After it became obvious how tedious it was to write down numbers on pieces of paper which didn't even fulfill one's own sense of reality and which did not remind one of the goals of the project we all in little ways started avoiding our work and cheating on the project . . . We had a special category in our coding |
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