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ally biased; and autopsies (which are rarely done) have a low rate of agreement with the code on the form (Fagot-Largeault 1989). |
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Even when there is relatively simple consensus about the cause of death, the act of assigning a classification can be socially or ethically charged. Thus, in some countries the death certificate has two faces: a public certificate handed to the funeral director so that arrangements can be made quickly and discreetly, and a statistical cause filed anonymously with the public health department. In this case, the doctor is not faced with telling the family of a socially unacceptable form of death: syphilis can become heart failure, or suicide can become a stroke. For example, as we discuss in chapter 4, the process of moving to an anonymous statistical record may reveal hidden biases in the reporting of death. Where the death certificate is public, stigma and the desire to protect the feelings of the family may reign over scientific accuracy. |
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Over the years, those designing the list of causes of death and disease have struggled with all of these problems. One of the simple but important rules of thumb to try to control for this degree of uncertainty is to distribute the residual categories. "Not elsewhere classified" appears throughout the entire ICD, but nowhere as a top-level category. So since uncertainty is inevitable, and its scope and scale essentially unknowable, at least its impact will not hit a single disease or location disproportionately. Its effects will remain as local as possible; the quest for certainty is not lost, but postponed, diluted, and abridged. |
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With the rise of very-large-scale information systems, the Internet, the Web, and digital libraries, we find that the sorts of uncertainties faced by the WHO are themselves endemic in our own lives. When we use email filters, for example, we risk losing the information that does not fit the sender's category: junk email is very hard to sort out automatically in a reliable way. If we have too many detailed filters, we lose the efficiency sought from the filter in the first place. As we move into desktop use of hyperlinked digital libraries, we fracture the traditional bibliographic categories across media, versions, genres, and author. The freedom entailed is that we can customize our own library spaces; but as Jo Freeman (1972) pointed out in her classic article, "The Tyranny of Structurelessness," this is also so much more work that we may fall into a lowest level convenience classification rather than a high-level semantic one. In one of our digital library projects at Illinois, for example, several undergraduates we interviewed in |
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