Although instructions for proper completion of the cause-of-death section of the death certificate are available, a number of published examples are controversial, confusing, or inconsistent with other recommendations and guidelines. Several such examples are described to illustrate the need for improved instructions for death certification, with the goal of improving the consistency, accuracy, and reliability of death statistics. Also discussed is the general relationship between state vital records registrars, the National Center for Health Statistics, and the World Health Organization, in terms of death certification paperwork, procedure, policy, and death certificate revision. Since medical examiners certify substantial numbers of deaths, the need for medical examiners to be involved in revisions of death certificate forms and policies is emphasized.