From mono to multi-causality: Towards a comprehensive perspective on understanding death

•Cause-of-death statistics are based on the idea of one underlying cause of death per deceased (mono-causality).•This idea is less and less applicable to contemporary patterns of dying in high income countries with aging populations suffering from chronic diseases and multi- or comorbidity at the end of life.•Multi-causality is an alternative suiting contemporary philosophical ideas of (network) causality and current epidemiological developments, leading towards a more comprehensive way to understand death. Cause-of-death statistics are an age-old source of information for health policy and medical research. In these statistics, the presentation of data is based on the idea of an underlying cause of death, i.e. one (“the”) cause of death per deceased. This idea reflects an 18th Century causal thinking and is less and less applicable to contemporary patterns of dying in high income countries with an aging population suffering from chronic diseases and multi- or comorbidity at the end of life. Therefore, today's clinical reality calls for an innovation of cause-of-death statistics. For this, I will consider contemporary philosophical ideas on causality and their application to death. I will argue multi-causality is a more comprehensive way to understand death than mono-causality, implying a change of perspective with regard to current cause-of-death statistics.