 [ Symptoms ] i had neuroendocrine tumor evaluation is it affected by an increase in pancreatic polypeptides [ Disease ] first i am very sorry to hear of your loss my sympathy to you and your family as to your question it sounds like you are asking about the manner of death listed on the death certificate in general a death certificate has a section called cause of death  which lists the direct event that led to a person is death such as myocardial infarction heart attack the death certificate usually also has a section called manner of death  which often consists of checkboxes labeled natural  accident  homicide  suicide  undetermined  etc generally speaking a perforated bowel would be considered a natural death a natural death usually is one that arises from a disease process or aging keep in mind i am not a physician or lawyer i am just offering information based on my best knowledge of death certificates if you have questions about your mother in law is death certificate you can consult the physician who certified the death certificate his or her name should be listed the centers for disease control cdc has a page on its website about how to fill out a death certificate i am unable to link to it here but a search of their site should reveal it again i am very sorry for your loss