He was voiced by the series' co-creator Trey Parker who also voices other characters in the series, including Eric Cartman and some of the celebrities as well as Kim Jong-il in Team America: World Police.
The Marsh family celebrates Grandpa Marvin Marsh's 102nd birthday, but he is tired of living and attempts to commit suicide. He tries to convince Stan to kill him. At first he refuses because he's afraid he'll get in trouble, but he finally agrees when Marvin shows him how horrible his life is by locking him in a room and forcing him to listen to music from Enya. The boys help by rigging a cow on a pulley to drop on Marvin. Before they were about to drop the cow on him, Death finally appears, but starts chasing the boys instead of Marvin, much to his anger.
Death chases the boys throughout town, but stops with the boys in front of a television watching an episode of Terrance and Phillip. They all start laughing until the show goes off the air. Death angrily touches and kills Kenny. He starts to leave until Grandpa Marvin demands that he kills him. Death refuses, for he was only there for Kenny. He shows the spirit of Stan's great great grandfather (Marvin's grandfather), who convinced Marvin to kill him when he was Stan's age. He tells him that he is forever trapped in Limbo because of that, and warns him not to kill himself or place the burden of suicide on others and that he must die of natural causes. Death finally disappears with the spirits of Marvin's grandfather and Kenny through a dark portal to the afterlife.
Death reappears in the episode "City on the Edge of Forever (Flashbacks)". He is seen in Kenny's flashback where Kenny kills him by jumping on him in said flashback. He also makes a cameo appearance in the crowd in the episode "I'm a Little Bit Country".