Manner of death

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In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinction is made between the cause of death, which is a specific disease or injury, versus manner of death, which is primarily a legal determination, versus the mechanism of death (also called the mode of death), which does not explain why the person died or the underlying cause of death and can include cardiac arrest or exsanguination.

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Different categories are used in different jurisdictions, but manner of death determinations include everything from very broad categories like "natural" and "homicide" to specific manners like "traffic accident" or "gunshot wound". In some cases an autopsy is performed, either due to general legal requirements, because the medical cause of death is uncertain, upon the request of family members or guardians, or because the circumstances of death were suspicious.

International Classification of Disease codes are sometimes used to record manner and cause of death in a systematic way that makes it easy to compile statistics and feasible to compare events across jurisdictions. [1]

Terminology

Natural causes of death

A natural cause of death occurs due to illness and its complications, or internal body malfunctions, and is not directly caused by external forces other than infectious diseases. Examples include pneumonia, diarrheal diseases, cancer, a stroke, heart disease, and sudden organ failure.

As organisms age, various health-related consequences arise. In humans, a few examples include slower healing of skin tissue, thickening of blood vessel walls, and a less effective immune system. For example, a fall may be more likely to cause internal bleeding, plaque buildup becomes more likely to cause a heart attack, and a cold may be more likely to result in pneumonia. [2]

For much of human history, doctors who lacked the ability to understand causes of death attributed unknown causes to "old age." With modern medicine and medical machinery, doctors are now able to learn more about how an elderly person may have died. Still, many doctors will refer to a cause of death as "old age" if it is more comforting for loved ones than providing specific details. [2]

There is particular ambiguity around the classification of cardiac deaths, triggered by a traumatic incident such as in stress cardiomyopathy. Liability for a death classified as by natural causes may still be found if a proximate cause is established, [3] [4] as in the 1969 California case People v. Stamp. [5]

Unnatural causes of death

An unnatural cause of death results from an external cause, typically including homicides, suicides, accidents, medical errors, alcohol intoxications and drug overdoses. [6] [7] Jurisdictions differ in how they categorize and report unnatural deaths, including level of detail and whether they are considered a single category with subcategories, or separate top-level categories. [8] [9] There is no international standard on whether or how to classify a death as natural vs. unnatural. [10]

"Mechanism of death" is sometimes used to refer to the proximate cause of death, which might differ from the cause that is used to classify the manner of death. For example, the proximate cause or mechanism of death might be brain ischemia (lack of blood flow to the brain), caused by a malignant neoplasm (cancer), in turn caused by a dose of ionizing radiation administered by a person with intent to kill or injure, leading to certification of the manner of death as "homicide".

The manner of death can be recorded as "undetermined" if there is not enough evidence to reach a firm conclusion. [11] For example, the discovery of a partial human skeleton indicates a death, but might not provide enough evidence to determine a cause. [12]

Categories by jurisdiction

United States

In the United States, a manner of death is expressed as belonging to one classification of a group of six possible: [13] [8] [12]

In some jurisdictions, some more detailed manners may be reported in numbers broken out from the main four or five. For example:

United Kingdom

In the United Kingdom, when people die, either a doctor writes an acceptable natural cause of death medical certificate, or a coroner (procurator fiscal in Scotland) investigates the case. [10] Coroners are independent judicial officers who investigate deaths reported to them, and subsequently whatever inquiries are necessary to discover the cause of death, this includes ordering a post-mortem examination, obtaining witness statements and medical records, or holding an inquest. [15] In the unified legal jurisdiction of England and Wales, most deaths are certified by doctors without autopsy or coroner involvement. Almost all deaths certified by the coroner involve an autopsy but most do not involve a formal inquest. [16]

In England and Wales, a specific list of choices for verdicts is not mandated, and "narrative verdicts" are allowed, which are not specifically classified. The verdicts aggregated by the Ministry of Justice are: [17]

Other jurisdictions

Some jurisdictions[ which? ] place deaths in absentia, such as deaths at sea and missing persons declared dead in a court of law, in the "Undetermined" category on the grounds that due to the fact-finder's lack of ability to examine the body, the examiner has no personal knowledge of the manner of (assumed) death; others[ which? ] classify such deaths in an additional category "Other", reserving "Undetermined" for deaths in which the fact-finder has access to the body, but the information provided by the body and examination of it is insufficient to provide sufficient grounds for a determination.

The Norwegian Medical Association classifies what other jurisdictions might call "undetermined" as "unnatural": [9] [ why? ]

A death ruled as homicide or unlawful killing is typically referred to police or prosecutor or equivalent official for investigation and criminal charges if warranted. Deaths caused by capital punishment, though homicides, are generally assumed to be lawful and are not prosecuted. Most deaths due to war are not prosecuted, unless there is evidence of a war crime, in which case troops on foreign territory might be prosecuted by the military justice system, domestic law enforcement, or the International Criminal Court.[ citation needed ]

Some insurance contracts, such as life insurance policies, have special rules for certain manners of death. Suicide, for example, may invalidate claims under terms of such a contract.[ citation needed ]

Related Research Articles

Inquests in England and Wales are held into sudden or unexplained deaths and also into the circumstances of and discovery of a certain class of valuable artefacts known as "treasure trove". In England and Wales, inquests are the responsibility of a coroner, who operates under the jurisdiction of the Coroners and Justice Act 2009. In some circumstances where an inquest cannot view or hear all the evidence, it may be suspended and a public inquiry held with the consent of the Home Secretary.

<span class="mw-page-title-main">Forensic pathology</span> Medical speciality

Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.

<span class="mw-page-title-main">Coroner</span> Government official who confirms and certifies the death of an individual

A coroner is a government or judicial official who is empowered to conduct or order an inquest into the manner or cause of death. The official may also investigate or confirm the identity of an unknown person who has been found dead within the coroner's jurisdiction.

<span class="mw-page-title-main">Autopsy</span> Medical examination of a corpse

An autopsy is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death; or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.

In law, medicine, and statistics, cause of death is an official determination of the conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. In rare cases, an autopsy needs to be performed by a pathologist. The cause of death is a specific disease or injury, in contrast to the manner of death, which is a small number of categories like "natural", "accident", "suicide", and "homicide", each with different legal implications.

<span class="mw-page-title-main">Medical examiner</span> Post-mortem investigation forensic pathologist

The medical examiner is an appointed official in some American jurisdictions that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology.

<span class="mw-page-title-main">Death of Lisa McPherson</span> Medical case

Lisa McPherson was an American Scientologist who died in the care of the Church of Scientology in Clearwater, Florida. After a minor traffic accident where McPherson seemed unharmed, she removed her clothes in the street and paramedics transported her to a local hospital. In order to avoid psychiatric intervention, local Scientologists convinced her to leave the hospital and seek care at the nearby Church of Scientology Flag Service Organization (FSO). There she was held against her will for 17 days without any medical care, while her physical and mental condition rapidly deteriorated and she died. Following the report by the state medical examiner that indicated that McPherson was a victim of negligent homicide, FSO was indicted on two felony charges, "abuse and/or neglect of a disabled adult" and "practicing medicine without a license." The charges were dropped after the state's medical examiner changed the cause of death from "undetermined" to an "accident" on June 13, 2000. A civil suit brought by McPherson's family was settled on May 28, 2004.

Michael M. Baden is an American physician and board-certified forensic pathologist known for his work investigating high-profile deaths and as the host of HBO's Autopsy. Baden was the chief medical examiner of the City of New York from 1978 to 1979. He was also chairman of the House Select Committee on Assassinations' Forensic Pathology Panel that investigated the assassination of John F. Kennedy.

<span class="mw-page-title-main">Thomas Noguchi</span> American coroner (born 1927)

Thomas Tsunetomi Noguchi is the former Chief Medical Examiner-Coroner for the County of Los Angeles. Popularly known as the "coroner to the stars", Noguchi determined the cause of death in many high-profile cases in Hollywood during the 1960s, 1970s, and 1980s. He performed autopsies on John Belushi, Albert Dekker, William Holden, David Janssen, Janis Joplin, Robert F. Kennedy, Harris Glen Milstead, Marilyn Monroe, Gia Scala, Inger Stevens, Sharon Tate, and Natalie Wood.

The open verdict is an option open to a coroner's jury at an inquest in the legal system of England and Wales. The verdict means the jury confirms the death is suspicious, but is unable to reach any other verdicts open to them. Mortality studies consider it likely that the majority of open verdicts are recorded in cases of suicide where the intent of the deceased could not be proved, although the verdict is recorded in many other circumstances.

<span class="mw-page-title-main">Coroners Court of Queensland</span>

The Coroners Court of Queensland is a court in the court hierarchy of Queensland, Australia. The Court has exclusive jurisdiction in Queensland over the remains of a person and to make findings about the cause of death of a person.

<span class="mw-page-title-main">Coroner's Court of the Australian Capital Territory</span>

The Coroner's Court of the Australian Capital Territory is a court which has exclusive jurisdiction over the remains of a person and the power to make findings in respect of the cause of death of a person or fire in Australian Capital Territory.

An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine the cause of a person's death. Conducted by a judge, jury, or government official, an inquest may or may not require an autopsy carried out by a coroner or medical examiner. Generally, inquests are conducted only when deaths are sudden or unexplained. An inquest may be called at the behest of a coroner, judge, prosecutor, or, in some jurisdictions, upon a formal request from the public. A coroner's jury may be convened to assist in this type of proceeding. Inquest can also mean such a jury and the result of such an investigation. In general usage, inquest is also used to mean any investigation or inquiry.

In the United Kingdom, death by misadventure is the recorded manner of death for an accidental death caused by a risk taken voluntarily.

A death is suspicious if it is unexpected and its circumstances or cause are medically or legally unexplained. Normally, this occurs in the context of medical care, suicide or suspected criminal activity.

The following outline is provided as an overview of and a topical guide to death:

Legal death is the recognition under the law of a particular jurisdiction that a person is no longer alive. In most cases, a doctor's declaration of death or the identification of a corpse is a legal requirement for such recognition. A person who has been missing for a sufficiently long period of time may be presumed or declared legally dead, usually by a court. When a death has been registered in a civil registry, a death certificate may be issued. Such death certificate may be required in a number of legal situations, such as applying for probate, claiming some benefits, or making an insurance claim.

A coroner in the U.S. state of Washington is a quasi-judicial, public official principally charged with the certification of human death. It is completely identical in authority to the parallel office of medical examiner, which also exists in the state. Washington uses a "mixed system" of death investigation with some counties employing coroners, and some employing medical examiners.

<span class="mw-page-title-main">Accidental death</span> Unnatural death caused by accident

An accidental death is an unnatural death that is caused by an accident, such as a slip and fall, traffic collision, or accidental poisoning. Accidental deaths are distinguished from death by natural causes, disease, and from intentional homicides and suicide. An accidental death can still be considered a homicide or suicide if a person was the unintentional cause.

References

  1. 1 2 3 "ICD - Classification of Death and Injury Resulting from Terrorism". www.cdc.gov. 2023-06-29. Archived from the original on 2020-06-09. Retrieved 2024-02-06.
  2. 1 2 Goldenberg, David (March 6, 2023). "You Can't Actually Die Of Old Age". Youtube. Archived from the original on June 15, 2023. Retrieved August 21, 2024.
  3. ↑ Gill, James R. (2022-10-05). Adelson's The Pathology of Homicide: A Guide for Forensic Pathologists and Homicide Investigators (2nd ed.). Charles C Thomas Publisher. p. 88. ISBN   978-0-398-09391-4. Archived from the original on 2023-10-29. Retrieved 2023-07-10.
  4. ↑ Lesnikova, Iana; Leone, Lisa; Gilliland, MGF (September 2018). "Manner of Death Certification After Significant Emotional Stress: An Inter-Rater Variability Study and Review of the Literature". Academic Forensic Pathology. 8 (3): 692–707. doi:10.1177/1925362118797741. ISSN   1925-3621. PMC   6490595 . PMID   31240064.
  5. ↑ Criminal Law. Wolters Kluwer. 2008-01-25. p. 180. ISBN   978-0-7355-7185-3. Archived from the original on 2023-10-29. Retrieved 2023-07-10.
  6. ↑ External causes of death Archived 2020-08-04 at the Wayback Machine , University of Melbourne, retrieved April 25, 2019
  7. ↑ Zeegers, Maurice (2016-05-18). Forensic Epidemiology: Principles and Practice. ISBN   9780124045842.
  8. 1 2 Bryant, Clifton D. (2003). Handbook of death & dying . Thousand Oaks: Sage Publications. pp.  968. ISBN   0-7619-2514-7.
  9. 1 2 Alfsen, G. Cecilie (2013). "Medical autopsies after deaths outside hospital". Tidsskrift for den Norske Laegeforening. 133 (7): 756–9. doi: 10.4045/tidsskr.12.1081 . PMID   23588179.
  10. 1 2 Harris, A. (2017). "'Natural' and 'Unnatural' medical deaths and coronial law: A UK and international review of the medical literature on natural and unnatural death and how it applies to medical death certification and reporting deaths to coroners: Natural/Unnatural death: A Scientific Review". Med Sci Law. 57 (3): 105–114. doi:10.1177/0025802417708948. PMID   28669276. S2CID   24216334.
  11. ↑ Palmer, Brian (21 December 2009). "What, Exactly, Are "Natural Causes"?". Slate.com. Archived from the original on 3 October 2018. Retrieved 25 April 2019.
  12. 1 2 3 "Cause & Manner of Death | Snohomish County, WA - Official Website". snohomishcountywa.gov. Archived from the original on 2023-06-07. Retrieved 2024-02-06.
  13. ↑ "Cause, Mechanism, and Manner of Death". Crime Museum. Archived from the original on 2023-05-30. Retrieved 2024-02-06.
  14. ↑ Stark, Martha (2000). A physician's guide to clinical forensic medicine. Totowa, NJ: Humana Press. p. 225. ISBN   0-89603-742-8.
  15. ↑ "Coroners, post-mortems and inquests | nidirect". www.nidirect.gov.uk. 2015-11-04. Archived from the original on 2019-04-27. Retrieved 2024-02-06.
  16. ↑ Archived 2020-08-04 at the Wayback Machine – Figure 1, page 16
  17. ↑ "Statistics on deaths reported to coroners England and Wales, 2008" (PDF). Ministry of Justice Statistics bulletin. 7 May 2009. p. 17. Archived (PDF) from the original on 28 April 2019. Retrieved 28 April 2019. – Table 6: Inquest verdicts returned, 1994-2008

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