death investigation systems 47
the fact that not every fatal condition has accompanying anatomic changes
that can be discovered on autopsy examination. The human body is in fact an
electrochemical mechanism, and many fatal physiological processes are not
associated with demonstrable anatomic alterations. When these processes
cannot be inferred from historical or investigative information, the cause of
death may remain undetermined. It is the mark of a good forensic pathologist
that this conclusion is invoked whenever appropriate, without the attempt to
form an unsupportable cause of death conclusion.
4.5.2 Manner of Death
Assignment of a manner of death is also a required part of the death certi-
fication process. Ostensibly, this is an attempt to classify the death as to the
circumstances by which death came about; unfortunately, this classification
is often problematic. There are five classical manner of death categories.^21
• Homicide: Death caused by the intentional actions of another person.
• Suicide: Connotes a death due to one’s own intentional acts.
• Natural: Death due to natural disease processes only, with no contri-
bution from traumatic or external factors.
• Accident: Death due to unforeseen traumatic or external factors.
• Undetermined: The manner of death is not known or could not
be determined.Some jurisdictions also add additional categories, such as unclassified,
therapeutic misadventure, etc., but these are not universal. The idea of a
manner of death classification is an American invention,^31 and the manner
of death categories available for use in death certification are promulgated by
state vital records departments. Physicians, medical examiners, and coroners
are bound to and limited by these available choices.
The problem with manner of death classification is that the “pigeonhol-
ing” of complex and disparate deaths into one of five (actually four) catego-
ries is fraught with problems. One difficulty in reproducibly assigning an
appropriate manner of death category is the lack of agreement on definitions
for the classification terms. The brief definitions listed above are quite rudi-
mentary and broad, and are subject to considerable and substantive variation
in various jurisdictions. For example, a homicide is generally considered to
be a death at the hands of another person, whereas suicide is death at one’s
own hands. Yet a death due to a motor vehicle crash is generally classified
as an accident, regardless of whether one or both of the drivers were at fault
or caused the crash. If a hunter fires at a target he believes to be a deer, but
inadvertently kills another hunter, many MEs will classify this death as a
homicide, since the rifle was purposely fired at a target, which was struck