38 Forensic dentistry
4.4 Modern American Death Investigation Systems
As will be seen subsequently, the systems of death investigation in the United
States are widely varied. However, they generally share a number of mission
components in common. To paraphrase DiMaio and DiMaio,^21 the various
components of a death investigation system are as follows:
- Determine the cause of death, and how the death came about
- Identify the decedent
- Determine the time of death and injury
- Collect evidence from the body that may be useful in the police
investigation
- Document injuries that are present, or their absence
- Deduce how injuries occurred
- Document any natural disease present
- Document or exclude any causative or contributory factors in the death
- Provide testimony in court as needed
In spite of the widespread distribution and long history of the office of
the coroner, as medical science and the understanding of death have become
more complex, shortcomings of the system have became apparent. Most
obvious is the fact that most coroner jurisdictions do not require a coroner
to be a physician. Obviously, a nonphysician is in a poor position to render
a medical opinion on the cause of death, a determination that is manifestly
the practice of medicine. The likelihood of omissions or misinterpretations is
increased in such jurisdictions where the responsibility for this duty is vested
in someone other than a trained physician. Second, coroners are elected
officials in the United States. The necessity of maintaining public electoral
support has long been considered a potential impediment to the development
and maintenance of absolute impartiality in death investigation by coroners.
Death investigators must often make very hard and controversial decisions
that are difficult for families, local political forces, and others to accept. In
theory, at least, an appointed official, as opposed to an elected one, can make
such decisions without the fear of alienating a voting block necessary for his
or her continued employment in the position.
Proponents of the coroner system respond that the nonmedical coroner
functions as an administrator and quasi-judicial agent, and can employ phy-
sicians to perform examinations and make medical decisions under his or
her directions. However, since the coroner retains ultimate authority for the
investigation and determination of the circumstances and cause of death,
the possibility that such an individual will exercise that authority to veto or
influence the medical decision of an employed physician still remains. Some
coroner proponents also point to the greater political authority of an elected
