Forensic Dentistry, Second Edition

48 Forensic dentistry

and killed. Others would consider it to be an accidental death since the

hunter did not intend to kill a human being. Some jurisdictions require that

intent to cause one’s own death be a factor in classifying a death as suicide.

Others require only that the act leading to death be intentional, regardless

of whether or not death was anticipated. For example, if a person is play-

ing Russian roulette with a partially loaded revolver and dies of a gunshot

wound of the head, many MEs would classify this as a suicide, without con-

sideration of whether or not the player actually intended to die, or just was

engaging in thoughtless, extremely risky behavior. Others would agree that

the death represents a suicide, but largely because of the high inherent risk of

the activity. Deaths due to acute intoxication by ethanol or other drugs are

usually classified as accidents unless suicidal intent is evident. But deaths due

to the chronic effects of the same drugs (cirrhosis, endocarditis, etc.) are typi-

cally classified as natural deaths. These are but a few of the inconsistencies

and disagreements that may plague a manner of death determination.

As a demonstration of this point, a survey consisting of twenty-three

separate and varied medical examiner case scenarios was sent to members

of the National Association of Medical Examiners (NAME) in 1995.29,30

The survey presented the cases and asked the respondents to answer a vari-

ety of questions, particularly relating to manner of death determination.

Subsequently, a panel discussion was convened at a meeting of the National

Association of Medical Examiners in 1996 in which five well-known and

respected forensic pathologists discussed their opinions of the cases. The

degree of discordance was striking in both the survey and the subsequent

panel discussion. Complete agreement was reached in only one case, and in

some cases, the level of disagreement was such that no majority opinion was

identified. It is a fact that highly trained and experienced MEs frequently

disagree on manner of death classification. Though it may be assumed that

the use of a particular manner of death classification schema is based on

consistent scientific principles, it is in fact based more on local tradition and

habit, and national consistency has proven to be an elusive goal.

Another factor causing difficulty in producing consistent manner of death

classifications is the exceptional complexity of various death processes. Each

case is quite unique, with many facets of the death process being unknown,

partially known, or merely inferred. In such cases, it is extra ordinarily difficult

to distill this complexity into one of four or five categories, and if it can be

done, some would consider it to be of little practical use. After all, categoriz-

ing disparate and dissimilar types of deaths together into overly broad and

artificial categories seems to be of questionable value.

In an attempt to better define the various manner of death categories,

NAME published a booklet giving guidelines for death classification in

2003.^31 Its methodology has not, however, become universally adopted at this
time, and variations in manner of death classification continue to abound.