Death is defined as the moment when all brain function, including the brain stem activity stops and brain death is irreversible. Eventually we all die. No one can hide from death. When someone dies a sudden unexpected death outside of a hospital it causes concern and leaves many unanswered questions.
Often the person who died appeared healthy. This does not mean the decedent was the picture of health. Neither is it likely the person was standing on death’s doorway, or expected to die in the near future. All sudden unexpected deaths justify a medicolegal death investigation or death inquiry. An autopsy may be requested if the cause of death cannot be determined by investigational processes alone.
Determining the Cause and Manner of Death
According to Forensics for Dummies, “the manner of death is the root cause of the sequence of events that lead to death.” The manner of death is listed on the death certificate as one of the following categories: natural, accidental, suicide, homicide, or undetermined.
A natural death occurs solely from the progression of age or disease. An accidental death occurs when an unplanned sequence of events results in death. A suicide occurs when someone makes the choice to intentionally end their life. A homicide occurs when one person is responsible for the death of another person. Finally an undetermined death is one that does not fit neatly into any of the other four choices or when a cause of death cannot be determined despite an investigation or autopsy.
A death inquiry is the investigational process carried out by a trained medicolegal death investigator who considers all aspects of the decedent’s life before making a final decision into determining the cause of death. The MDI begins his or her investigation by interviewing anyone who observed the death or found the decedent and he or she must take into careful consideration any and all factors that precipitated or contributed to the death.
Contacting close family and friends often provides valuable insight into the person’s past medical or surgical history, as well as lifestyle and cultural choices that may have played a role in their death. One of the most important aspects in determining the cause and manner of death is a careful analysis of the immediate area surrounding the deceased and their personal effects.
Sudden Unexpected Natural Death (SUND) is Common
There is a term for the sudden and unexpected natural deaths that occur from the process of aging and disease in people from 30 to 70 years of age. It is an acronym called SUND meaning sudden unexpected natural death. When someone over the age of 70 dies abruptly it is very likely the result of a natural cause yet the death may not be unexpected. On the other hand when someone under the age of 30 dies suddenly it is less likely due to natural causes and more likely a result of an accident.
The Centers for Disease Control and Prevention (CDC) is a federal agency regulated by the U.S. Department of Health and Human Services and is responsible for supporting public health activities in the United States. The CDC also gathers and maintains a variety of statistics on how certain things can affect us at different stages of life. According to the Center for Disease Control (CDC) in 2007 the average life span was determined to be 77.9 years and there were “2,423,712 reported deaths” in the United States. In 2007 the 15 leading causes of death (in order) as determined by the CDC are listed below.
- diseases of heart (heart disease)
- malignant neoplasms (cancer)
- cerebrovascular diseases (stroke)
- chronic lower respiratory diseases
- accidents (unintentional injuries)
- Alzheimer’s disease
- diabetes mellitus (diabetes)
- influenza and pneumonia
- nephritis, nephrotic syndrome and nephrosis (kidney disease)
- septicemia
- intentional self-harm (suicide)
- chronic liver disease and cirrhosis
- essential hypertension and hypertensive renal disease (hypertension)
- Parkinson’s disease
- assault (homicide)
Death scenes can be deceiving when a natural death may not appear to be of natural causes or in cases when someone will try to cover up a homicide or suicide and make it appear to be a natural death. It is the job of the medicolegal death investigator to question anything that appears to be out of the ordinary. An obvious cause of death cannot be taken for granted unless the investigation or an autopsy confirms the evidence.
If an autopsy is not completed the decision must be made carefully, as there is only one chance to do an autopsy before evidence begins to be destroyed. The MDI is the last person who will ever speak for the decedent and it is imperative that the investigator tells the decedent’s story correctly. This means the MDI must validate what the death scene shows with the information gathered during the investigational process before determining what happened in a case of a sudden unexpected death.
Sources:
- Center for Disease Control (CDC) "Deaths: Final Data for 2007" (accessed April 9, 2011).
- Forensics for Dummies “Forensics: Defining Death” (accessed April 10, 2011).
Erika Lyn Smith - Erika Lyn Smith - is a Psych RN, who has completed the UMSL Medicolegal Death Investigator Training Course, and is finishing a BS in ...
