Manner of Death Classification Guide

Introduction

• Purpose: This guide is intended to provide consistency in classifying manners of death on death certificates. It is not a legally binding standard but aids medical examiners, coroners, and certifiers in making informed decisions.
• Manner of Death: Must be reported and is an American addition to the death certificate since 1910.
• Primary Categories:
  • Natural
  • Accident
  • Suicide
  • Homicide
  • Undetermined

General Principles

• Exceptions to Rules: Rules can be modified in exceptional cases but should generally be followed.
• Basic Rules:
  • Natural: Death solely from disease or aging.
  • Accident: Unintentional external causes (e.g., poison, injury).
  • Suicide: Intentional self-inflicted harm.
  • Homicide: Death due to a volitional act by another, intent to harm not required.
  • Undetermined: When multiple possible manners exist.
• Interpretation Avoidance: Certifiers should refrain from interpreting legal statutes in their classification process.
• Time Interval: The time between injury/event and death generally irrelevant if related to the cause.
• Objectivity: Certification should avoid bias and be based on established criteria.

Specific Guidelines

• Suicide: Requires evidence beyond a reasonable doubt.
• Natural Events in Hostile Environments: Often prioritized as non-natural if the environment significantly contributes to death.
• Chronic Substance Abuse: Typically classified as natural due to disease from substance dependency.
• Acute Toxic Effects: Accidents unless intent to harm is evident.
• Therapy-Related Deaths: Generally classified as natural unless due to clear medical error.
• Risk-Taking Behavior: Often challenging; requires careful assessment.
• Judicial Executions: Classified as homicide.

Special Cases

• SIDS: Varies from natural to undetermined based on investigation details.
• Multiple or Sequential SIDS: Often classified as undetermined due to low natural occurrence probability.
• Infant Deaths by Environment: Distinct classification if due to negligence versus accidental exposure.
• Complications of Therapy: Requires thorough detail in cause-of-death statements to reflect treatment and underlying conditions.

Review Process

• Feedback and Revisions: Guide revised after feedback from NAME members. Comments addressed included:
  • Ricochet Deaths: Judgment calls; can be accident or homicide based on intent.
  • Anaphylaxis: Typically classified as accidents.
  • SIDS Recommendations: Manner often classified as undetermined.
  • Unclassified Option: Suggested but generally not available; undetermined used instead.

Conclusion

• Objective: Aim for consistency and avoid reliance on personal philosophy or external pressures.
• Future Updates: Anticipated supplements or revisions to the guide.

Note: Subsequent sections of the guide provide detailed scenarios and recommendations for handling specific cases, requiring careful judgment and adherence to outlined principles.