Forensic Pathology for Police - Brainshare Public Online Library

76 5 Death Certification
death is identified at autopsy. The victim may have been strangled or may have
had their neck slashed or perhaps some other mechanism of neck trauma had been
used to kill them. Because of the condition of the body, a definite cause of death
cannot be determined; however, the case is obviously a homicide. In such cases, it
is appropriate to rule the cause of death as “homicidal violence,” and the manner
of death as “homicide.” Besides burns, decompositional changes and sometimes
massive postmortem body trauma may mask the cause of death in such cases.
Cases that are particularly difficult to make MOD rulings on include cases where
acts of omission or carelessness result in the death of another person. In many of
these case types there exists a reasonable argument for making a ruling of homicide;
however, in some, by convention, “accident” is used. The most common example is
a motor vehicle collision fatality related to someone else’s drunk driving. Many of
these deaths unquestionably represent “deaths at the hands of others,” yet, for a variety
of reasons, such cases are considered accidental. Despite the MOD ruling in such
cases, most states have laws which specifically deal with fatalities related to drunk
driving. In other case types, arguments may be made for ruling a death an accident
or a homicide. Consider the case of an infant who is accidentally left unattended in a
car seat in a very hot automobile who succumbs to hyperthermia. Some would argue
that the case represents a homicide due to negligence while others would argue that
the case represents an unfortunate accident.
Pedestrians who die after being hit by a motor vehicle, wherein the motorist
flees from the scene are commonly referred to as “hit and run” deaths. By convention,
some forensic pathologists rule these deaths as “homicides” while others, by
convention, rule such cases as “accidents” unless it can be shown that the driver
intentionally hit the pedestrian.
Other MOD Issues – The National Association of Medical Examiners (NAME)
has published guidelines regarding MOD rulings. Some general considerations are
described here, but the reader is referred to the NAME guidelines for a more detailed
explanation.
– If more than one COD is listed, and each has a different MOD, a non-natural
MOD takes precedence over a natural MOD. In a like fashion, a suicide
MOD should take precedence over accident, and a homicide MOD should take
precedence over all others.
– A death related to the acute (quick) toxic effects of drugs taken during
recreational drug use activity is typically considered an accident.
– A death related to the chronic (long term) effects of drug abuse is typically
considered a natural death.
Another issue that occasionally arises occurs when one is attempting to decide
whether or not a specific event played a role in a particular death when death occurs
some time after the original event. There are several possibilities with regard to this
issue. First, if a person was directly injured by the event, and subsequently dies as a
result of the injury, even if it is years or decades later (as in the example above within
the “cause of death” section where a person died many years following a gunshot