Forensic Pathology for Police - Brainshare Public Online Library

78 5 Death Certification
use involves an attempt to determine the “baseline” health and activity level of the
individual prior to the injury. Establishing this baseline involves interviewing health
care workers and perhaps others, and reviewing relevant medical records. The forensic
pathologist then attempts to determine whether or not the individual improved
following the injury such that he/she made it back to his/her baseline status prior to
death. If the person returned to baseline status prior to death, then it is reasonable
to conclude that the injury did not play a role in the death. On the other hand, if
the person never returned to baseline status, but ended up dying before fully recovering
from the injury, then it is reasonable to conclude that the injury did, in fact,
contribute to death, if not directly, then certainly as an added stressor for someone
with underlying significant natural disease. When a person’s baseline status
is steadily headed downward prior to the injury, and the person showed definite
signs of improvement from the injury prior to death, but not back to the baseline
that existed immediately before the injury, then it becomes very difficult to make a
definitive ruling, because one cannot be sure of where the person’s baseline would
have been if there had not been an injury.
In certain jurisdictions, other options are available for MOD rulings. In some
regions, a therapeutic complication MOD is available to use for deaths that result
from the adverse effects of medical therapy. Readers are referred to Chapter 21 for
further discussion of death related to medical therapy. In some jurisdictions, there is
an unclassified MOD, which is used for recreational drug abuse deaths, since neither
suicide nor accident (an unforeseen event) are very good descriptors of these deaths.
In the majority of jurisdictions, these other MOD options are not available for use
on death certificates.
Another important point regarding MOD rulings deserves reiteration. Manner
of death rulings should be considered medical opinion statements used for statistical
purposes. No entity (insurance companies, prosecutors, courts, etc.) is legally
bound to agree with such rulings, and the terms accident and homicide should not
be equated with various legal terminology. For example, a MOD ruling of homicide
does not necessarily equate to the legal term murder. Specifically with regard
to the example provided above within the “cause of death” section wherein a man
was forcibly restrained by police officers, if the restraint is considered contributory
to death, even if underlying cocaine-induced excited delirium is considered the
major factor in death, it is appropriate to rule such a death a “homicide.” This does
not necessarily mean that the police were “out of line,” but only that the police
officers’ actions were considered contributory to death. Certainly, in a similar scenario,
wherein a person resisting arrest is subsequently shot and killed by police
officers, there is no question that such a case represents a homicide. Whether or not
it represents a “murder” or whether or not such a shooting is “justified” is not for
the medicolegal death investigation community to decide. Such questions and their
subsequent answers are best left to the courts.
In addition to the fact that no one is required to necessarily agree with or be bound
by a MOD ruling, another fact regarding MOD rulings is that a variety of case types
do not “fit nicely” into a particular MOD category. As such, there can be considerable
debate regarding how to appropriately rule the MOD in certain case types. For