Understanding “Cause” and “Manner” of Death

Understanding “Cause” and “Manner” of Death

Among other functions, the medical examiner or coroner is responsible for investigating sudden and unexpected deaths and completing a medicolegal death investigation. Part of that investigation will include completing a death certificate which includes information about the person who died as well as the investigation’s determined “cause” and “manner” of death for that individual.

The SUDC Foundation often receives phone calls from distraught family members trying to understand their child’s cause of death as well as the manner of death on the death certificate. We will then contact the medical examiner or coroner on behalf of the family to facilitate communication and obtaining answers to their questions that often surface as they try to understand their tragedy. The cause of death is a medical opinion.

In addition to trying to understand the cause of death medical opinion, families are often confused by the manner of death description. It is not uncommon for a parent to call us, shocked, stating “how can they say my 2-year-old’s death was natural?!? It is not natural for 2-year-olds to just die!!” While most adults understand “cause of death” as the medical opinion which describes why a death occurred, many are unfamiliar with the reason for including a “manner” description or its purpose. (see definitions below)

When a 2-year-old dies solely from a known natural disease process, the manner of death is natural.  It does not mean that there is public tolerance for such a disease but rather “how” they died did not reflect an accident, homicide, suicide, or death that could not be determined.  The manner description characterizes their death for public health purposes. This information can be used in many ways to help improve public health including advocacy for allocating resources appropriately.

Most often, when a specific cause of death cannot be determined, as in cases of SUDC, the manner is most often listed as undetermined. However, in some cases the medical examiner or coroner considers the death natural even though they cannot determine the specific cause of death. By doing this, they are conveying that they are confident that the death, although not explained, was not due to accident, homicide, or suicide.

If someone has questions about the final cause of death or manner opinion, we recommend contacting the person who completed the death certificate. While the death certificate conveys important information in all deaths, it infortunately does not provide clarity in SUDC.

A Guide to Relevant Definitions

  • Cause of Death= A medical opinion of the disease or injury that resulted in a person’s death. (What the person died of)
  • Manner of Death= Classification system developed for public health statistics based on the circumstances under which death occurred (How the person died); Manners of death currently includes 5 categories:
  • Accident= An unexpected or unforeseen death due to injury.
  • Homicide= Death as a result of a volitional act committed by another person (e.g. injury, poisoning).
  • Natural= Death due solely to natural disease.
  • Suicide= Death resulting from intentional self-inflicted act.
  • Undetermined= Manner of death used when the information pointing to one manner of death is no more compelling than another.

If you have further questions on understanding cause or manner of death, please email [email protected] or comment below.  Thank you.

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