Where death investigation is concerned, the cause, mechanism and manner of death shall be determined by a postmortem examination. Autopsy findings may help in providing clues as to how and why a person dies. However,this article focuses on the manner of death.
Firstly, in order to establish manner of death, one must first understand the cause and mechanism of death. Cause of death is defined as a disease or injury that initiates the events leading to death, while mechanism of death is a physical abnormality produced by cause of death, that is incompatible with life.
The following case senario illustrates the terms, cause and mechanism of death.
‘Michael has set David’s house on fire. David stabs him in the chest. Michael dies on the way to the hospital.’
In this case, the cause of death is stab wound to the chest and the mechanism of death is excessive blood loss.
Manner of death
The manner of death is the underlying circumstance that places in motion a physiologic process, culminating in the person’s death.
As an example, If the person died solely due to natural disease, such as diabetes, the manner of death would be ‘natural.’
However, when the physiologic process is due to circumstances that give rise to the infliction of an injury, the manner of death is no longer natural. Instead, it is either an accident, homicide or suicide. For example, an incident, in which a pedestrian was struck by a vehicle from behind, may have been the result of the driver trying to avoid a pothole. In turn, it caused the vehicle to enter the shoulder of the roadway, where the pedestrian was walking, and hit him. Under this circumstances, the manner of death would be ‘accident.’ If however, the driver of the vehicle, who just had a dispute with the pedestrian, purposely ran into him, the manner of death would be ‘homicide,’ i.e., the driver intended to cause harm to the pedestrian by using his car as a weapon.
According to the Guidelines for the Determination of Manner of Death by Illinois Coroners and Medical Examiners Association, manner of death is defined as the category, into which that individual’s death best fits. These categories were established almost a hundred years ago and are now standardized into five categories, namely, natural, accidental, suicidal, homicidal and undetermined.
- Natural Death.
The most common manner of death in Malaysia is natural death. Natural death is defined as death due to interruption or failure of body functions from ageing or disease. Examples of natural deaths are ischemic heart disease, pneumonia and chronic renal failure.
Natural Death : Hypertensive Cardiovascular Disease
- Accidental Death
Accidental death is death following events in which there in no intent to cause harm or death. Road traffic collisions and occupational-related deaths are among the examples that may be considered as accidental deaths.
Accidental Death : Motorvehicle Accident
- Homicidal Death
Homicidal death is death of one person due to another person. There is a motive behind the killing of a person by another.Posibble motives are anger, jealousy, cover-up, revenge and others. Slash wound to the neck, multiple stab wounds and manual strangulation are examples of deaths that fall under this category.
Homicidal Death : Murder
The act of killing oneself is a suicidal death. There are many ways of taking one’s own life, such as hanging, jumping from high places and poisoning. The three most common suicide methods in Malaysia are hanging/strangulation/suffocation, jumping from high places and exposure to pesticides. In suicides, we may find suicide notes from the deceased, addressed to family members or loved ones.
Suicidal Death : Carbon Monoxide Poisoning
- Undetermined Death
When no cause of death can be established and the death cannot be categorized as natural, accidental, suicidal and homicidal, the death shall be considered as undetermined. In such deaths, no conclusive post-mortem findings can be obtained to establish the cause. Ancillary investigations also could not provide a possible cause. An example of undetermined death is in a decomposed body where the cause of death cannot be ascertained.
Undetermined Death : skeletal remains
Significance of Manner of Death
Why must manner of death must be established?
Basically, when a person dies,there are several parties that may be affected. Not only does a death affect the deceased, it also has an impact on the family/relatives, suspects, police and the court of law. The importance of manner of death to the respective parties is as follows;
- Family / relatives
In cases such as a fall from a height, there are three possible manners of death to be considered, accidental, suicidal and homicidal. A proper and thorough investigation of death is essential in determining the manner. Family’s grief and anguish over the death of their loved ones can be alleviated when questions are answered. A suicidal death may cause additional distress due to the stigma attached to it and also where insurance claims are concerned.
Establishing the manner of death is vital in deciding whether to charge or discharge a suspect of an alleged crime. The charge for a person suspected to kill another, depends on whether it is an accidental or homicidal death. For example, a person who allegedly shoots his friend with a shotgun during hunting may be charged with manslaughter, instead of murder.
- Police Force
The manner of death shall guide the investigating police officer to which course he should take. Investigation of a homicidal death would be more comprehensive compared to that of a natural death.
- Court of law
As mentioned previously, a criminal charge is specific for a particular manner of death (accidental or homicidal). The penalty shall be based on the charge, should the accused be proven guilty by the court of law.
With regards to deaths that take place in an occupational or industrial setting, the manner of death may prompt an investigation, scrutinizing the pre-existing systems that could have contributed to or caused the death, even if it is an ‘accidental’ or ‘natural’ death.
As a conclusion, it is important to determine the manner of death for the benefit of the deceased’s family and relatives, and to assist the legal system. It forms part of the process of protecting the rights of the deceased individual and upholding justice.
- Photographs courtesy of Department of Forensic Medicine, Hospital Tengku Ampuan Afzan, Kuantan, Pahang.
- Cox WA. Cause, mechanism, and manner of death. In: Forensic Medicine with Dr Cox.2009. forensicmd.wordpress.com
- Departments of Forensic Medicine and Psychiatry & Mental Health. National Suicide Registry Malaysia Preliminary report: July – December 2007. Kuala Lumpur: Suicide Registry Unit, Hospital Kuala Lumpur, 2008.
- DiMaio VJ, DiMaio D. Forensic pathology, 2nd ed. Boca Raton: CRC Press, 2001.
- Illinois Coroners and Medical Examiners Association. Guidelines for the Determination of Manner of Death. 2007.
|Last Reviewed||:||23 August 2019|
|Writer||:||Suhailey bt. Md Noor|
|Accreditor||:||Dr. Sri Marni bt. Zainal Abidin|
|Reviewer||:||Dr. Khoo Lay See|