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CAUSE and MANNER of DEATH DEGREES of CERTAINTY 86 Yr. Old Man Assaulted by 4 teenagers Struck, knocked down Wife knocked down and fell on his legs Found the next day Hospitalized: red marks on neck; no other bruising No internal injuries 86 Yr. Old Man Released to Niece’s care Died 1 month following assault Autopsy by forensic pathologist Pulmonary emboli Arteriosclerotic heart disease Emphysema Cause of Death: Pulmonary Emboli due to Phlebothrombosis of leg 86 Yr. Old Man Manner Forensic pathologist: Undetermined Elected Coroner: Homicide Result: of Death Trial and Conviction 60 year sentence 4 Month Old Female Found dead in playpen by mother Last seen alive by father (not biological father) No medical history Small bruise on neck Two healing rib fractures “Confession” by father to previous smothering 4 Month Old Infant Cause of Death : Smothering Manner of Death: Homicide Trial Confession retracted Forensic pathologist: possible SIDS Result: Conviction CAUSE and MANNER of DEATH CERTAINTY FOR DEATH CERTIFICATE PROBABILITY >50% CAUSE AND MANNER OF DEATH CERTAINTY FOR MEDICAL EXAMINERS HIGHLY VARIABLE A CAUSE OF DEATH VS. THE CAUSE OF DEATH CAUSE of DEATH DISEASE INJURY COMBINATION The cause of death is a medical diagnosis MECHANISM of DEATH PATHOPHYSIOLOGY and BIOCHEMISTRY Violent deaths: structural Natural deaths: functional MANNER of DEATH NATURAL ACCIDENT SUICIDE HOMICIDE UNDETERMINED IMMEDIATE CAUSE OF DEATH vs. PROXIMATE CAUSE OF DEATH Very important in cases of severe injury with long term survival CONTRIBUTORY CAUSE OF DEATH Contributes to death but is an unrelated disease or injury STANDARDS Cause of Death Competence in practice of forensic pathology Manner of Death Convention Common sense Legitimate argument Death Investigation Evaluate the circumstances Operate without undue influence Forensic Autopsy Performance or Supervision Limit to number performed Interprets all ancillary reports Determines cause of death Determines manner of death Autopsy Standards External Examination Postmortem Changes Injuries Photographic Documentation Internal Examination X-rays Laboratory Testing Histology Autopsy Report Description of Findings Interpretation of Results