Death is the permanent cessation of all biological functions that sustain a living organism. The manner of death refers to the circumstances surrounding a person’s death. There are generally considered to be 5 manners of death – natural, accidental, suicidal, homicidal, and undetermined.
Natural Death
A natural death is one that is primarily attributed to an illness or an internal malfunction of the body not directly influenced by external forces. It occurs when a person dies from natural causes such as disease, illness, old age or complications from a health condition. Some examples of natural manners of death include:
- Heart attack
- Stroke
- Aneurysm
- Chronic or terminal illness such as cancer, COPD, diabetes, kidney failure, etc.
- Organ failure
- Infection such as pneumonia, sepsis, etc.
- Degenerative disease such as dementia, Parkinson’s disease, Huntington’s disease, etc.
- Malnutrition or dehydration
In a natural death, the person’s official cause of death would be listed as whatever disease or medical condition led to their demise. Natural deaths make up the majority of all deaths worldwide.
Accidental Death
An accidental death is one that occurs unintentionally or unexpectedly from external causes rather than illness or old age. Some examples include:
- Automobile accident
- Falling
- Drowning
- Choking
- Drug overdose
- Electrocution
- Smoke inhalation
- Complications of medical treatment
In an accidental death, the person’s official cause would be whatever external factor led to their death such as motor vehicle collision, fall from height, drowning, etc. Accidents are a major cause of preventable deaths worldwide.
Suicide
Suicide is death caused by injuring oneself with the intent to die. Some examples of suicide include:
- Gunshot wound
- Hanging
- Drug overdose
- Jumping from height
- Cutting
Suicide would be listed as the person’s official cause of death. It is usually indicated by evidence of planning, preparatory behavior or expressions of suicidal intent by the deceased. Suicide is a leading manner of death worldwide.
Homicide
Homicide is death deliberately caused by another person. Some examples include:
- Gunshot wound
- Stabbing
- Bludgeoning
- Strangulation
- Poisoning
In homicides, the medical examiner lists the official cause as the means by which the person was killed such as “gunshot wound to head”, “stab wounds to chest”, etc. Homicide investigations aim to determine the perpetrator responsible for the death.
Undetermined Death
An undetermined death is one whose manner cannot be clearly identified or categorized based on available information and evidence. Some reasons why a death may be listed as undetermined include:
- Insufficient or conflicting evidence to assign a clear manner of death
- Inability to definitely determine whether death was accidental, suicidal, homicidal or natural
- Pending police investigation or toxicology results
- Decomposition of the body makes findings inconclusive
Undetermined is a temporary ruling used when more information is needed to categorize the manner conclusively. The medical examiner may eventually reclassify an undetermined death if new evidence emerges.
Investigating the Manner of Death
Determining the manner of death is the job of a medical examiner or coroner. They utilize information from several sources such as:
- Autopsy findings
- Toxicology test results
- Police reports
- Medical records
- Scene and witness statements
- Suicide notes
The examiner puts together findings from the investigation, autopsy results, lab tests and other reports to assign the manner and official cause of death. This provides statistics on mortality and helps identify public health threats and preventable deaths.
Autopsy
An autopsy is a detailed internal and external examination of a body after death. It is performed by a medical examiner or coroner to determine cause and manner of death. Autopsy findings that may help indicate manner of death include:
- Presence of injuries, wounds or trauma – suggests homicide, suicide or accidental death
- Disease processes identified that could explain death – suggests natural death
- Evidence of soot in airways – suggests smoke inhalation in fires
- Evidence of drowning such as fluid in lungs – suggests drowning
Toxicology Tests
Toxicology tests check body fluids and tissues for traces of drugs, poisons or alcohol. These lab tests may identify intoxication or overdose and can indicate whether death was accidental, suicidal, homicidal or natural.
Scene Investigation
Investigating the scene provides context to determine manner of death. A disorganized scene may suggest a struggle occurred. The presence of weapons, drugs, or suicide notes may also provide clues. Evidence at the scene is photographed, documented and collected.
Examining the Body
The exterior examination of the body at the scene looks for signs of trauma, wounds, injuries and time of death. Position of the body and rigor mortis may give insight into death circumstances. Evidence is collected from fingernails, hands and clothing.
Witness Statements
Interviews with witnesses, family and friends provide information about the deceased’s behavior and events preceding death. This may offer clues pointing to accident, suicide, homicide or natural causes.
Medical History
The person’s medical records are reviewed for health conditions that could have contributed to natural death. Psychiatric history may reveal risk of suicide. History of substance abuse may suggest accidental overdose.
Importance of Determining Manner of Death
Accurately determining and documenting the manner of death is important for many reasons:
- Produces mortality and public health statistics on causes and manners of death
- Identifies potentially preventable deaths
- Determines if any persons were responsible for the death
- Provides closure to the family regarding how loved one died
- Influences distribution of insurance payouts
- Determines if any public safety hazards contributed to accidental deaths
- Provides data to improve safety standards and health policies
- Identifies high risk factors for unnatural deaths such as suicide
- Aids law enforcement in possible criminal investigations
Given the important ramifications of classifying the manner accurately, medical examiners undergo extensive training to differentiate between natural, accidental, suicidal, homicidal and undetermined deaths based on all available evidence.
Manner of Death Statistics
The following table summarizes typical statistics on manners of death in the United States according to data from the CDC:
| Manner of Death | Percentage of Total Deaths |
|---|---|
| Natural | 89.4% |
| Accidents | 4.8% |
| Suicide | 1.6% |
| Homicide | 0.5% |
| Undetermined | 3.7% |
This shows natural death accounts for the vast majority of deaths, while accidents, suicide, homicide and undetermined manners make up a relatively small proportion of total deaths annually. However, the CDC estimates that accidents and homicides are two of the top 3 causes of death for those aged 1 to 44 years old.
Risk Factors for Manner of Death
Certain risk factors can increase a person’s risk of specific manners of death:
Accidental Death Risk Factors
- Alcohol or drug intoxication
- Dangerous occupations like mining, fishing, logging, roofing
- Lack of safety equipment use – no seatbelts, helmets, life jackets
- Taking risks and ignoring hazards
- Distracted driving
- Chronic conditions or disabilities affecting mobility or coordination
- Unsafe work sites and job conditions
- Lack of child supervision
- Hazardous housing conditions
Suicide Risk Factors
- Mental health issues – depression, schizophrenia, personality disorders
- Previous suicide attempt(s)
- Family history of suicide
- Substance abuse disorders
- Access to lethal means like firearms
- Major financial, work, or relationship stressors
- Recent bereavement or loss
- Chronic pain or illness
Homicide Risk Factors
- Involvement in high risk scenarios – illegal activity, gangs, violent relationships
- Being a victim of past abuse, assault or threats
- Working in volatile environments – law enforcement, security, mental health services
- Low socioeconomic status and poverty
- Living in areas with high crime rates
- History of violence or aggression
- Drug and alcohol abuse
Identifying and mitigating these risk factors through public awareness, safety measures, mental healthcare access and policy changes can help prevent many accidental injuries, suicides and homicides.
Prevention of Unnatural Deaths
Though natural death cannot be prevented, many strategies can help reduce rates of accidental, suicidal and homicidal deaths:
- Accident prevention through safety regulations, public awareness campaigns, product design changes, traffic laws, occupational safety standards
- Suicide prevention through mental health screenings, crisis management, means restriction, public education about warning signs
- Homicide prevention through criminal justice reform, domestic violence resources, youth outreach programs, gun law changes
- Drug and alcohol programs to reduce substance abuse and overdoses
- Training and access to emergency medical care to reduce fatalities
- Advances in vehicle safety, medicine, and public health all contribute to reducing mortality from preventable manners of death
While the manner of someone’s death is not always preventable, public health efforts to promote safety practices, mental wellbeing, and responsible behaviors can help save many lives.
Conclusion
In summary, the 5 primary manners of death are natural causes, accidental, suicide, homicide and undetermined. The manner is determined by a medical examiner or coroner based on autopsy results, toxicology tests and death scene investigation. Accurately categorizing and documenting the manner of death produces vital public health data and may aid law enforcement if a death was suspicious or criminal in nature. While natural death accounts for most mortality, accidental injuries, suicides and homicides especially impact younger populations. Implementing prevention initiatives that promote safety, mental health, responsible behaviors and access to emergency care can help reduce preventable deaths from unnatural causes.