'Natural Causes' Is One Of The Most Common Deaths Globally, But What Does It Actually Mean?

By now we all know the typical autopsy scene from TV and film, right? There's a forensic pathologist digging a scalpel into a corpse on a cold, metal table laid out in an equally cold, metal room. Maybe there's a scale for weighing organs, and someone is narrating the autopsy to a voice recorder, like, "Making incision along the anterior blah blah." There's a clipboard somewhere, which the examiner uses to make notes and tick boxes. "Was it a homicide?" a detective in a trench coat asks. "Well you see," starts the examiner, who continues blabbing something that the writers thought would make the examiner sound knowledgeable and definitely required research. In the end, what's the proclaimed cause of death? Natural causes. But what does natural causes actually mean?

Understanding death by natural causes necessitates looking at the word "natural," i.e., related to nature. The body is a thing of nature, and over time will (wait for it) naturally die of x, y, z. This isn't the same as generally dying of old age, which ends in some natural, triggered event that causes the actual death. As Live Science explains, natural causes of death include conditions or diseases that tend to afflict the body over time, like heart failure, cancer, or stroke. The opposite — non-natural — describes causes of death that prematurely cut off the body's natural aging and deterioration. So getting clubbed on the head by a manic on a motorcycle? That's pretty non-natural. 

Death by natural means

Depending on one's perspective and values, dying of natural causes might be something to be grateful for. It means someone didn't get detonated on a battlefield. A person didn't trip while rushing down the stairs on their way to the mailbox and snap their neck. A person didn't get into a car accident and have a skewer of glass puncture their eye and lance their brain. Dying of natural causes doesn't mean someone and their loved ones didn't suffer — far from it. But at least it means a person wasn't violently murdered, didn't burn to death, die of strangulation from a garrote wire or jungle-dwelling python, and so forth.

Looking at data compiled by the World Health Organization, natural events compose the entire list. This includes causes that might come across as surprising, like diabetes, respiratory infections, Alzheimer's disease, and neonatal conditions, the latter of which the Virginia Department of Health explains includes things like the horrifying sudden infant death syndrome (SIDS). Five Thirty-Eight says that heart disease and cancer in 2013 accounted for nearly half of all deaths in the United States. The next eight natural causes of death accounted for 23% of all deaths. The category "all other diseases" accounted for 12% of deaths. This leaves a small percentage of deaths — somewhere around 15% — attributed to non-natural causes. Among non-natural causes "accidental poisoning" ranks number one, followed by car accidents, falls, and suicide by different means.

Weighing evidence like a judge

When talking about death by natural causes, we have to contend with the old "No death is actually 'natural'" rhetorical objection. But that's just a matter of terminology. Provided someone died from a cause inherent to the nature of their own physiology, the cause of death was "natural," as we say. In other words, no biological creature spontaneously keels over from a gunshot wound. A non-natural death is induced from the outside, and requires biological life to be impinged on by some force not inherent to itself. 

That being said, reasoning like this can complicate the work of medical professionals. Going back to our original autopsy scene, medical examiners have to, "weigh the evidence, and based on the predominance of evidence you come to a decision that I think this is what caused the problem," as Dr. David R. Fowler, president of the National Association of Medical Examiners, says on CNN. "When a medical examiner fills out a death certificate, it's their medical opinion based on all their experience and training that this is what happening," he continues, adding, "You're rather like a judge." Decisions regarding official causes of death result from assessments, in the same way that doctors decide diagnoses. Sometimes non-natural and natural causes interlink, like someone shoveling snow so strenuously that they have a heart attack, as Fowler explains. But in the end, some specific cause has to be written down on a death certificate.