The Difference Between Cause Of Death And Manner Of Death In Autopsy Reports
We all know the scene by now. A detective involved in an investigation circles around to a medical examiner who, at the moment the detective enters the room, is standing over a body with a clipboard and dressed in surgical scrubs. "Well, what do you think?" the detective asks. The medical examiner lifts a medical chart to the light and squints at it. "As far as I can tell, we're looking at acute aortic blah blah blah," they say. "You mean a heart attack?" the detective rejoins. The medical examiner turns to face the detective for the first time. "I mean poison," he replies. Dun dun duuuuuuuun! (The dramatic sound effect thing.)
Believe it or not, that very played-out scene from a predictable crime procedural depicts the precise difference between "cause of death" and "manner of death" in an autopsy report. What caused the death in the above example? As Pathology Outlines says, that would be the final, physical mechanism that shut down the human, i.e., the acute aortic blah blah blah. That's the specific trigger that flipped the deceased from alive to dead. And because poison is responsible for the final cause of death, the manner of death is (drumroll): homicide. Otherwise, the manner of death might have been natural. As numerous sites like the Maryland Department of Health outline, there are five — and five only — broad, general categories for manner of death: homicide, natural, accidental, suicide, or undetermined.
Assessing causes of death
As John Hopkins Medicine says, it's up to a medical examiner to perform an autopsy and determine a cause of death and manner of death. Usually, this medical examiner is a pathologist who specializes in examining bodily tissues, has knowledge of chemicals and diseases, conducts lab tests, etc. If there's a suspected crime involved, a forensic pathologist can link the cause and manner of death to crime scenes, per the University of New Mexico School of Medicine.
According to Pathology Outlines, a cause of death must incorporate a specific etiology — a chain of causal, physical events that led to a final, culminating cause of death, the "immediate cause of death." That final cause may also be linked to an "underlying/proximate cause of death," i.e., a trigger that started the sequence of events that led to the immediate cause. The immediate cause and proximate cause of death might also have been influenced by an "intervening cause" that hindered or facilitated the immediate cause of death. And then there are "contributing factors to death," which encompasses any other conditions involved in the demise.
Oxford Reference has an excellent example of a cause of death etiology, including an "antecedent cause of death" that preceded the immediate cause. In the example, the underlying condition of coronary arterial atherosclerosis, aka coronary artery disease, may have kicked off the antecedent cause of death, myocardial ischemia (an arterial obstruction). This led to the immediate cause of death, heart failure (not enough blood pumped through the body).
Determining manners of death
Even though determining a cause of death sounds like piecing together a colossal and complex jigsaw puzzle, it's also based on pure, dispassionate observation and the recording of observable data. In that way, the manner of death might actually be the trickier to determine, as it requires applied reasoning and deduction, not merely the accumulation and assemblage of knowledge. Case in point, the conditions for the five manners of death: homicide, natural, accidental, suicide, and undetermined. Those are the only five manners of death by which a person may die. Maybe someone went drunk driving and hit a tree and died — that's accidental. Undetermined means "we don't know," and suicide is self-explanatory.
As for homicide and natural, we can look to the example at the beginning of this article. The detective asked the medical examiner if the person died from a heart attack, and the medical examiner said, "No, poison." The two are crossing wires on terms, but they're nonetheless describing different antecedent causes of death that led to the same immediate cause of death: heart failure. If the antecedent cause is an arterial obstruction, then the manner of death is natural. If the antecedent cause is something-something poison, then the manner of death is homicide. This is why the manner of death is such a critical determination — it can cast a wildly different light on the case.