The determination of how a person died involves two distinct classifications: the cause and the manner of death. The cause of death is the specific injury, disease, or combination of factors that resulted in the body’s physiological failure, such as a gunshot wound or coronary artery disease. The manner of death, however, is a high-level classification of the circumstances surrounding the death, establishing the context in which the cause occurred. This determination is an investigative and legal finding, not strictly a medical one, and is used for public health statistics and legal proceedings.
Natural Death
Natural death is the most common classification, applied when the death results exclusively from internal factors. This manner is assigned when the death is caused solely by disease, aging, or a congenital medical condition without any external, traumatic injury contributing to the final event. Examples commonly include a myocardial infarction, or heart attack, caused by progressive coronary artery disease, or death resulting from an aggressive form of cancer.
Even if an individual’s lifestyle choices, such as a long history of smoking or poor diet, accelerate the progression of a disease, the manner of death remains classified as Natural. The focus is on the direct medical pathway to death, which originates inside the body and is not a consequence of external trauma. Certain conditions, such as Sudden Infant Death Syndrome (SIDS), are also typically classified as Natural after a thorough investigation rules out external causes and injury.
Accidental Death
The Accidental death classification is applied when the death is the result of an external force or event, but the outcome was unintended and unforeseen. This classification requires a finding that the decedent did not intend to die, and no other person intended to cause the death. Examples range from motor vehicle collisions where no criminal negligence is found to falls that result in fatal head trauma.
Unintentional drug overdoses, which are a leading cause of accidental death, fit this category because the person did not intend for the substance to be lethal. This manner involves a traumatic or toxic external event, distinct from underlying disease. The circumstances must demonstrate an inadvertent chance happening, separating it from acts driven by intent.
Intentional Death: Suicide and Homicide
Intentional deaths are divided into two distinct manners based on the source of the lethal action: self-inflicted or caused by another person. Suicide is the manner assigned when a person dies from a self-inflicted action with the conscious intent to end their own life. Forensic pathologists examine physical evidence, such as the location of wounds and the presence of gunpowder residue on the hands, to confirm the self-inflicted nature of the injury.
Homicide is the death of one person caused by the direct or indirect volitional act of another person. Homicide is a neutral classification of the circumstances—who caused the death—and is separate from the legal finding of criminal culpability, such as murder or manslaughter. For instance, a death caused by self-defense or a justifiable police shooting is still classified as a Homicide, even though it may not result in criminal charges.
The Role of Undetermined Classification
The classification of Undetermined is a necessary category used when the available evidence is insufficient to definitively assign the death to one of the four standard manners. This finding reflects the limitations of the investigation and is used when the information equally supports or conflicts with more than one manner of death. A case may be deemed Undetermined if the body is too decomposed, such as skeletal remains found in the wilderness, or if a death could plausibly be an accident, a suicide, or a homicide without clear evidence to confirm one over the others.
This classification may be temporary, listed as “Pending” while the medical examiner waits for complex analyses. However, it may become the final ruling when competing narratives or an absence of soft tissue prevent a conclusive determination. The Undetermined manner serves to maintain an accurate public record and ensures the case remains open for potential reclassification should new evidence emerge.