In common language and media reports, the phrases “died of natural causes” or “died of old age” are frequently used to describe a passing without apparent trauma or violence. These terms possess distinct and precise meanings when used by medical professionals, forensic pathologists, and legal authorities. Understanding the difference between the medical cause of death and the legal manner of death is necessary to grasp how these classifications are applied. The use of these phrases directly impacts public health data, legal proceedings, and the official documentation of death.
Defining the Legal and Medical Term “Natural Causes”
“Natural causes” is a classification that forensic and medical professionals use to describe the manner of death, not the specific cause itself. The determination of a natural death means the passing was due solely to internal factors, such as a disease process or the failure of internal organs. This category encompasses a wide range of conditions, including heart disease, stroke, cancer, and infections like pneumonia.
The classification places the cause of death within the body’s physiological processes. For a death to be considered natural, it must be established that no external intervention, injury, poisoning, or violence contributed to the passing. For instance, a person dying from complications of a lifelong chronic condition, like diabetes or cardiovascular disease, would have their death classified as natural. Even if a person’s lifestyle contributed to a disease, the resulting death from that internal disease is still categorized as natural.
The Myth and Reality of Dying from “Old Age”
The common phrase “died of old age” is not recognized as an acceptable medical cause of death on an official death certificate. Medical certifiers are discouraged from using vague terms like “old age” or “senescence” because they provide little value for medical research or public health statistics. Since the age of the person is already recorded separately, the goal of the death certificate is to record a clear sequence of events that led to death, which “old age” fails to do.
In reality, people die from specific diseases or complications that their aged bodies can no longer withstand, not simply because they reach a certain age. Biological aging, or senescence, involves the cumulative deterioration of cells and organs, which increases vulnerability to disease. This deterioration may manifest as a specific condition like heart failure, a fatal infection, or a stroke. Even in very elderly people, a physician is expected to list the most likely identifiable medical condition, such as advanced frailty, as the underlying cause.
How Cause of Death is Determined
The process of determining and documenting the cause of death is a formal medical procedure culminating in the issuance of a death certificate. This responsibility falls to an attending physician, a coroner, or a medical examiner, depending on the circumstances of the death and local jurisdiction. The attending physician generally certifies deaths that are expected and determined to be natural, such as a patient dying after a long illness. If the death is sudden, unexpected, or involves injury or poisoning, the case is usually referred to a medical examiner or coroner for investigation.
The death certificate requires the certifier to outline a sequence of events leading to death, divided into two main parts. Part I details the chain of events, starting with the immediate cause of death (the final condition) and working backward to the underlying cause (the disease or injury that initiated the sequence). For example, the immediate cause might be a pulmonary embolism, which was due to deep vein thrombosis, which in turn was due to cancer, the underlying cause. Part II lists other significant conditions that contributed to the death but were not part of the direct causal chain.
Distinguishing Natural from Non-Natural Causes
The determination of the manner of death is a legal classification that categorizes the circumstances surrounding the death, and this determination guides whether a formal investigation is required. The classification of “natural” is one of five standard categories used by forensic pathology, all of which contrast with the “non-natural” or “external” classifications. The non-natural categories are Accident, Suicide, Homicide, and Undetermined.
Non-Natural Manners of Death
The following categories are used to classify non-natural deaths:
- Accident: Defined as an unnatural death resulting from an inadvertent chance happening, such as a fall or a motor vehicle crash.
- Suicide: A death resulting from a fatal, self-inflicted trauma with the intent to cause harm.
- Homicide: Occurs when a person dies as a result of another person’s actions, though this classification does not necessarily imply that a crime was committed.
- Undetermined: Assigned when information is insufficient or equally supports multiple manners of death.
The primary function of classifying a death as non-natural is to notify authorities, like the medical examiner, that an external factor may have been involved, triggering a medicolegal investigation.