CAUSES OF DEATH

The primary purpose of a medico-legal autopsy is the determination of the cause of death. It must further be shown that the death is the direct and proximate consequence of criminal or unlawful act of someone. If death developed independent of an unlawful act, then the person who committed the unlawful act cannot be held responsible for the death.

The cause of death is the injury, disease or the combination of both injury and disease responsible for initiating the trend or physiological disturbance, brief or prolonged, which produce the fatal termination. It may be immediate or proximate.

1. Immediate (Primary) Cause of Death – this applies to cases when trauma or disease kill quickly that there is no opportunity for sequalae or complications to develop. An extensive brain laceration as a result of a vehicular accident is an example of immediate cause of death.

2. The Proximate (Secondary) Cause of Death – the injury or disease was survived for sufficiently prolonged interval which permitted the development of serious sequelae which actually caused the death. If a stab wound in the abdomen later caused generalized peritonitis, then peritonitis is the proximate cause of death.

The mechanism of death is the physiologic derangement or biochemical disturbance incompatible with life which is initiated by the cause of death.

Cardio-respiratory arrest is a terminal mechanism of most causes of death and can never stand independently as a reasonable explanation for the fatality.

The manner of death is the explanation as to how the cause of death came into being or how the death arose. The manner of death may be natural or violent.

1. Natural Death – it is natural when the fatality is caused solely by disease (lobar pneumonia, ruptured tubal pregnancy, cancerous growth, cerebral hemorrhage due to hypertension, etc.).

2. Violent or Natural Death – Death due to injury of any sort (gunshot, stab, fracture, traumatic shock, etc.). A physician must not include in the consideration of the manner of death that such violent death is suicidal, accidental or homicidal.

Medico-legal Masquerade – Violent deaths may be accompanied by minimal or no external evidence of injury or natural death where signs of violence may be present.

Degree of Certainty to the Cause of Death:

1. When the structural abnormalities established beyond doubt the identity of the cause of death.

2. When there is that degree is that degree of probability amounting to almost certainty the cause of death.

3. When the cause of death is established primarily by historical facts which are confirmed by supported by positive or negative anatomic or chemical findings.

4. When neither history, laboratory and anatomic findings, taken individually or in combination is sufficient to determine the cause of death but merely speculate as to the cause of death.

Steps in the Intellectual Process in the Determination of the Cause of Death:

1. Recognition of the structural organic changes or chemical abnormalities responsible for cessation of vital functions.

2. Understanding and exposition of the mechanism by which the anatomic and other deviations from normal actually caused the death, or how the deviation created or initiated the train of sufficiently potent functional disturbance which led ultimately either to cardiac standstill or to respiratory arrest.

Instantaneous Physiologic Death (Death from Inhibition, Death from Primary Shock, Syncope with Instantaneous Exitus):

This is a sudden death which occurs within seconds or a minute or two after a minor trauma or peripheral stimulation of relatively simple and ordinarily innocuous nature.

Death by inhibition can be made only by exclusion and is completely dependent on the availability of accurate information.

Sudden Infant Death Syndrome (Crib Death) – this is the unexpected death of infants, usually under six months of age , while in apparently good health.

Sudden Unexplained Nocturnal Death (SUND) – this is known as “pok-kuri” disease in Japan and “bangungut” in the Philippines. It is a sudden death of healthy men of young age seen in East Asian countries.

The term Dead on Arrival (DOA) must not be construed literally. It may mean that the patient was actually dead on arrival or was dying on arrival. Death occurs on a precise time while dying is a continuing process.

MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH:

a. Natural Deathb. Violent Death

(1.) Accidental Death(2.) Negligent Death(3.) Infanticidal Death(4.) Parricidal Death(5.) Murder(6.) Homicidal Death

a. Natural DeathThis is death caused by a natural disease condition in the body. The disease may develop spontaneously or it might have been a consequence of physical injury inflicted prior to its development.

b. Violent DeathViolent deaths are those due to injuries inflicted in the body by some forms of outside force.

Penal Classifications of Violent Deaths

(1) Accidental Death – Death due to misadventure or accident. In a pure accidental death, the person who causes the death is exempted from criminal liability.

(2) Negligent Death