By Dr. Carl L. Parrott Jr.
A hunter shoots at what he thinks is a deer and kills a housewife hanging up her wash. An accident? No, a homicide.
Two elderly men, lifelong friends, are having a spirited political discussion on the sidewalk. One disgustedly shoves the other, who falls, striking his head and sustaining lethal brain injury. An accident? No, a homicide.
Six Cincinnati policemen restrain a violent, intoxicated individual with severe medical problems, who dies during the struggle. An accident? No, a homicide.
The simple answer: that's the rule. Regarding the last case, the National Association of Medical Examiners' "Guidelines for Manner of Death Certification" so states, explaining that "in such cases there may not be intent to kill, but the death results from one or more intentional, volitional, potentially harmful acts directed at the decedent."
Invoking "the rule" isn't a very satisfying explanation for most people, however. It is easier to understand why such deaths are so certified if the circumstances underlying the practice are explained.
In medical-legal speech, "homicide" is a neutral term. It doesn't imply wrongdoing. That determination is left, properly, to the judicial system. While the medical examiner, like any observer, can usually recognize an intent to harm or kill, he or she often cannot, and volition becomes the test: whether the act causing or contributing to death was purposeful, whatever the intent. Thus, even if I think the gun is unloaded when I point it playfully at my friend and pull the trigger, my friend's death is a homicide because I aimed it and pulled the trigger.
When a medically at-risk citizen dies during legal intervention, another principle applies: the manner of death is unnatural, here homicide, when injury hastens the death of one already vulnerable to significant or even life-threatening disease.
Certification of such deaths as homicides arises from the requirement that manner of death be sorted into only four categories: natural, accidental, suicidal and homicidal. This system has little relevance to the criminal and civil justice systems, since self-defense and legal-intervention homicides usually don't result in prosecution, while some accidental deaths may. Certifying a death as natural certainly does not preclude a civil suit. The "check one of the four boxes" system serves the purposes of statistical data gathering, rather than medical, legal or public understanding.
The International Classification of Diseases (ICD) lists deaths due to legal intervention near, but separately from, other deaths due to "injury purposely inflicted by other persons." A logical evolution of the U.S. Standard Certificate of Death would be elimination of the "manner" characterization and its replacement by on-certificate ICD coding providing a more detailed and subtle classification of the individual case.
Alternatively, consideration might be given to creating more official manners of death: legal intervention, therapeutic misadventure and the like. Until some such modification occurs, however, we as medical examiners face the prospect of unwillingly lumping police officers, honorably discharging their sworn duty to preserve the peace, with common murderers when certifying deaths occurring during legal intervention.
Dr. Carl L. Parrott Jr. is the Hamilton County coroner.
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