When the cause of death is undetermined, this can mean quite a few things. At first glance it appears that it simply means the medical examiner cannot conclude how the person died; however, it is not quite that simple. The main problem is the use of the “undetermined” terminology when classifying a death due to a lack of understanding intent, as explained in a report issued to the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Despite substantial evidence, if a medical examiner is still in doubt and cannot reconcile findings with the intent surrounding the death, he will often list the cause of death as undetermined in accordance with legal standards.
Meaning of Undetermined
Most states recognize five causes of death: undetermined, natural, homicide, suicide and accidental. The main problem for medical examiners in classifying death is that homicide, suicide and accidental all involve intent. A medical examiner may classify the cause of death as undetermined if the intent is not understood at the conclusion of an autopsy, due to legal consequences attached to such cases. For legal purposes an undetermined cause of death simply means the medical examiner cannot say for sure what caused the death of the person. For example, if a person with severe heart problems dies of a heart attack and is found to have a large dose of cocaine in his system during autopsy, it may not be clear if the heart attack was natural or cocaine caused it. If the medical examiner cannot conclude, he might list the death as undetermined.
Problems in Possible Homicide
In cases of homicide, according to Michael Panella, MD in a feature article written for the Tennessee Bar Association, in order to list a cause of death as homicide, the medical examiner must conclude from the autopsy and other reports that the death resulted from a violent act where one human being kills another. In the event the autopsy does not reveal sufficient evidence that the death resulted from homicide, even if there is evidence of possible homicide, this may result in an undetermined ruling. In other cases, it might be just the opposite. Because the medical examiner does not take into account intent (except when reading other reports when available) he may conclude a person died of homicide (such in cases of a gunshot to the head) although it may very well been the result of an accident.
Problems in Possible Suicide Cases
In the same article, Dr. Panella also explains that for a ruling of suicide, the medical examiner must conclude beyond a reasonable doubt that the person intentionally meant to kill himself. This can prove tricky for a medical examiner, because once again he does not know the intent if there are not other reports available to help him make that determination. If a person dies after drinking a large amount of alcohol and ingesting a large amount of sleeping pills, it might appear as suicide, but there is reasonable doubt. The person might not have realized how many pills he was taking or meant to take something else, not sleeping pills. According to Dr. M.J. Breiding of the Centers for Disease Control and Prevention, many suicides end up as undetermined classification due to the lack of knowledge surrounding intent.
Problems in Possible Accidental Cases
Accidental cases present the exact same issues. Intent makes a big difference between homicide, suicide and an accident. Since a medical examiner knows nothing of intent, if the autopsy does not conclusively tell him that a death was the result of an accident, he is still reluctant to call it homicide of suicide, resulting in an undetermined classification. As Dr. Panella explains, an accidental death is a death that occurs in an unintended manner. This can be hard to tell in an ongoing investigation.