It matters to know why a person dies. As a Public Health Officer, I monitor trends of disease and death to better understand avoidable causes. Law enforcement officers need to know cause of death if there is a criminal issue involved. Life insurance companies may need that information before a claim is paid. Most importantly, family and the people around that person need to have the closure that comes with being able to understand the why behind the death of a loved one.
Cause of death is not necessarily obvious. It is often a series of events, pathogens, toxins, or diseases that lead to final death. Laws require that a cause of death be determined, but how that is done is amazingly sloppy. This is from a CDC instruction on how a physician is to record a cause of death, The cause-of-death information should be YOUR best medical OPINION (emphasis in the original). Also keep in mind that the physician, attending the person at the time of death (or potentially another non-medical authority depending on State law), is the only one who is allowed to assign cause of death – until an autopsy determines otherwise. That person may have very little knowledge of the patient’s conditions, may be a busy hospital or ER doctor who just needs to finish yet another form, or may have very little knowledge about complex issues that contribute to death. Published medical literature clearly outlines how inaccurate that opinion is, when compared to autopsy (literature links at the end).
A very good example of this is the story of Elijah McClain. This 23 year old man died after being detained by law enforcement and administered forced medical treatment. The original death certificate listed his cause of death as “undetermined”. It took three years and an amended autopsy report to give final closure to this undetermined death – he was killed by a forced drug overdose.
Autopsy is an important and underutilized tool. I am advocating for its proper use.
The requirements of performing an autopsy vary by State: this table published by the CDC lays out the State based requirements: https://www.cdc.gov/phlp/docs/coroner/table2-autopsy.pdf
In this piece I will refer to Nevada law (summary):
NRS 259.050 Investigation into cause of death; postmortem examination; inquest.
1. When a coroner or the coroner’s deputy is informed that a person has been killed, has committed suicide or has suddenly died under such circumstances as to afford reasonable ground to suspect that the death has been occasioned by unnatural means, the coroner shall make an appropriate investigation.
2. In all cases where it is apparent or can be reasonably inferred that the death may have been caused by a criminal act, the coroner or the coroner’s deputy shall notify the district attorney of the county where the inquiry is made, and the district attorney shall make an investigation with the assistance of the coroner. If the sheriff is not ex officio the coroner, the coroner shall also notify the sheriff, and the district attorney and sheriff shall make the investigation with the assistance of the coroner.
3. If it is apparent to or can be reasonably inferred by the coroner that a death may have been caused by drug use or poisoning, the coroner shall cause a postmortem examination to be performed on the decedent by a forensic pathologist unless the death occurred following a hospitalization stay of 24 hours or more.
4. A coroner may issue a subpoena for the production of any document, record or material that is directly related or believed to contain evidence related to an investigation by the coroner.
5. The holding of a coroner’s inquest is within the sound discretion of the district attorney or district judge of the county. An inquest need not be conducted in any case of death manifestly occasioned by natural cause, suicide, accident, motor vehicle crash or when it is publicly known that the death was caused by a person already in custody, but an inquest must be held unless the district attorney or a district judge certifies that no inquest is required.
6. If an inquest is to be held, the district attorney shall call upon a justice of the peace of the county to preside over it. The justice of the peace shall summon three persons qualified by law to serve as jurors, to appear before the justice of the peace forthwith at the place where the body is or such other place within the county as may be designated by him or her to inquire into the cause of death.
7. A single inquest may be held with respect to more than one death, where all the deaths were occasioned by a common cause.
NRS 259.053 Postmortem examination by forensic pathologist: Determination of cause of death; death certificate. If a forensic pathologist performs a postmortem examination on a body under the jurisdiction of the coroner:
1. The forensic pathologist shall determine the cause of death of the decedent; and
2. The certifier of death shall record on the death certificate the exact cause of death as determined by the forensic pathologist.
NRS 259.020 Sheriffs are ex officio coroners; exceptions. Except in any county where a coroner is appointed pursuant to NRS 244.163, all sheriffs in this state are ex officio coroners
In addition, family members may request an autopsy and it can be done long after the death - https://state.nv.networkofcare.org/ph/library/article.aspx?hwid=hw2451
Requested vs. required autopsies: https://state.nv.networkofcare.org/ph/library/article.aspx?hwid=hw2451
It is important to note that:
one of the provisions for a requested autopsy is - If there are questions about a sudden death that appears to be from natural causes
one of the provisions for a required autopsy is - result of any injury. Examples include a fall, a car crash, a drug overdose, or poisoning
This is from the Washoe County Regional Medical Examiner’s FAQ page:
Under What Circumstances Will an Autopsy be Performed?
The National Association of Medical Examiners’ Forensic Autopsy Performance Standards indicate that a forensic autopsy will be performed when:
The death is known or suspected to have been caused by apparent criminal violence.
The death is unexpected and unexplained in an infant or child.
The death is associated with police action.
The death is apparently non-natural and in custody of a local, state, or federal institution.
The death is due to acute workplace injury.
The death is caused by apparent electrocution.
The death is by apparent intoxication by alcohol, drugs, or poison, unless a significant interval has passed (while hospitalized), and the medical findings and absence of trauma are well-documented.
The death is caused by unwitnessed or suspected drowning.
The body is unidentified and the autopsy may aid in identification.
The body is skeletonized.
The body is charred.
The forensic pathologist deems a forensic autopsy is necessary to determine cause and/or manner of death, or document injuries/disease, or collect evidence.
The deceased is involved in a motor vehicle incident and an autopsy is necessary to document injuries and/or determine the cause of death.
Here is the bottom line: All-cause mortality is going up at an unprecedented rate. There are no good explanations as to why. We are slipping into a new Dark Ages with claims of not understanding the basic mechanisms of life and death – that is only because of willful ignorance. We can do better. Autopsy is a proven and underutilized tool that needs to be properly applied to keep us from drowning in our superstition and ignorance.
When your loved one dies, demand a complete and satisfying answer as to why. If you are a person in a position of responsibility or trust, do your due diligence in providing family and community members with that complete answer.
It is important to inform the family on the importance of autopsy and DNA testing
Where no cause of death is identified, genetic testing of deoxyribonucleic acid extracted from postmortem blood (the molecular autopsy) may identify a cause of death in up to 30% of SADS cases. (this article from 2015 uses the acronym SADS to refer to sudden arrhythmic death syndrome, not the current meaningless label of Sudden Adult Death Syndrome)
Troy Ross, MD, MPH
October 24, 2022
Willfully blind. Because to look closely might shatter the rosy myth of safety and of any social and technological progress.
I say myth because we are regressing and rapidly into a new dark age.
Reasonable doubt confuses everything, was that sudden flare up of cancer caused by x, or was it from a,b or c? This toxic world where toilet sprays, construction waste, chemical cleaners or micro-plastics confound the carcinogenic process and muddy the waters.
Look for signs of mitochondrial damage and dysfunction above and beyond regular levels expected for their age. Look for the absence of nucleocapsid proteins. But burying your head in the sand is not a great survival strategy. Just like closing your eyes in a boxing match isn't going to make the opponents haymaker hurt any less.