Mind Your Manners: 20 Years Later

Abstract

The authors of a 1995 manner of death survey were asked to revisit it 20 years later. A new survey conducted in May 2015 included 11 scenarios from the 1995 survey for which agreement about manner was less than 70%, as well as 19 new scenarios. One-hundred-fifty-two people responded. None of the 30 case scenarios had 100% agreement concerning manner of death classification. Four (13%) had 90% or higher agreement, nine (30%) had 70 to 89% agreement, 11 (37%) had 50 to 69% agreement, and six (20%) had less than a majority of responders agreeing. The scenarios were written to address known controversies about manner of death, so the lack of agreement in many scenarios is not surprising. For the great majority of deaths certified by medical examiners and coroners, manner of death is fairly straightforward, so it is unlikely that variations observed in our 30 scenarios would have a major impact on vital statistics summaries. The major issues that arise in the scenarios of this survey necessitate consideration of the following controversial topics in manner of death classification: intent, legal definitions, consent of deceased, the role of a hostile environment, perpetrator age, allergic reactions, excited delirium, possible asphyxia in infant deaths. We discuss shifts in opinion, reasoning given by responders for their manner of death classification, the role of training in long-term manner of death classification, and other items pertinent to differences of opinion. These concerns have been debated for decades, and it is obvious that agreement is still lacking. Perhaps consensus guidelines could be developed with recommendations for managing and certifying such cases.