Chapter 6

Causes of Death

Primary purpose of a medico-legal autopsy is the determination of the cause

of death.
If death developed independent of an unlawful act, then the person who
committed the unlawful act cannot be held responsible for the death.
However, there are some post-mortem findings of a physician which may be
useful in the proper adjudication of the case.

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. Kinds:
1. Immediate (Primary) Cause of Death applies to cases when trauma or disease
kill quickly that there is no opportunity for sequelae or complications to develop.
2. The Proximate (Secondary) cause of death the injury or disease was survived
for a sufficiently prolonged interval which permitted the development of serious
sequelae which actually caused the death.
The mechanism of death is the physiological derangement or biochemical
disturbance incompatible with life which is initiated by the cause of death. It may be
hemorrhagic shock, metabolic disturbance, respiratory depression, toxemic
condition, cardiac arrest, tamponade, etc.
The manner of death is the explanation as to how the cause of death came into
being or how the cause of death came into being or how the cause of 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.
2. Violent or Unnatural death death due to injury of any sort.
Medico-legal masquerade In case of homicide, the medical findings may tend to
favor suicide or accidental death, and vice versa.
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 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 or 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.
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.
Understanding and exposition of the mechanism by which the anatomic and other
deviations from normal actually