Determination of Cause of Death after Autopsy- “A Dilemma”

Abstract

Determination of the cause of death after autopsy is the fundamental responsibility of the autopsy surgeon, yet very little has been written about the criteria that need to be satisfied to make this decision. This issue causes confusion in courts where both autopsy surgeons and lawyers fail to appreciate the philosophy of causation. It is generally assumed and believed by the lay public including lawyers that the cause of death will be easy to establish after detailed autopsy. However, things are not always as simple as they seem. Leaving aside the cases where the lesion observed at autopsy is incompatible with life (e.g. decapitation) what infect usually happens in coming to a conclusion is that a cause of death discovered at autopsy, which accords with the medical history and circumstances, is elevated to the cause of death. The autopsy surgeon makes a subjective decision that a certain autopsy finding is capable of leading to death, and that is consistent with the deceased’s medical history and circumstances of death. Furthermore, a conclusion about the cause of death is retrospective and cannot be tested. These problems emphasize the need to discover all the pathological processes present in the deceased before considering them in relation to the medical history and the circumstances of death.
Causation Philosophy and Problems. One group of academicians believes that the cause is not
only sufficient but is necessary for the effect: A is always followed by B, and B never occurs unless A occurred. Others disagree and advocate that it is the sum total of the conditions in which an event occurred: It is not correct to isolate one of the conditions in which an event occurred as
the exclusive cause. To the One, The statement “The rising of the sun causes daylight”, would have been reasonable, since the rising of the sun is always followed by daylight, and daylight never comes about unless the rising of the sun has occurred. To Others, the statement is, in fact, incomplete because daylight could not occur unless there is an atmosphere. So one must include an atmosphere in the statement about what causes daylight because it is one of the conditions in which the event occurs.
The restrictiveness of the first group can be seen in the commonest cause of death in the western world:
coronary atherosclerosis. The development of the coronary atherosclerosis is not always followed by death, and death does not occur only when coronary atherosclerosis has developed. Yet clearly it is a reasonable proposition that coronary atherosclerosis has been the pathological basis for an enormous number of deaths. It seems that the first approach is suited more to those cases where the cause of death is incompatible with life. This is not to say that other’s approach is necessarily the answer. Take the example of a heavy smoker who dies of carcinoma of the lung. One of the conditions in which the death occurred is smoking, but there are more: a person may smoke because of the effect of  advertising, because of parents, because of particular personality trait. The autopsy surgeon (and in some cases, courts) have to make a practical decision that cause stops somewhere. In general, the line is drawn at the “Medical Cause” of death, but as the example shows, this is often unsatisfactory: because smoking is increasingly noted again on death certificates in western world. Autopsy surgeons have some instinctive understanding of these issues but there are a particular sort of cases where the difficulties are even greater.