Medical examiners play mind games a lot. We create hypothetical death scenarios and work out the best certifications – the forensic pathology equivalent of Sudoku puzzles.
We play these games alone and in groups. We play for fun and to sharpen our wits. We do it to minimize biases that inevitably result from liking or sympathizing or identifying with one real-life family more than another. We do it because once we’ve thought through the twists and turns of a difficult, hypothetical case, it’s easier to make sound (or at least consistent) decisions and to explain them logically when the flying wad of fecal material hits the proverbial fan.
Give it a try. I’ll supply the case and some pertinent questions. You figure out the answers. There’s no right or wrong. Whatever you decide, some medical examiners will agree with you and some will not.
A newly-pregnant woman says she was raped by a masked intruder. The police have no independent proof of rape but also no reason to doubt her story. She disapproves of abortion and chooses to have the child. Unmanageable complications arise during delivery, and she bleeds to death. What is the manner of death?
Homicide is the usual classification for a death that results from the willful act of another person when the intent is to harm or frighten or when the act is unreasonably negligent. Intent to kill isn’t required. Death should be a foreseeable consequence of the act.
Is this woman’s death a homicide? A rapist inflicts harm and fear, but can maternal death be considered a foreseeable consequence of pregnancy given its rarity?
Rape is a criminal act. So is driving while intoxicated, but hardly any drunken driving fatalities are classified as homicides. Manner-of-death classification is a vital statistics function, not a legal determination. Is the legality or illegality of the precipitating act relevant?
Manners are assigned before cases are adjudicated. What level of proof of a criminal act is required? Remember that we have only the dead woman’s word. I’ve read that around 40 percent of rape allegations turn out to be false. Is a 60 percent statistical probability that this rape allegation is true sufficient to support a homicide determination?
What is the effect of the woman’s choice to carry rather than abort the child? Did her choice rather than the rape itself cause her death? If so, would her death be a natural complication of pregnancy? Does it matter whether or not abortion after a rape is legal?
Medical examiners certify “undetermined” when they can’t decide between two options of similar likelihood, haven’t enough information to make a decision or don’t think any available classifications fits. Is “undetermined” the best choice here? Why?
Change some of the parameters, and even more questions arise:
What if the “consenting” victim was a 13-year-old minor child whose parents decided against abortion?What if the deceased was the third wife in a consensual but illegal polygamous marriage?What if both parties were adult residents of an institution devoted to the care of people with Down syndrome? The woman was incapable of consent; the man couldn’t understand consequences. Would this woman’s death be a homicide because of caregiver negligence? A natural complication of pregnancy? An accident because harm was neither intended nor foreseen? Medical examiners disagree a lot. When we discuss hypothetical cases, we’re forced to confront different and equally valid points of view. Sometimes we reconsider; sometimes we agree to disagree. Either way, we learn.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at email@example.com.