argument is often made that these deaths are chronic poisonings or that they result from
continuous exposure to external agents and are, therefore, not natural deaths. Further,
some argue that there is a “sub-intent” to do self- harm. However, the classification of
such deaths as natural has a long history, widespread acceptance, and recognition that
such behaviors result in “diseases” and become part of the person’s “normal” lifestyle
which often includes psychiatric elements such as a dependency or addictive disorder.
For these latter reasons, classification as natural seems most appropriate.
4. Deaths directly due to the acute toxic effects of a drug or poison (i.e., poisoning),
such as acute alcohol poisoning, excited delirium from acute cocaine intoxication, or
cardiac dysrhythmia due to tricyclic antidepressant toxicity have been traditionally
classified as Accident (assuming there was no intent to do self harm or cause death). In
general, these are adverse acute events involving external factors, and the occurrence of
the adverse event is not planned, reasonably expected, or reliably predictable as to time,
place, or person. The difficulty often encountered is whether the drug or substance
detected represents an acute exposure. For example, if benzoylecgonine only is detected
in blood, does that constitute an “acute exposure”? The issues involved are highly
dependent on the substance involved, are beyond the scope of this Guide, and are better
left to other publications. Suffice it to say that if death results from an acute intoxication
and the death was “unintentional,” tradition and logic indicate that the manner of death is
best classified as “accident.” Further discussion (and exceptions) are discussed in #6
below in reference to some deaths involving medications and treatments.
5. “Natural” disorders precipitated by an acute intoxication, such as cerebral
hemorrhage associated with acute cocaine intoxication, or rupture of a coronary
atherosclerotic plaque during acute cocaine intoxication, for the purpose of consistency,
may be classified as Accident if toxicology tests are supportive of an acute intoxication.
The problem is, however, as in #4, deciding upon how “acute” such an intoxication is or
must be to classify the manner of death as accident—and how acute effects of the drug
relate to more chronic effects, if present. A convincing argument could be offered that
preference should be given to the natural event while citing the intoxication in Part II and
classifying the death as natural. It is recommended, however, to remain consistent with
General Principle B (last bullet) that such deaths be classified as accidents. It is also
recommended that “acute” be interpreted liberally, perhaps even as “recent.” That is, if
the circumstances appear to link the death and a very recent intoxication, that the
intoxication be considered when classifying manner of death.
6. Deaths due to predictable, essentially unavoidable toxicity related to accepted
treatment of a medical disorder, such as digoxin toxicity in severe congestive heart
failure, or bone marrow suppression with fatal infection secondary to chemotherapy (a
poison), may be classified as Natural. In such cases, the treatment may have prolonged
the life of the individual. Because such deaths are “poisonings,” some advocate
classification as accident. However, tolerance, the need for high doses, and other factors
can make interpretations difficult. For these reasons, natural is the preferred
classification.
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