Manner Determination in Forensic Pathology

A traditional function of forensic pathologists in the United States is the determination of cause and manner of death. The formal certification of manner of death is an American innovation of the early 20th century. Many countries do not follow this tradition. While originally established for vital statistics and public health purposes, the use of manner has grown to include increased legal, social, and business functions. The expanded role of manner determination has led to controversy regarding its true function, who should do it, and if it should be done at all. Much of the controversy regarding manner determination is due to inherent ambiguities that arise primarily from the limited number of categories and fundamental epistemic issues. Much of the heterogeneity in manner determination is structural and not a matter of error. Other criticisms come from those who focus on the legal implications of manner determination. Some have claimed that the use of circumstantial information in manner determination constitutes cognitive bias. Others suggest that manner determination is not a medical issue at all. A response is that the integration of circumstances and history with physical examination and laboratory findings represents the classic paradigm of medical diagnosis, and reinforces rather than opposes recognition that this is the practice of medicine. Transferring the task of manner determination to another agency would do nothing to improve accuracy, timeliness, or function. Other candidates to perform this function would be successful only to the degree that they were trained and function as forensic pathologists.