The Consistency and Advantage of Therapeutic Complication as a Manner of Death

Abstract

The standard manners of death of the Vital Statistics Bureau of the United States include: natural, accident, suicide, homicide, and undetermined. The therapeutic complication (TC) manner of death is used in some jurisdictions for fatalities caused by predictable complications of appropriate medical therapy; it is not a synonym for medical malpractice. The usefulness of the TC manner, and whether it can be applied consistently, has never been formally assessed. A survey was conducted that asked for the manner of death in 16 case vignettes of a variety of fatal medical complications. This survey was completed by forensic pathologists from a jurisdiction that routinely uses the TC manner of death and by forensic pathologists from other jurisdictions that do not have the TC option. The forensic pathologists from the TC jurisdiction had the option of selecting TC as the manner of death in the survey while the other group did not. There was excellent consistency for the TC fatalities among the TC-jurisdiction respondents. Among the non-TC group there was less agreement, particularly with allergic reactions and some procedural complications. In that one instance there was a 57% to 43% disagreement between a natural and accidental manner. The therapeutic complication manner of death may be more easily applied in a consistent fashion and may improve agreement of certification in certain types of deaths. Without the TC option, some forensic pathologists will certify deaths due to medical complications as natural and others will certify them as accidents.