Cause & Manner of Death

Cause of Death

Cause of Death is a term used to indicate the medical cause of death.  It lists the disease(s) or injuries that caused death.  Specific cause of death information is recorded on the death certificate and is entered into the Vital Statistics System of the State of Washington.

The reason why an accident occurred, a person took their own life, or why one person killed another person are not investigated by the medical examiner for the purpose of death certification.

Manner of Death

Manner of Death is the way to categorize death as required by the Washington State Department of Health.  The classifications are natural, accident, suicide, homicide, undetermined, and pending.  Only medical examiner's and coroners may use all of the manners of death.  Other certifiers must use natural or refer the death to the medical examiner.  The manner of death is determined by the medical examiner.

  • Natural Deaths

Natural is defined as death caused solely by disease or natural process.  If natural death is hastened by injury (such as a fall or drowning in a bathtub), the manner of death is not considered natural. 

Sudden Unexplained Infant Death (SUID), formerly known as sudden infant death syndrome (SIDS), is a subset of natural death.  It is the sudden death of an infant under one year of age which remains unexplained after a thorough and complete investigation.  The investigation includes a complete autopsy, examination of the death scene, and clinical history.  If significant risk factors were present, such as an unsafe sleep environment, including co-sleeping or inappropriate bedding, then the cause of death would fall out of the definition of SUID and the manner would be classified as "undetermined."

  • Accidental Deaths

Accident is defined for medical examiner death certification purposes as an unnatural death resulting from an inadvertent chance happening.  Traffic related fatalities (involving vehicles used for transportation on any public roadway) are classified as accidents.  On the job injury related deaths are referred to as industrial deaths and are classified as accidents.  Deaths related to illicit drug or excessive medication use, in the absence of specifically supporting the conclusion of the manner of death being homicide or suicide, are classified as accident.

Traffic Deaths are a subset of accidental deaths, but deaths resulting from traffic accidents are reported separately from other accidental deaths for statistical purposes.  A traffic death is defined as an unintentional death of a driver, passenger, or pedestrian involving a motor vehicle on public roadways.  Accidents involving motor vehicles on private property (such as driveways) are not included in this category and are classified non-traffic vehicular deaths.  Classification of traffic related deaths as an "accident" does not preclude the prosecution as a vehicular homicide by legal authorities.

Complication of Therapy Deaths are accidental deaths that occur during or due to complications that occur during medical, surgical, therapeutic, or diagnostic procedures.

  • Suicide

Suicide is defined for medical examiner death certification purposes as a death from self-inflicted injury with evidence of intent to die.  Evidence of intent includes an explicit expression, such as a suicide note or verbal threat, previous attempts, or an act constituting implicit intent.  An example would be a self-inflicted contact/close range gunshot wound (particularly of the head, chest, or abdomen) that is recognized as having very high potential for lethality, and is considered to be implicit evidence of intent to die.


  • Homicide

Homicide is defined as the action of one person directly causing the death of another.  A death that occurs during and is related to the commission of a felony is also considered homicide.  A violent death may stem from some kind of deliberate or purposeful action, but intent to cause death need not be present or proven for the classification as homicide.   

Homicide and murder are not the same.  All murders are homicides, not all homicides are murder.  "Murder" is not an acceptable manner of death classification for death certification purposes.  "Murder" is a term used under specific conditions in criminal law matters as as a general concept.  An example might be that of unintentional firearms-related hunting death.  While it may be classified as a homicide, it is up to legal authorities to determine when to prosecute such a case as "murder," "manslaughter," etc.

  • Undetermined

Undetermined is listed as the manner of death classification in only a small number of cases each year.  Undetermined is an appropriate designation for cases that have very little available information about the circumstances surrounding the death (e.g., partial skeletal remains) or where known information equally supports, conflicts with, more than one manner of death.  An undetermined manner of death is assigned to cases of unnatural death when a clear preponderance of evidence supporting a specific manner (homicide, accident, or suicide) is not available.

Some unexpected infant deaths that are not classified as "natural" (SIDS), such as when an unsafe sleeping environment is present, may be classified as "undetermined" in manner.

  • Pending

Pending may be listed temporarily on the death certificate for cause and/or manner when additional investigation, information and/or test results are required for certification.  These classifications are generally amended as soon as additional information becomes available.