Determination of intent

Within the criminal justice system, guilt is determined by a judge and/or jury convicting a defendant of breaking a law. Within the health care system, the process is far less rigorous. For fatalities coroners and medical examiners depend upon police reports, testimony of witnesses or family members, or notes left by the deceased to code underlying cause of death. A judgment about intentionality must be made before one knows even what section of the coding system to use. This code is then appended to the death certificate, and sent to the vital statistics office. Rarely if ever is that code on the vital statistics data file revised to reflect criminal proceedings or new information. For cultural or religious reasons, suicide may be less likely to be coded in some countries than others.

When we see an injury data table with columns marked “unintentional”, homicide/assault, and suicide/self inflicted, or when the World Health Organization lists these three as essentially different “causes of death”, it is tempting to think …