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Did that injury happen on purpose? Does intent really matter?
  1. Mary D Overpeck1,
  2. Elizabeth McLoughlin2
  1. 1US National Institute of Child Health and Human Development, 6100 Executive Blvd, 7BO3, Bethesda, MD 20892, USA
  2. 2Trauma Foundation, San Francisco Injury Center
  1. Correspondence to:
 Dr Overpeck.

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It is sometimes hard to know our own intentions when we act—much less those of someone else. Many actions leading to injury occur in moments of distraction, high emotion, or under the influence of alcohol or other drugs. Intent to injure may be peripheral to the action. Cheng et al make a useful distinction between intending to act and intending the damage caused by the act.1

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 …

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