What constitutes unnatural death

The answer to this vexed question will determine whether or not, once informed of the death, the coroner will deem is necessary to hold an inquest. Often, if the chances of death would have been high in any event, the coroner will conclude that the death was 'natural'. Alternatively, he may reach such a conclusion after considering the results of a postmortem examination which he can order. However, there may be additional circumstances which have the potential to change a natural death into an 'unnatural' death, and then an inquest must be held. 'Unnatural' is defined in the Oxford English Dictionary as 'at variance with what is natural, usual, or to be expected'. A sigificant proportion of patients are admitted to intensive care after some unexpected event. An inquest will be necessary if death ensues, whether the event was iatrogenic or an accident occurring despite exemplary care throughout. For example, the development of septicemia and fatal respiratory insufficiency after aspiration of vomit following uneventful gynecological surgery was 'unnatural'. It has also been held that death from an extremely rare disease should be considered 'unnatural', the somewhat surprising examples given being legionnaires' disease and typhoid fever (R.v. HM Coroner for Inner North London ex parte Thomas [1992]). It is important to recognize the distinction between certainty as to cause of death but uncertainty as to whether or not it was 'natural'. If in doubt, it is wise to inform the coroner, usually possible to explain this further difficulty to the bereaved family without exacerbating their distress, and better for such a requirement to be clear from the outset rather than be met unexpectedly when the registrar declines to issue a death certificate. Once the coroner has been notified, he or she is likely to open an inquest but then adjourn while evidence is gathered and preparations are made for the hearing. In all but exceptional circumstances, the coroner will authorize burial or cremation before the inquest is reopened.

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