Equivocal Death

An equivocal death is one that cannot be neatly categorized as specifically natural, accidental, suicidal, or homicidal. Every death, independent of its cause, is classified by the coroner as one of these four modes. Equivocal deaths are those inquiries that are open to interpretation; they are uncertain and unclear. Occasionally, there is a death which, although clear as to its cause, is ambiguous and equivocal as to its mode, usually between accident and suicide. However, the mode of almost any death can be mistaken for another when the circumstances are not clear. The facts are purposefully vague or misleading as in the case of a staged crime scene. Death is suspicious or questionable based upon what is presented to the authorities; it may resemble homicide or suicide, accident or [Page 415]natural. It is open to interpretation pending further information of the facts, the victimology, and the circumstances of the event. General guidelines issued by the U.S. National Association of Medical Examiners state that the undetermined manner-ofdeath classification is to be used “when the information pointing to one manner of death is no more compelling than one or more other competing manners of death in thorough consideration of all available information.”

Drug-related deaths can be among the most equivocal as to the mode of death. Proper certification often necessitates knowledge of the victim over and beyond standard toxicological information, including such questions as what dosage was taken (related to the exact time of death) and the time at which autopsy blood and tissue samples were taken; the decedent's weight and build; the decedent's long-term drug habit and known tolerance; and the possible synergistics of other ingested materials.

Death by hanging is usually considered to be instances of suicide (excluding executions). Hanging, like shooting oneself, ingesting a quickacting poison, or jumping from a high place, is one of those methods by which one reaches precipitously the conclusion of a case of suicide. However, some cases of hanging or asphyxiation are equivocal, such as in the case of deaths involving men who seemed to be engaged in autoerotic activity judged by such features as partial nudity, binding of the body and the genitals, pornographic writing and pictures, and special fetishes such as articles of female clothing, leather belts, and chains. Although the investigation of death orientation of these people may add relevant details regarding their lives (such as loneliness, isolation, hopelessness, and suicide attempts), they should accurately be counted as accidental rather than as suicide. Sometimes a delay of time between the selfdestructive action and the death, or intervening events, clouds the direct sequence of cause and effect and creates difficulties in certification.

The certification of the death certificate is a very important item, of great import to the survivors, with implications for insurance, for reputation, even for criminal prosecution. According to classical suicidology, a sizable percentage of deaths (up to 15#x0025;) are equivocal regarding the mode, and most of these are eventually certified as accidental, without an adequate psychological investigation. Some of these uninvestigated equivocal deaths are in fact suicides. Pioneer studies conducted at the Los Angeles Suicide Prevention Center by Shneidman and associates recommended that in equivocal cases, the coroner use behavioral scientists to conduct a psychological autopsy, interviewing key survivors who can throw light on the decedent's motivations. It is widely acknowledged that the specialists on whom the coroner traditionally calls (e.g., the pathologist, the toxicologist, the biochemist) can fairly accurately tell the cause of death, but the social scientist is in a pivotal position in cases of equivocal deaths to render the most significant information as to the victim's intention to kill himself or herself. Intention and motivation are neither chemical nor tissue matters; they are psychological in nature. This is where the social scientist can assist the coroner's office.

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