Actress Brittany Murphy, famous for her roles in Clueless and 8 Mile, died Sunday of sudden cardiac arrest at the age of 32. The L.A. County Assistant Chief Coroner has stated that the death “appears to be natural.” What does it mean to die of natural causes?
For a coroner, any death caused by disease or old age is natural. When someone dies a violent or suspicious death, medical examiners try to determine both a “cause” and a “manner.” The cause refers to the biological condition that killed the victim—in Murphy’s case, sudden cardiac arrest. The manner describes all the other circumstances that led up to that particular cause. Most states recognize five different manners: homicide, suicide, accident, natural, and undetermined. If a manner of death is deemed to be “natural,” then the victim is thought to have died of an internal disease process or normal deterioration of the body. Outside forces, like chemicals or human intervention, had only a minimal influence. (There are some gray areas: Death by infectious disease is typically categorized as being natural, even though the killer microbes come from outside the body.)
In general, it’s much easier to determine the cause of death than the manner. To say that Murphy died of sudden cardiac arrest means only that her heart stopped beating unexpectedly, a fact that might be explained by any of the five manner classifications. Her death might have resulted from “natural” conditions like an enlarged heart, thickened ventricle walls, disruptions in the heart’s electrical signals, or clogged arteries—not unknown among 32-year-olds, especially if they have diabetes. Or it might have followed from the ingestion of drugs (like cocaine) or poisons—making it a homicide, a suicide, or an accident. (A massive blow to the chest can stop the heart, too, but that would have left obvious signs.) Drug deaths can be tough to categorize, because circumstantial evidence is required to separate accidental overdoses from suicides.
When all the tests are back from the lab, the medical examiner or the coroner—typically an elected official without medical training who consults the medical examiner—prepares the death certificate with the cause, manner, and a brief description. There is some variation in the forms. John Lennon’s death certificate, for example, contains a series of causes to indicate the cascading physical effects of his gunshot wound.
Even when the facts are clear, medical examiners sometimes disagree on the manner. If a patient is killed by a clot that breaks off during a procedure to clear up his clogged arteries, medical examiners can call it an accident (the medical error) or natural (the underlying disease). A man who has a heart attack while shoveling snow dies a natural death, but if the heart attack happens during a fistfight, his death is usually a homicide. Death from an allergic reaction to a bee sting can be called natural or accidental. While acute alcohol intoxication from a night of binge drinking is always classified as an accident or suicide, the death of a lifelong alcoholic from cirrhosis of the liver is usually classified as natural. (If Murphy’s heart was weakened as a result of an eating disorder, as has been rumored, the medical examiner may analogize this to an alcoholic’s impaired liver.)
These classifications are medical, and they sometimes diverge from legal usage. For example, if a victim were killed by a drunk driver, the medical examiner would typically classify the death as an accident, but prosecutors may consider it a homicide. The opposite result is also possible. In cases such as a killing in self-defense, the medical examiner might deem a death a homicide, but the prosecutor would not file charges.
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Explainer thanks Randy Hanzlick of the Fulton County Medical Examiner’s Office and Jeffrey Jentzen of the University of Michigan.
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AP Video: Brittany Murphy Dies at 32