After someone passes away — be it a loved one, celebrity or other newsworthy person — you’ll often hear they died of “natural causes.” In fact, more than 90% of deaths in the United States are due to natural causes.
But what does “natural causes” actually mean — and what’s considered an “unnatural” cause, for that matter?
A natural death is one that occurs due solely to an internal disease process in the body, said Dr. Kathryn Pinneri, a forensic pathologist and president of the National Association of Medical Examiners. It is not caused by an external factor like a traumatic injury. Deaths caused by cancer, heart disease, stroke or diabetes would fall under the “natural” umbrella.
“Non-natural” deaths would be those due to something external: a suicide, a homicide or an accident such as drowning, a car wreck or a drug overdose.
On death certificates, you’ll find a distinction between the cause of death and the manner of death. Even though we say a person died of natural causes, technically “natural” is the manner of death, not the cause.
“Manner of death is a classification of the causes based on how death occurs, which includes natural, accident, suicide, homicide and undetermined,” Dr. Cheng-Ying Ho, associate professor of pathology at Johns Hopkins University School of Medicine, told HuffPost.
“Cause of death is the disease or injury that leads to death,” she explained.
The death certificate will specify the immediate cause of death, as well as the underlying conditions that may have contributed. For example, the immediate cause of death might be intracerebral hemorrhage — or stroke — due to hypertensive cardiovascular disease, the underlying cause.
For natural deaths, the doctor treating the patient often determines the cause and manner of death. It could be the person’s primary care physician, a specialist such as an oncologist or a hospital physician if the person dies while hospitalized, Pinneri said.
However, if death is due to non-natural causes, then the death certificate would be completed by a medical examiner or coroner instead.
“When determining cause and manner of death for a natural death, medical records and the circumstances surrounding the death are reviewed,” Pinneri said. “For non-natural deaths, additional information is required, such as scene investigative findings, law enforcement and EMS reports.”
In some cases, determining whether a death was natural or not isn’t so clear-cut. It’s not unusual for a person to develop a natural disease as a result of a non-natural event, Pinneri said. Say someone contracts pneumonia while being hospitalized after falling and breaking their hip and dies. The manner of death would be considered an accident in this example, even though the immediate cause was pneumonia.
“Any non-natural event involved in a death will take precedence, no matter the interval between the injury or non-natural event and the death,” Pinneri explained.
“Sometimes the distinctions can be subtle.”
– Dr. Harold Sanchez, assistant professor of pathology at the Yale School of Medicine
This remains true even if decades have passed between the traumatic incident and the person’s death.
“For example, if a bank teller is paralyzed by a gunshot wound during a bank robbery and dies 20 years later as a result of the complications of paralysis, then that death is a homicide and not a natural death,” Dr. Harold Sanchez — a hospital pathologist and assistant professor of pathology at the Yale School of Medicine — told HuffPost. “Sometimes the distinctions can be subtle.”
“If there is any doubt, we always contact the medical examiner’s office,” he said. “They are the last word on such matters.”