Why the Practice Persists — and Why It Should Be Reexamined
Proponents of the current standard argue that manner-of-death classification should reflect intent, not just causation. Under this view, “homicide” should be reserved for cases where the evidence shows a volitional act directed at causing death or harm; absent proof of intent, the death is “accidental.” This standard aims to preserve a neutral, scientifically defensible classification system, avoiding criminal implications when intent is unclear. Indeed, medical examiners often caution that manner-of-death classifications are not legal determinations — they reflect medical judgment about circumstances, not guilt or innocence. NAP+1
Yet this intentionalist threshold introduces a discrepancy between causal truth and official certification. In effect, many fatal overdoses become de facto invisible as homicides, no matter how clearly another person’s actions caused the death. Given the scale of overdose mortality, this institutional policy has enormous consequences, potentially shielding large-scale contributors to drug deaths from homicide-level scrutiny.
Furthermore, the subjectivity embedded in manner-of-death determinations — reliance on varying levels of information, inconsistent training, and sometimes local political pressures (especially where coroners are elected) — raises serious concerns about fairness, uniformity, and transparency. As one commentator on the “overdose/homicide epidemic” puts it, death investigations “are not the impartial, scientific endeavors they are portrayed to be,” but can be “deeply influenced by law enforcement and prosecutors.” Georgia State University Law Review+2Reading Room+2
Policy Recommendations: Toward Greater Consistency and Justice
Given these concerns, I propose the following:
1. Reform Manner-of-Death Standards
- The forensic community should revisit and potentially revise the criteria for “homicide” classification, to better reflect factual causation (e.g., when another person supplied or administered a lethal substance), even absent clear proof of intent to kill. At minimum, there should be a separate category — e.g., “third-party poisoning” — to distinguish overdose deaths involving a third party from truly accidental self-administered overdoses.
- Standardization is essential: national guidance by NAME (or a successor body) should mandate clear, transparent criteria and require thorough documentation when third-party involvement is known or suspected.
- Improve Oversight and Review Mechanisms
- Independent review panels (e.g., at state or federal level) should audit overdose death certifications — especially in jurisdictions with high overdose mortality — to identify patterns of underclassification of third-party involvement.
- Transparent reporting of how many overdose deaths are certified as homicide, accident, undetermined, or suicide — disaggregated by suspected supply involvement — would help evaluate the impact of classification practices on public health and legal accountability.
2. Enable Legal Accountability Where Appropriate
- Legislators should consider clarifying or revising criminal statutes so that supplying a lethal substance — even absent clear “intent to kill” — can trigger manslaughter or homicide liability when causation is established. This would align legal accountability with factual causation, even if forensic classification remains conservative.
- Prosecutors and public-defense attorneys alike should be required to evaluate manner-of-death determinations critically, recognizing that a “certified accident” does not necessarily foreclose legal responsibility for third-party involvement.
3. Strengthen the Death-Investigation Infrastructure
- Invest in training and resources for forensic pathologists, coroners, and toxicologists, so that toxicology, scene investigation, and chain-of-custody documentation are thorough and uniform across jurisdictions.
- Support data-collection reforms that integrate toxicologic, circumstantial, and supply-source information into public-health surveillance and classification systems.
Conclusion
The current practice — under which most overdose deaths are certified as “accidents,” even when another person supplied or administered the fatal substance — represents a serious conceptual and practical tension. On a causal level, many overdose deaths are unequivocally deaths at another’s hands. Yet on a forensic-medical level, they are routinely stripped of the label “homicide,” effectively placing them outside the sphere of cases warranting homicide-level scrutiny, accountability, and public-health attention.
Given the enormous human cost represented by overdose mortality, this divergence merits urgent reconsideration. Revisiting the standards for manner of death, improving oversight, and aligning legal accountability with causal reality would be important steps toward a system that better serves justice, public health, and the truth.
By Larry Hatfield
Victim Advocate
Research Specialist
