column: Many factors taken into consideration when determining one's cause of death

In the end it will be up to the medical examiner (ME) to actually determine the “manner” of death. There are four manners of death for the ME to chose from: natural, accidental, suicide or homicide. There is actually a fifth manner of death, but it will leave room for doubt for families, friends and insurance companies and that is “undetermined” or “undeterminable.”

Police investigators and the medical examiners office work very closely to answer the questions surrounding a person’s death. The basic division of labor here is that the police are in charge of the scene of the death right up to the body. The medical examiner who will send an investigator (MEI) is in charge of the body, which is an important piece of evidence in this case.

The police and ME work very closely together to figure these cases out. Before any post-mortem examination and autopsy in the morgue the scene will be thoroughly investigated. Before the scene is worked by investigators, a psychological autopsy of sorts will already have begun.

A psychological autopsy is a collaborative effort between the medical examiner’s office, health care and mental health professionals, as well as the police to try to establish a person’s state of mind at the time of their death. The basic assumption here is that a person’s personal history is a good predictor of future behavior.

From a police perspective, I liked to have all the information I can obtain from prior police reports before I respond to a suspicious death scene. There may not be time to read every police report, but police reports contain a wealth of information. When the identity of the deceased is already established from the scene, starting a profile on the deceased is important.

Checking criminal histories, driving records, past police reports and now social media sites can provide police investigators with a wealth of information. If a person is never mentioned in a local police report it means either that person is a very straight arrow, good citizen or they just moved into the area.

Most of our names will be in a police report somewhere as reporting a crime, witnessing something, being a driver who got a ticket or into a crash, an owner of damaged or stolen property, someone the police assisted in some way, a victim, suspect or arrestee.

Being a suspect or an arrestee means a person has been in trouble with the law. If that person was involved in a violent crime or youth gangs, the chances of that person meeting a violent end are more probable. There is a lot of truth to the old adage, “Live by the sword, die by the sword.”

If the deceased person was a violent criminal checking through the police reports for other people involved in the violent crimes either on the same side as the deceased or opposing that person may provide the first clues on who might have pushed the person to cause their fall into the alley. Thus before a detective gets to the scene they may be thinking homicide.

The police reports may show the deceased was involved with vice-related crimes such as use, sale or manufacture of drugs, prostitution or gambling. If so these affiliations place a person at greater risk of becoming a homicide victim.

If on the other hand this person has lived in the area for a long time, has not appeared on police reports and the addresses around of the incident also are not in many police reports, perhaps we are dealing with an accidental death. Time to closely examine the scene for any obvious clues the person was working high up in an adjacent building.

A cautionary note as Washtenaw County residents venture outside and onto ladders this spring: a death investigator’s rule of thumb is that a fall from a height greater than three times the height of the victim can be fatal. Be careful climbing on roofs and ladders.

The most common use of a psychological autopsy is in the cases of suspected suicide — as in the hypothetical case of the body in the alley, which might be someone who jumped.

The majority of people who commit suicide do not just wake up one morning and decide this is the day to die. The exception to this rule of thumb is that when suicides occur suddenly and without warning, they normally are due to some sudden severe life-altering event — things like “embarrassing” arrests or events, terminal medical diagnoses or hyper-emotional romantic break-ups. These events have to be uncovered by thorough investigation and interviews.

Most people who attempt or commit suicide have suffered from depression, substance abuse or other psychological disorders for a long while. This will manifest itself in police reports in the form of medical assists, ambulance requests, check on the well-being calls, overdoses, suicide attempts, suspicious incidents or behaviors, petitions for mental health evaluations and mental health commitments.

If a person’s behavior has not quite risen to the level of police intervention, it is very likely the deceased has some medical or psychological evaluation history that the medical examiner’s office will have access to. Most MEI's check hospital records before they respond to a death scene, like the police investigators check police records. These psychological autopsy checks certainly are not the end all, but they can provide some direction in a death investigation.

For those deaths where the ME and police investigators simply can not ascertain the state of mind of the victim& #8212; like drug overdoses, which usually are accidental, or suicide — the manner of death must remain “undetermined.”

Lock it up, don’t leave it unattended, be aware and watch out for your neighbors.