What Does a Coroner Mean by Death By Natural Causes?
The loss of a loved one is a very difficult time – even more so when the person dies in unexpected or unexplained circumstances.
In this article Katja Robins, a medical negligence solicitor specialising in inquest representation for families, considers the circumstances that lead to an inquest, asks what it means when the coroner verdict is returned as natural causes, and looks at the reasons you may want an experienced solicitor to accompany you.
What is an inquest?
In circumstances where the death appears to be violent or unnatural, sudden and without a known cause, in prison (or other specified circumstances of state detention), or in the public interest the local Coroner is required by law to conduct an investigation and then inquest. In most cases, a post mortem will be carried out and the Pathologist will comment on whether the death is considered natural or unnatural. This can lead to delay in releasing the body for burial or cremation. If the death is clearly natural after post mortem, then the coroner might conclude his investigation without holding an inquest, but if there are questions or issues the Coroner needs to look at, then he will carry out further investigations and an inquest will be arranged.
Coroners are sympathetic to families, but the language and procedure of an inquest can be confusing. The purpose of an inquest is to establish who has died, and when, where and in what circumstances – meaning how the death occurred. The Coroner will be looking to establish the facts and the purpose of the inquest is not to determine any criminal liability (such as whether any road traffic offences, health and safety offences or any other offence such as manslaughter may have been committed) or civil liability where someone could be to blame for the death (such as potentially negligent medical treatment, health and safety breaches or negligence by other drivers in road traffic accidents.
However, during the course of the inquest, the Coroner will often investigate issues which are relevant to potential criminal or civil liability, and often evidence can be heard which can be used later in a civil or criminal case.
When someone dies in prison or whilst sectioned under the Mental Health Act, the Coroner will have a heightened duty of investigation regarding how their death occurred – this is called an “Article 2” inquest. In practice this means that there will be a more detailed investigation, and a jury will usually hear the evidence with the Coroner.
What is the Coroner’s conclusion or verdict?
At the end of the inquest, the Coroner will summarise the factual circumstances leading up to the death, and then return a ‘conclusion’ (previously known as a ‘verdict’) on how the death occurred. There are a number of conclusions available to the Coroner and these include natural causes, drug-related, industrial disease, neglect, unlawful killing, suicide, accidental death and misadventure.
A narrative conclusion is given where the description of what happened, does not neatly fit into one of these “short” conclusions. It is a brief, neutral description of how the person’s death came about – for example “Mr Smith died from a pulmonary embolism which occurred as a consequence of a recognised complication of necessary surgery”.
A conclusion of neglect does not have the same meaning as negligence in a compensation claim, for instance in relation to medical treatment provided. The definition of ‘neglect’ was originally very narrow and taken to mean that a person had died because of a gross failure to provide basic medical care and nourishment to someone who was obviously in need of it.
The meaning of neglect has since been expanded a little, but it is still a rare conclusion and is not often used by Coroners even in circumstances where there may have been issues regarding the medical treatment provided to the deceased. It can be combined with other conclusions – for example “death was due to natural causes, contributed to by neglect”. It can be difficult for a family to understand the legal difference between “neglect” and “negligence”.
What is classed as death by natural causes?
The meaning of the coroner verdict “natural causes” as a conclusion is also not always straightforward or what families may expect natural causes to mean; particularly where they have concerns regarding the medical treatment provided to their loved one.
There is no formal definition of natural causes, but it is generally seen as the normal progression of a natural illness which has led to death, with or without any significant intervention.
In contrast, a death due to unnatural causes is a death caused by something else – sometimes a positive act, or a failure to act (omission) (other than proper attempts to save the person’s life). Nevertheless, in a case where it is suggested that the medical treatment provided may have been substandard, these distinctions can easily become blurred.
For example, a patient attending hospital with chest pain is sent home despite an abnormal test result and dies some time later as a result of a cardiac arrest. In these circumstances, a death could be seen to have arisen from natural causes due to the normal progression of the patient’s heart condition but similarly, the death could be seen as unnatural if the failure to follow up the abnormal test result is significant and, if followed up, would have prevented the death.
The conclusion the Coroner reaches will very much depend on the evidence given at the inquest by the witnesses and any medical experts, as well as the Coroner’s view on the relevant law.
A conclusion of natural causes does not necessarily imply that there is no negligence or civil liability, and a conclusion of unnatural causes does not necessarily mean that there is negligence. In addition, what may look like a death due to natural causes initially, may end up after all the evidence has been heard, as “accidental death”, which may or may not involve negligence.
What to do if you need inquest representation
Attending an inquest can be daunting, and it is often difficult to know which questions to ask. Our team can assist by helping you early in the inquest process, accompanying you to an inquest, and ensuring that you get the information needed to establish if negligence was involved. If there are questions about hospital or medical care involved, it is likely that the hospital or doctor will have legal representation and it can be important for a family to have access to a lawyer in the same way.