Cause, mechanism and manner of death
- Topic
The cause is the disease or injury that starts the chain, the mechanism is how the body fails, and the manner is the circumstance: natural or not.
What it is
Three concepts that exams always ask about. The underlying cause is the disease, injury or circumstance that starts the chain of events leading to death (for example, a gunshot wound to the chest). The mechanism (or mode) is the final physiological derangement through which death occurs (for example, haemorrhage or arrhythmia); on its own it is not enough to certify. The manner is the circumstance: natural, accident, suicide, homicide or undetermined. In the WHO international format, Part I is written from the immediate cause (line a) down to the underlying cause (last line), each «due to» the next, and Part II lists other conditions that contributed without belonging to that chain. The same cause can have different manners.
Key facts
- Example: I(a) intracranial haemorrhage, due to I(b) skull fracture, due to I(c) head injury from a fall from height.
- «Cardiorespiratory arrest» describes dying, not why: it is not an acceptable cause.
- A natural manner is due only to disease or ageing; the others have an external cause.
- If the external cause is old (for example a spinal cord injury years earlier), it is still the underlying cause and defines the manner.
The three concepts applied to one case
| Concept | Question it answers | Example |
|---|---|---|
| Underlying cause | What started the chain? | Gunshot wound to the chest |
| Immediate cause | What produced death in the end? | Haemorrhage from perforation of the heart |
| Mechanism | How did the body fail? | Hypovolaemic shock |
| Manner | In what circumstance? | Homicide, suicide or accident, according to the investigation |
Next step: what to do and document
- Write the full Part I chain down to the underlying cause, one condition per line, with the approximate interval between onset and death.
- Do not use mechanisms alone as the cause (cardiorespiratory arrest, multiorgan failure) without the disease or injury that produced them.
- If the underlying cause is external or in doubt, do not certify: notify the judicial police for a medico-legal autopsy.
- Record the manner only when it is known; otherwise leave it pending or undetermined as the current form allows.
- Complete the death certificate in the RUAF-ND system (see medical certificates in Medical ethics).
Legal framework in Colombia
- Decree 786 of 1990, art. 6 (compiled in Decree 780 of 2016, art. 2.8.9.6): violent deaths, suspected ones and those of unclear cause go to medico-legal autopsy; the expert establishes cause and manner.
- The death certificate is registered in the Ministry of Health's RUAF-ND system; how to complete it is covered on the death certificate page.
- Official text checked on 2026-11-05 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
What is the difference between cause of death and mechanism of death?
The cause is the disease or injury that starts the chain; the mechanism is the final physiological derangement (haemorrhage, arrhythmia) through which death occurs.
What are the manners of death?
Natural, accident, suicide, homicide and undetermined.
On which line of the certificate does the underlying cause go?
On the last line used in Part I; line a holds the immediate cause, and each line is «due to» the next.
Is «cardiorespiratory arrest» an acceptable cause of death?
No. It describes the fact of dying, not the disease or injury that caused it.
Elsewhere in DurgiPedia
Connections
Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016), glossary: cause, mode and manner of death (Office of the United Nations High Commissioner for Human Rights, 2017); Decree 786 of 1990: clinical and medico-legal autopsies and viscerotomies (compiled in Decree 780 of 2016) (Función Pública, Gestor Normativo, 1990).
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Representative model, for educational purposes only.