[Forensic Life] Controversial Cause of Death in Alcohol-Related Injury Homicide

A heavily intoxicated Mr. Park began to loudly slur his words to his companions. Mr. Kim, who was drinking at a nearby table, shouted, "Please keep it down." In response, Mr. Park, in his mid-50s, became angry at the much younger-looking Mr. Kim and suddenly threw a punch. Mr. Kim jumped up and kicked Mr. Park in the abdomen. Mr. Park fell down, groaning loudly and struggling to get up. However, his groaning gradually subsided. The people who had been glaring at each other urgently checked Mr. Park’s condition and called 119 and 112. The 119 paramedics rushed to the scene and checked Mr. Park’s vital signs, including blood pressure and pulse. His blood pressure was somewhat low. When he was transported to a nearby large hospital, Mr. Park’s heart had stopped beating, and despite one hour of cardiopulmonary resuscitation, he could not be revived. The police requested an autopsy considering the charge of injury resulting in death.

The forensic pathologist carefully examined Mr. Park’s internal body. The 8th and 9th ribs on the left side were fractured. The spleen was partially torn and ruptured due to the rib fractures. Approximately 500 mL of blood was found in the abdominal cavity, possibly due to this. The pathologist thought that 0.5 liters was too little an amount to cause death. Moreover, Mr. Park appeared to have severe fatty liver disease. The autopsy report delivered to the police 10 days later stated that the cause of death was “reasonably considered to be death due to hemoperitoneum caused by splenic rupture and/or related to severe fatty liver.” The police were perplexed. Mr. Park had died, and it was certain that Mr. Kim had kicked his abdomen, but depending on the interpretation of “and/or,” the classification of death as natural or homicide among external causes was ambiguous due to the pathologist’s vague opinion.

The cause of death is defined as “the disease, pathological condition, or injury that led to a person’s death.” In forensic medicine, determining the cause of death is very important because it involves legal responsibility for the death and the degree of that responsibility. The classification of death refers to the legal cause of death. Determining the classification of death in forensic medicine does not ultimately decide the circumstances of the death. It only provides a comprehensive medical opinion on the death situation.

The classification of death can be determined based on Mr. Park’s cause of death. If the cause of death is the hemoperitoneum caused by splenic rupture, as the pathologist first mentioned, the classification of death would naturally be homicide among external causes. However, considering the phrase “and/or related to severe fatty liver” that follows, the classification of death would be natural death.

Ultimately, the author’s logical basis is as follows: In determining the causal relationship between the abdominal injury causing splenic rupture and death, △ the medical fact that external trauma (traumatic splenic rupture) can cause death, △ the absence of any disease likely to cause sudden death before the external trauma, and △ the sudden death after the trauma with a reasonable time course, all lead to the conclusion that regardless of how the direct cause of death is judged, the underlying cause of death is the splenic rupture that ultimately led to Mr. Park’s death.

In short, if the abdominal injury that caused the spleen to rupture occurred in a violent situation, it is reasonable to classify the death as homicide. As such, the determination of whether a death is natural or external completely changes the nature of the case.

Yoo Seong-ho, Forensic Scientist

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