Fatalities associated with traffic accidents may generate an impressive number of medico-legal problems of vital importance to the families of victims, insurance companies, compensation boards, prosecuting attorneys, traffic regulating authorities, and the public at large.
The medical and legal causality of death, the determination of the role played by the victim in the accident, the responsibility of the victim in initiating the accident, the estimation of the postaccident survival incurring compensation for pain and suffering and legal problems of survivorship related to inheritance, are only some of the more important motives in the medico-legal potpourri of traffic deaths.
Obviously the pivotal medico-legal problem is the determination of the causality of death: did the demise occur before or after the accident, and is any causal relationship present between the traffic accident and the death.
Causality is a wondrous prism of endless facets, and the medical and legal viewpoints may be quite far apart. The medical emphasis of causality is more complex, implicating multiple effective factors and mechanisms, more rigid and strict in its requirements of undisputable proof, and aiming towards the understanding of pathogenetic processes culminating in death. The legal emphasis on causality is more empirical and practical, focusing on the probable and legally effective cause of death, even if tangential in nature, and vies towards the determination of legal responsibility.
The legally imposed certification of death resolves the issue by requiring the physician to list side by side the medical cause(s) of death (e.g., pneumonia, subdural hematoma, etc.) and the legal cause of death or the manner of death (e.g., accident, homicide, natural, etc.).
The proper certification of death in general and in traffic associated fatalities in particular is, therefore, not only related to the medical competence of the physician but also to his knowledge and understanding of the related medicolegal issues.
One may stress the obvious in mentioning that not every traffic associated fatality is accidental. Natural death, and even homicides and suicides have to be considered as possibilities.
The following elements are to be considered in the determination of medical and legal causality of death: (1) autopsy findings, (2) immediate circumstances of death, (3) explicit or implicit mental intent of the victim, and (4) psychological profile and pattern of the victim.
While implicit mental intent of the victim and his psychological profile and pattern may be important in understanding the genesis of the accident, their legal value is highly questionable. Legal demonstration and proof of these elements is extremely difficult and uncertain. Major determinants of medico-legal causality remain the autopsy findings and the factual reconstruction of the accident.