Elected coroners report fewer suicides than appointed counterparts

More than 1,500 counties in America elect their coroners, and that voting may play a role in their decisions on whether to classify deaths as suicides.

Elected coroners report about 12% fewer suicides among females and 6% fewer among males than appointed medical examiners, even after controlling for other factors that affect suicide rates, according to a study presented in August at the American Sociological Assn.'s annual meeting.

Because people who commit suicide usually do not leave notes or other explanations for their actions, it is often left to coroners to determine based on the evidence available whether a death is due to suicide, accident or some other cause. A lot rides on the decision, as many families and survivors fear the stigma associated with suicide or may lose out on insurance benefits if the death is ruled a suicide.

"Elected coroners would feel pressure because they are elected by the public at large and would be worried about antagonizing local community stakeholders who might badmouth them," said Joshua Klugman, PhD, first author of the study and assistant professor of sociology at Temple University in Philadelphia. "For medical examiners, we think the pressure is still there, but it's to a lesser degree. They feel insulated from that."

Klugman and his colleagues looked at cause-of-death records between 1999 and 2002 as well as 2000 U.S. Census data. They analyzed how suicide reporting differs among counties based on whether death examiners are appointed medical examiners, appointed coroners or elected coroners. Medical examiners are almost always physicians, while coroners do not have to be medical doctors.

At the time of the study, 1,578 counties had elected coroners and 1,036 had appointed medical examiners. An additional 174 coroners were appointed. After adjusting for factors such as rates of poverty, marriage, household income, education levels and gun ownership by county, elected coroners who were not physicians reported 12% fewer suicides among females and 6% fewer among males than did medical examiners. Elected coroners reported 15% fewer suicides among males and females. (See correction)

The coroners who were appointed had a suicide reporting rate similar to that of medical examiners, suggesting that elections played a decisive role in affecting death classifications, the study said.

The long-term trend among counties is toward an appointed medical examiner system, and these individuals usually have more professional autonomy and more training in forensic pathology, Klugman said.

"The professional efforts among medical examiners have made them more immune to local pressures," he said. "They are more responsive to their professional community and to professional standards."