[Forensic Life] Lethargy of Unknown Cause of Death

[Asia Economy] Having had no serious romantic relationships until her mid-30s, she had given up on marriage. Although she had a stable job and a home, she always felt lonely. One day, the owner of a restaurant she frequented introduced her to a man. He was a diligent self-employed man. When she first met him, he was more handsome than she had imagined. Tall and slim, he did not look like he was in his early 40s. They fell in love and started living together. The simple joys of having dinner together and going out on weekends made her happy.

His gentle tone gradually turned violent. He closed his business and drank every day. He also demanded money. Her face grew darker. Even her coworkers became worried. One day, she did not go to work. Since a diligent person did not show up, her coworkers called her. The person who answered was her live-in boyfriend. He said she was unresponsive and that he had called 119 (emergency services) and was taking her to a university hospital. She was transported to the hospital unconscious. Her blood pressure was low, and her breathing was weak. Although spontaneous circulation was restored through cardiopulmonary resuscitation, she remained in a coma and was treated in the intensive care unit. She never regained consciousness and died one month after being hospitalized.

The death of a healthy woman with no underlying conditions shocked those around her. The cause of death was recorded as hypoxic ischemic encephalopathy, meaning death resulted from a prolonged lack of oxygen supply to the brain. The type of death was natural. Her coworkers reported the case to the police, suspecting something was wrong. They had grounds for suspicion. They had heard from her that her live-in boyfriend had taken out a life insurance policy with her as the beneficiary. The police confirmed a large insurance payout and obtained a warrant for an autopsy. At the autopsy, her entire body was swollen. A month is enough time for injuries such as bruises to heal. It was possible that even if death was caused by poison, it might not be detected. As expected, there were no injuries or pathological findings, and toxicology tests were all negative. It is very frustrating to present such autopsy results. Now that she has died without recovering, the only possible evidence to reveal any crime would be her condition when she first arrived at the hospital, but there is no way to verify this under our country’s system. The police clearly expressed suspicion based on the circumstances and asked if there were truly no findings, but the only answer was ‘unknown.’ When a forensic pathologist cannot clearly explain why someone died, it is the most helpless feeling.

This case remains one of the painful memories for me. Even when all circumstances are suspicious, forensic pathologists can only provide limited conclusions if there is no body or if the person dies after a long hospitalization. An autopsy does not always reveal the cause of death. Many people die without abnormal findings on autopsy. In such cases, there are a few possible solutions. First, the government could establish a system to verify insurance payouts and, if there is a large insurance sum, at least review medical records. Considering the U.S. medical examiner system might be beneficial. It is also necessary to grant authority to medical examiners in each province to review death certificates before cremation to eliminate any possible doubts. Although it is inevitable as a human being to sometimes fail to determine the cause of death despite best efforts, it is clearly problematic when the situation does not allow for doing one’s best.

Yoo Seong-ho, Forensic Pathologist