Bills of mortality preceded modern death certificates, and they suffer from similar challenges.

Bills of mortality preceded modern death certificates, and they suffer from similar challenges.

Years ago, in a job-related field trip, I attended a tour of the medical examiner’s facility in Clark County, Nevada. As the chief office of the pathologist for Las Vegas and its environs, it was a busy place.

Like most of the living, I had never given much thought to the multiple tasks that must be performed on the dead—especially if they died under suspicious circumstances or not under the care of a doctor.

As I learned that day, the task of the M.E. is often a complex one. And nothing is more complex than the element that is often the sole source of interest for others: affixing the single cause of death.

I was reminded of that challenge during a State Bar of Arizona CLE a few weeks ago. There, a pro-con was staged on the legalization of marijuana. Though the wider acceptance of medical marijuana may suggest we’re approaching legalization, the topic is still a thorny one, as evidenced by the vehement dialogue at the CLE.

Sure as no-rain in Arizona, though, a recent death was raised, one that may suggest more questions than answers.

As background, we recall the oft-repeated position of marijuana advocates that not one death has ever been attributed to pot—and compare that with the millions killed by cigarettes and alcohol.

It’s a compelling statistic, one that continues to irk enforcement advocates. And that may be why we have heard advocates mention a Colorado death a lot the past few weeks.

The story (reported here by the Denver Post) is about a young man who jumped to his death after eating marijuana-infused cookies. Here’s the story lede:

“A college student visiting Denver jumped to his death from a hotel balcony after eating marijuana-infused cookies, according to a coroner’s report that marks the first time authorities have publicly linked a death to marijuana since legal sales of recreational cannabis began in Colorado.”

“Levy Thamba, a 19-year-old student at Northwest College in Powell, Wyo., died last month at a Holiday Inn in northeast Denver. On Wednesday, the Denver coroner released a report concluding that Thamba’s death was caused by ‘multiple injuries due to a fall from height.’”

“The coroner also listed ‘marijuana intoxication’ from cannabis-infused cookies as a significant condition contributing to the death. The report classifies the death as an accident.”

At the Bar CLE, Maricopa County Attorney Bill Montgomery alluded to the death, saying that it punches a hole in his opponent’s argument.

But does it?

An article this month in the New Yorker would suggest any coroner’s conclusion is a more nuanced one. In “Final Forms: What death certificates can tell us, and what they can’t,” Kathryn Schulz explores the history of one of civil society’s most ambiguous documents (you can read some of her great article here; sorry, but a subscription wall prevents you from reading the whole thing). And resting your argument on such a piece of paper may not tell the whole story.

Huckleberry Finn had many skills, but determining causes of death was not one of them.

Huckleberry Finn had many skills, but determining causes of death was not one of them.

Schulz opens by describing the meandering history of “bills of mortality” and the coroners who wielded them. The shift from the publicly published bills to the modern-day death certificates has been accompanied by increasing professionalism—but they still may not be the scientifically accurate document the certainty-loving may hope for.

Along the way, Schulz notes, coroners have been known to alter a cause of death to protect reputations or to soften the blow felt by grieving families of means. But if death certificates may be used to protect the dead, could they also be used politically to throw aspersions on the dead? Sure, but that’s not even the biggest challenge.

The toughest nut to crack for M.E.s may reside in the question posed by us lay-people: “Finally, what was the one thing that killed him?

As Schulz writes, “The why of death remains elusive—practically, philosophically, above all emotionally. And, the more extensively we attempt to document it through death certificates, the stranger and more troubled that project comes to seem.”

So if the accuracy of death certificates faces numerous challenges—as Schulz shows—a primary one “is how we decide what counts as a good answer.”

In that exploration, I was extremely pleased to see her turn to Mark Twain, specifically a passage from Huckleberry Finn. It involves a conversation between the stubborn Huck and the Wilks sisters, who are having none of his malarkey.

“One afternoon,” writes Schulz, “while chatting with the Wilks sisters, Huck spontaneously invents a new disease—a form of mumps so virulent that, he claims, a neighbor is in danger of dying from it.”

One sister objects, but Hucks doubles down, saying it can kill the neighbor because it’s “mixed up with other things,” from “yaller janders” to “brain fever.”

Susan Wilks—whom I hope inspires M.E.s everywhere—will have none of it, reminding Huck that it is therefore not the mumps that may cause the neighbor’s demise:

“A body might stump his toe, and take pison, and fall down the well, and break his neck, and bust his brains out, and somebody come along and ask what killed him, and some numskull up and say, ‘Why, he stumped his toe.’ Would ther’ be any sense in that? No. And ther’ ain’t no sense in this, nuther.”

I leave you with Schulz’s point: “This is precisely the problem posed by death certificates; when filling them out, how far back should we chase the causal chain?

That chain could, I suppose, end with a cookie. But I suspect Susan Wilks would arch an eyebrow at that supposition.