The Political Economy of Death: Do Elected Coroners perform as well as Medical Examiners in determining suicide?

The determination of death in the US can have strong financial implications. For example, a declaration of suicide can nullify life insurance benefits. However, the intent of death may be made by an elected official who is not required to have any medical training. Medical examiners and coroners determine cause of death when the death is sudden, violent, or untimely. Consequently, these officials can affect counts of sudden infant death syndrome, homicide, and suicide in a state. This paper uses a diff-in-diff model to estimate the effect of elected coroners versus appointed medical examiners on a state’s suicide rate. Elected coroners are exclusively used to determined death in 11 states while medical examiners are exclusively used in 21 states. The remaining 18 states use a mixture of coroners and medical examiners. Elected coroners need not receive training in 13 states, must receive initial and continuous training in 16 states, and are required to be physicians in 4 states. We exploit state policy changes to the minimum required training elected coroners must complete as well as transitions from coroner control states to medical examiner states to estimate the effect of coroners on suicide rates. Data on the underlying intent of death is collected from the CDC Wonder mortality files from 1968 – 2016.

We find strong evidence that elected coroners misclassify suicides as accidents. Changes in death investigation system do not appear to directly affect homicide counts, but a substitution pattern appears between accidents and suicides. This substitution pattern is most pronounced in states with centralized medical examiner systems or states with elected coroners and a state medical examiner. We find no discernible effect of coroner training on death misclassification.