The Political Economy of Death: Do Coroners Perform as well as Medical Examiners in Determining Suicide?

Abstract

The determination of death in the United States 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 difference-in-differences model to estimate the effect of elected coroners versus appointed medical examiners on a state’s suicide rate. 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. Data on the underlying intent of death is collected from the CDC Wonder mortality files from 1968 - 2016. We find strong evidence that states with a centralized medical examiner reports between 11 - 16 percent higher rate of suicides than coroner controlled states. Likewise, coroner states with a state medical examiner report a similar increase in suicide rates of 11 percent.

Keywords: suicide, medical examiners, coroners, elections, training

JEL Classification: H75, I18, K16