Toxicology and sudden death

When is toxicology required?

Although there are no fi xed guidelines, toxicology should be considered in all
sudden deaths. Toxicology should be considered necessary in any apparent or
suspected suicide, drug-related death, homicide, death of a child, death of an
apparently healthy individual, or as part of a defi ned protocol (e.g. research into
drug use in road traffi c fatalities). The presence of disease or pathology suffi cient
to cause death does not mean that drugs or poisons were not involved — to dismiss
toxicology as being unnecessary following an apparently natural death is to ignore
the lessons of Shipman (see b p.486).

Manner of death
Manner of death is diffi cult to determine from toxicology alone. The fact of a
deliberate overdose in a drug user does not indicate suicidal intent (indeed, a drug
user effectively needs to ‘overdose’ in order to overcome the effect of tolerance). It
is vital to take account of all additional information in order to establish whether a
death was a suicide or an accident (or indeed, homicide). This emphasizes the
importance of a comprehensive police enquiry into sudden death and, crucially, a
team approach to the investigation.