ABSTRACT
Accurate certification of deaths in custody that occur either during or immediately following contact with law enforcement personnel (especially physical contact) involves consideration of one or more modalities of contact. These modalities include physical restraint (hand/ankle cuffing, prone positioning, application of pressure on the torso and/or limbs, maximal prone restraint, application of conducted electrical weapons) and chemical restraints (lacrimal agents/chemical irritants) in the setting of psychotic illness/agitation, struggle/physical exertion, intoxication with stimulant drugs and underlying cardiovascular pathology that can predispose to sudden death. Assessment of these case are often not straightforward, and their certification can be some of the most difficult cases that a forensic pathologist can be faced with in respect to the determination of both cause manner of death. Perceived unfair and/or unpopular certifications of these cases can result in professional criticism, allegations of bias, complicity or bias by certifying pathologist, social dissatisfaction/unrest and violent public protests. Recent deaths in custody in the United States (US) are typical examples of this phenomenon.
This Chapter outlines the main clinicopathologic considerations that must occur in the pathologic assessment of these cases
