Suicide determination and the professional authority of medical examiners

Since Durkheim pioneering study, official suicide statistics have been suspected of underreporting the true suicide rate. A majority of researchers asserts that mistakes are minimal and not systematic while a minority claims that suicide statistics are systematically biased. Lingering uncertainties about suicide rate accuracy call into question the claims of scholarship and the efficacy of prevention programs. From the perspective of the sociology of professions, the critique of suicide accuracy challenges the professional authority of death investigators. Ethnographic observations show that medical examiners tend to underclassify suicides because the suicide classification requires positive proof of suicidal intent and because false negatives do not challenge the authority of medical examiners as much as false positives. Sufficient proof for suicide results from medical examiners' privileging of pathological evidence, the legal threshold to interpret evidence, and close relationships with law enforcement and clinicians. The same professional characteristics that safeguard forensic authority result in suicide underreporting: medical examiners protect their authority by determining suicide conservatively. Relatives acting to avoid the stigma of suicide and public health officials concerned with underreporting have a marginal influence on suicide determinations. This article contributes to the sociology of professions literature by analyzing how a professional group maintains authority in spite of profound criticism from outside parties.