As John Hopkins Medicine says, it’s up to a medical examiner to perform an autopsy and determine a cause of death and manner of death. Usually, this medical examiner is a pathologist who specializes in examining bodily tissues, has knowledge of chemicals and diseases, conducts lab tests, etc. If there’s a suspected crime involved, a forensic pathologist can link the cause and manner of death to crime scenes, per the University of New Mexico School of Medicine.
According to Pathology Outlines, a cause of death must incorporate a specific etiology — a chain of causal, physical events that led to a final, culminating cause of death, the “immediate cause of death.” That final cause may also be linked to an “underlying/proximate cause of death,” i.e., a trigger that started the sequence of events that led to the immediate cause. The immediate cause and proximate cause of death might also have been influenced by an “intervening cause” that hindered or facilitated the immediate cause of death. And then there are “contributing factors to death,” which encompasses any other conditions involved in the demise.
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Oxford Reference has an excellent example of a cause of death etiology, including an “antecedent cause of death” that preceded the immediate cause. In the example, the underlying condition of coronary arterial atherosclerosis, aka coronary artery disease, may have kicked off the antecedent cause of death, myocardial ischemia (an arterial obstruction). This led to the immediate cause of death, heart failure (not enough blood pumped through the body).
