If a person dies in the United States and is not in the care of a doctor, then any investigation into their cause of death will probably be conducted by a medical examiner or coroner. To qualify as a medical examiner, a person must be a physician and they are often board qualified in forensic pathology. In contrast, most states have only two qualifications for coroner: a person must be of legal age and have no felony convictions. Coroners are often elected while medical examiners are typically appointed to their position. The editors of Scientific America recently argued in favor of eliminating coroners in favor of medical examiners. While I do agree with their position, this matter is worth considering within the context of political philosophy.
From what seems to be a neutral standpoint, the editors are correct. If we take the view that the job of the death determiner (coroner or medical examiner) is to correctly determine the cause of death of a person, then they should be experts in that job. This would require adequate medical training and a lack of bias. But it can be argued that this standpoint is not neutral. After all, this position is based on a value judgment about what the death determiner should be doing. By the standards of other values, the purpose of the job could be quite different. This can be illustrated by considering two contexts that are extremely relevant today: COVID-19 deaths and deaths caused by law enforcement.
In the face of the COVID-19 pandemic, Trump and his fellows responded in accord with their lack of interest and lack of competence: they downplayed the pandemic and lied about it. With some notable exceptions, the right chose to politicize the pandemic to isolate and energize their base. They also effectively weaponized the pandemic against minorities, women and the lower economic classes. Honest and accurate reporting of COVID-19 deaths would have undercut the downplaying and exposed the lies. As such, it makes sense that the undercounting of COVID-19 deaths has been greatest in pro-Trump areas of the country. After the defeat of Trump, the right has clung to politicizing the pandemic, so the undercounting is likely to persist. After all, pro-Trump death determiners would tend to be operating with a bias against attributing a death to the virus and they would also have an ideological incentive to lie. While medical examiners can be politically biased, the fact that coroners are often elected entails that they would tend to match the ideology of the area where they are elected. Hence, pro-Trump areas would tend to have pro-Trump coroners who will conform to the right’s position on the pandemic.
For those who see the proper job of the death determiner as advancing their political goals, then the death determiners should be elected coroners, preferably without medical training. This is not to say that medical examiners cannot be politically biased, just that having a favorably biased coroner is more likely than having a favorably biased medical examiner. There are, however, two possible problems with this approach. The first is that favoring coroners would allow the left to elect left leaning coroners. The second is that death determiners who lack medical training are likely to do worse at their jobs when determining the true cause of death is important and not a matter of politics. As would be expected, those who are concerned with correct determination of cause of death will disagree with this approach and certainly argue that objective and competent medical examiners are critical to protecting society from harm. The second illustration is deaths involving law enforcement.
One concern that has been raised about coroners is that they can be too closely linked to law enforcement and in some cases the coroner can be a law enforcement official, such as a sheriff. Those who think that the proper job of the death determiner is accurately determining the cause of death tend to think this is a problem and would prefer to have a medical examiner who is independent of law enforcement handle cases involving deaths caused by law enforcement. The reason is that such death determiners (be they coroners or medical examiners) can be biased in favor of law enforcement. They might even be inclined to lie about the cause of death to protect law enforcement. It is due to such concerns that families who can afford to pay for an independent autopsy or forensic examination often do so in cases when a relative is killed by the police. There is the reasonable concern that a forensic examination conducted by someone associated with law enforcement or who is otherwise biased will not be accurate. The George Floyd case provides an example of how this can occur. While replacing coroners would not completely solve this problem, it would be a step forward. Those who believe in just and fair policing favor this approach based on this value. But there are clearly those who hold to other values.
For racists and those who benefit from racism, having the death determiners biased in favor of law enforcement is advantageous. Having medical science serve white supremacy is a common practice and advantageous to the white supremacists. As such, they would see the purpose of the death determiner to assist in maintaining the existing order by classifying deaths in ways that protect the police. As such, the proper job of the death determiner is a matter of value. Those who value truth, public safety and justice will want death determiners who are competent and unbiased. Those who value the triumph of the white right will favor death determiners who are biased in their favor.