The Office of Chief Medical Examiner (OCME) is responsible for determining the cause, mechanism, and manner of death in natural and violent deaths that occur within its purview. When a person intends to commit suicide by precipitating an incident designed to force police to kill him/her, the death meets the criteria for both homicide and suicide; it is the only "death at the hands of another" that is not always ruled a homicide by the OCME. Classifying the manner of death as suicide-by-police or homicide-by-police is an interpretive process for the medical examiner. The accuracy of the medical examiner's determination is critical to the legal and psychological outcome for all involved parties. In the current study, a review of five recent cases of police-involved deaths that occurred in a large metropolitan area demonstrated that a thorough examination of the circumstances of the death was sometimes, but not always, conducted, nor were all the circumstances always included in the manner-of-death determination made by the OCME. In the case of a death caused by a police officer's use of deadly force, the medical examiner must investigate the history and circumstances of death to make an accurate determination. This must include an inference of the presence or absence of suicidal intent from the victim's behavior prior to death. This interpretive process is subjective, and the final determination is left to the medical examiner's judgment within a reasonable degree of medical certainty. The absence of sufficient information for determining the mindset of the victim at the time of the confrontation with the police officer often leads to a classification of homicide. Such a classification has a significant impact on the legal ramifications of the shooting, the involved officer's career and mental state, the family of the officer, and the family of the victim. These ramifications are discussed in this article. 1 attachment