One house, two bodies: Investigating non-traumatic companion deaths and challenges in the "Philemon and Baucis" syndrome.

Companion deaths have received little attention in the forensic literature, especially those resulting from natural causes. These include so-called "Philemon and Bauci" deaths, referring to the natural demise of two emotionally bonded individuals, occurring within brief temporal proximity, conceptualized as the death of one person as a reaction to the death of the other. This study investigates companion fatalities documented by two large medical examiner offices in the United States over 10 years, focusing on cases where at least one individual's cause of death is non-traumatic. Ninety-two total companion cases met the inclusion criteria, including 14 double natural deaths characterized as caregiving relationships, where the dependent individual died after the natural death of the caregiver. Five companion cases were separately categorized as "Philemon and Baucis-like", as they were similar in features to the so-called Philemon and Baucis deaths previously described in the literature, and a caregiving relationship could not be substantiated. Other case types involved drug toxicity, carbon monoxide poisoning, hypothermia, and several unique causes and manners of death. The largest study on non-traumatic companion deaths to date, this investigation reveals the opportunities, challenges, overlap, and limitations in distinguishing between "Philemon and Baucis" deaths and double deaths resulting from caregiving relationships. Key points of emphasis in the investigation, autopsy, and certification of such companion deaths are discussed, as considerations for the practicing forensic pathologist.