Dark Side: It is never easy!

 

A medico-legal autopsy is carried out at the behest of the appropriate authority. The pathologist must not begin his examination until he is satisfied that such authority has been issued in respect of that particular death. The means of delivering such authority will vary from place to place: it may be a written document, a verbal or telephoned message, or a tacit standing arrangement. Where wo official organizations are involved, it must be clear who has the premier right to order an autopsy. For example, in England and Wales, the police may request a pathologist to examine a body externally at the scene of death, but the right to order an autopsy is the sole prerogative of the coroner. Though in serious incidents he or she should take the advice of the Chief of Police regarding the choice of a pathologist, the final decision remains that of the coroner. As stated earlier, in a medico-legal autopsy the relatives are not consulted for their consent to autopsy, as such permission cannot be withheld. As a matter of courtesy it is usual to inform them before the autopsy is carried out unless the circumstances are too urgent. In most cases, however, a relative will have attended to identify the body before the examination begins. Pathologists should be cautious about performing autopsies where the authorization or consent aspects are not clear. It sometimes happens that a 'consent document' for a hospital death has been obtained but the case has later been reported for medico-legal investigation. The pathologist should not then proceed under the 'consent' authority until the coroner or other official has decided whether to order his own autopsy (perhaps using another pathologist). If that official decides not to proceed, then usually the consent document becomes valid once more. Permission for the retention of material from an autopsy (ranging from small fluid samples to the entire body, if necessary) is usually covered in a medico-legal case by the original authority issued for the examination. There is, however, considerable variation in the legal aspects of tissue and organ retention in different countries, and each pathologist must become fully conversant with local regulations. In the legislation controlling the English coroner, it is not only permissible, but also obligatory, for the pathologist to retain any tissue that may assist in the further investigation of the death.

 

Once again, each nation or state has different legislation and regulations on the conduct of medico-legal examinations. Though it is pointless to try to survey these, it must be emphasized that every pathologist must learn and abide by the laws applicable to his or her position. Often the relatives of the deceased person, or an accused person, must be informed of the place and time of the autopsy so that they may be represented by a lawyer or doctor acting on their behalf. In some jurisdictions, including Britain, there is nothing that specifically forbids the relatives attending in person and the authors have had several experiences of this nature. It is open to the pathologist to refuse to conduct the autopsy if he objects to their presence. In many homicides, a second autopsy is performed by another acting on behalf of the defense lawyers representing the accused person. This usually takes place at a later date, after the accused has been charged and granted legal representation, but sometimes the second pathologist will attend the original autopsy.

 

In a criminal or suspicious case, the pathologist should try to limit the number of those present to a minimum. Not only is there a greater risk of loss of confidentiality, but sheer physical numbers, especially of large policemen, can make the mortuary overcrowded. This hampers movement, causes distraction, and adds to the risk of infection and contamination, especially with the present concern about the various forms of hepatitis (B, C, D, E), tuberculosis and human immunodeficiency virus (HIV) infectivity. No one should be present merely as a casual observer, nor. even senior police officers not directly involved in the investigation. With the increased sophistication and complexity of forensic and police procedures, more and more people cram into the mortuary, cluttered with cameras, videos, recorders, scene-of-crime kits and so on, until there is hardly room for the pathologist to move.

 

Acknowledgements

 

www.politie.nl and a Chief Inspector – Mr. Henk van Essen©

www.aivd.nl      AIVD – Mr. Erik Akerboom ©

 

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