Under the Microscope: #1 Medico-Legal Investigation

The upcoming articles will Focus on forensic pathology. Forensic pathology, unlike its sister discipline forensic science, does not change quickly or have dramatic developments such as the current DNA revolution. Indeed, because its base is the interpretation of autopsy findings, forensic pathology still rests largely on the principles of morbid anatomy founded in the nineteenth century and earlier. However, this is not to say that it remains fossilized.

 

In particular, the sections on chid abuse, head injuries and traumatic subarachnoid haemorrhage have been amended or supplemented. Sixty new illustrations have been incorporated, and another area of attention has been the references and recommended reading, as there were some textual citations not listed in the first edition -and very many more have added. However, the literature is now so vast, both in forensic journals and scattered profusely throughout other specialist publications, that it is futile to try to capture all of even the most seminal papers, which now need computerized and other modern library techniques for their retrieval.

 

Though medical conventions and legal systems vary considerably from country to country, there are generally two main types of autopsy:

The clinical or academic autopsy is one in which the medical attendants, with the consent of relatives, seek to learn the extent of the disease for which they were treating the deceased patient. In most jurisdictions this type of autopsy should not be held to determine the nature of the fatal disease because, if this was unknown to the physicians, the death should have been reported for medico-legal investigation.

 

The medico-legal or forensic autopsy, which is performed on the instructions of the legal authority responsible for the investigation of sudden, suspicious, obscure, unnatural, litigious or criminal deaths. This legal authority may be a coroner, a medical examiner, a procurator fiscal, a magistrate, a judge, or the police, the systems varying considerably from country to country.

 

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.

 

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.

 

In many homicides, a second autopsy is performed by another acting on behalf of the defence 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. Others entitled to be present naturally include the officials or deputies of the department ordering the autopsy – for example, a coroner, magistrate or judge. The police, including their technical teams, are also present if the death is criminal or suspicious. Whether other doctors and medical students are allowed depends upon the wishes of the official commissioning the examination. When the deceased has been under medical care before death, it is almost invariable practice to allow - and indeed encourage - the physician to be present, as he has the best knowledge of the medical history.

 

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  Politiekorpschef  @Janny Knol©

www.aived.nl    AIVD – @Erik Akerboom ©

www.politie.nl WEB Politie - @Henk van Essen©

https://www.police-nationale.interieur.gouv.fr/ @ Stephane Folcher ©

 

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