Post-mortem examination (or autopsy)
Where a coroner is inquiring into a death, he has the right to take possession of the body, and he may require a post-mortem examination to be carried out. Unlike a hospital post-mortem (which the hospital cannot insist on carrying out), relatives have no right to forbid a coroner’s post-mortem. A fee is payable to the pathologist who carries out the examination.
A Code of Practice was published by the Department of Health in April 2003 entitled "Families and post mortems". It deals with the relationship between the hospital where someone dies and that person's family, rather than with the realtionship between the coroner and the family. Accordingly it concentrates mostly on the hospital post mortem rather than the coroner's post mortem. But it contains information designed to be given to families by hospitals even in relation to the latter.
There is no statutory definition of what constitutes a post-mortem examination, but the purpose of the examination is to establish, as far as possible, the medical cause of death, and to bring out as much information as possible about the circumstances of the death. Without a post-mortem examination, the cause of death would often remain unknown, or speculative. And in some cases, the examination reveals that the cause of death was completely different from what was at first thought. Medical schools now use the Internet for many teaching purposes. For example, the University of Leicester even has a Virtual Autopsy on its website. Another potentially useful website is that of HBO's Interactive Autopsy.
There is now some experience in the UK of carrying out postmortem investigation by means of magnetic resonance imaging ("MRI"), or "scanning" in popular terms: see Bissett et al, BMJ, 15 June 2002, vol 324 at 1423. (Earlier material includes an article in The Lancet (26 October 1996, vol 348 at 1139-41) and correspondence in the BMJ (21 November 1998, vol 317 at 1450; and 3 July 1999, vol 319 at 56).) This is a non-invasive procedure, and hence more attractive than a conventional autopsy for those relatives with personal or religious objections to that course.
But there are difficulties. First, it is accepted by radiologists that at present the technology is not yet good enough to give as much detail as a conventional autopsy. Second, there are very few MRI facilities in the UK willing to scan dead bodies, and for the moment it has to be done privately at considerable cost, which the coroner cannot pay under the current rules. Third, there are not enough experts available in the interpretation of post-mortem scans. Fourth, the Coroners Act 1988, s 22, imposes a territorial limit on where bodies may be taken for examination (ie the coroner's own or an adjoining district), and until this is amended the lack of post-mortem MRI facilities will make it impossible in many, perhaps most, cases in practice to carry out an MRI scan instead of a conventional autopsy.
For a recent study on full-body examination of a body by multislice computed tomography, see Thali et al, The American Journal of Forensic Medicine and Pathology 2003, 24(1), 22-27.
Post-mortem examinations in homicide cases pose many problems. They take longer to carry out, and call for special skills. Normally they are carried out by forensic pathologists whose names appear on a special Home Office List of those with appropriate experience (for that reason sometimes called "Home Office pathologists", though they are not employed by the Home Office). One particular problem for the coroner is the tension between the desire of the deceased’s family to have the body returned as soon as possible for funeral purposes, and the needs of the criminal justice system not to obstruct investigation of the homicide (including the need for fairness to anyone later accused in connection with the death). This is now the subject of a Home Office Circular.
The Home Office has now (March 2003) published a Review of Forensic Pathology Services in England and Wales, which examines the way in which these services are provided, and recommends changes for the future.
The Retained Organs Commission issued guidance and information update in September 2002 on various issues such as retention and disposal of human tissue, and issued a consultation paper in November 2002 on tissue blocks and slides.
On May 12 2003 the Department of Health published The Isaacs Report, by Dr Jeremy Metters, currently HM Inspector of Anatomy. It deals with the investigation into the events following the death of Cyril Mark Isaacs in 1987, when his brain was removed at autopsy for research purposes without the knowledge or consent of his wife. It goes on to investigate the practice in England generally of removing brains for these purposes, and makes recommendations for the future.
The Queen's Speech on 26 November 2003 announced that a bill would "be introduced to regulate retention of human tissues after death". No further information appears to be available as at the time of writing.
The DTI's Coal Health Claims Unit (responsible for compensation schemes for British coal miners suffering from certain diseases) has introduced a new protocol for the Collection of Additional Medical Records from 1 April 2003. This may involve requests made to coroners to supply post-mortem examination reports. Such requests will be made by a standard form of mandate signed by the deceased's widow or personal representative, and forwarded to coroners by the DTI's agent for this purpose, Elision Limited. Of course, it is not necessarily the case that a post-mortem examination will have been carried out in every case where a mandate form is signed and sent to coroners, and coroners will be put to some trouble in checking, particularly where the death took placesome years ago.
See, generally, Jervis, paras 6-18 - 6-52,
Levine, Chap 7, Halsbury’s Laws, Vol 9(2), paras 862-872,
Dorries, Chap 5, Thomas Friedman & Christian, Chap 9..
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Last modified: Monday, 09-Aug-2004 08:53:10 BST by: Malcolm Bishop