Autopsy

Question 1

Types of autopsy and their purpose

Answer 1

1. hospital (10%) - requires medical certificate cause of death
   used for teaching, research & governance
2. medico-legal (90%)
   determine cause and manner of the death

Question 2

2 types of medico-legal autopsies

Answer 2

Coronial autopsies - where death is not due to unlawful action
Forensic autopsies - where death is thought unlawful e.g. murder, fowl-play thought to be involved

Question 3

Role of coroner/coronial autopsy

Answer 3

to identify:
WHO was the deceased
WHEN did they die
WHERE did they die
HOW did their death come about

Question 4

Why are deaths referred to the coroner?

Answer 4

-when the death is presumed natural however the cause of death not known
Patient hasn’t seen doctor within 14 days prior to death (most common reason for referral)

-death presumed iatrogenic:
caused by medical examination or treatment
e.g. peri/post operative deaths, anaesthetic deaths, illegal abortions

• presumed unnatural:
  e. g. accidents, industrial death such as working in a coal mine/with asbestos, suicide, unlawful killing, neglect, custody death

Question 5

Who makes the referrals to the coroner?

Answer 5

1. Doctors - do NOT have a statutory duty to refer,
   common law duty
   GMC will provide evidence
2. Registrar of BDM (birth, deaths & marriages) - Statutory duty to refer
3. Others: Relatives, Police

Question 6

Who performs autopsies?

Answer 6

• Histopathologist

- Forensic pathologist

Question 7

Which autopsies do histopathologists perform?

Answer 7

• Hospital autopsies
• Coronial autopsies: Natural deaths, drowning, suicide, accidens, road traffic deaths, fire deaths, industrial deaths, peri/post operative deaths

Question 8

Which autopsies do forensic pathologists perform?

Answer 8

• Coronial autopsies:
  Homicide, death in custody, neglect, any from histopathologist coronial autopsy list that may be due to the action of a third party

Question 9

What is the Coroners Act 1988?

Answer 9

• Allows coroners to order an autopsy where death is likely due to natural causes to remove need for inquest
• Allows coroner to order an autopsy where death is clearly unnatural and inquest will be needed. Can authorise special investigations

Question 10

What are the Coroners Rules 1984

Answer 10

• Autopsy as soon as possible
• Autopsy performed by a pathologist of a suitable qualification and experience
• Report findings promptly and only to coroner
• Autopsy only on appropriate premises

Question 11

What are the Amendment Rules 2005?

Answer 11

• Pathologist must tell coroner precisely what materials have been retained
• Coroner authorises retention and sets disposal date
• Coroner informs family of retention and they have choice of where the material goes e.g. research/teaching.disposed
• Pathologist keeps record
• Autopsy report must declare retention and disposal

Question 12

What is the Coroners and Justice Act, 2009?

Answer 12

Not fully enacted!
Coroner can defer opening the inquest and instead launch an investigation
inquests have conclusions not verdicts

Question 13

What is the Human Tissue Act 2004?

Answer 13

-Autopsies only to be performed on licensed premises
-require license holder
-consent from relatives for ANY use of tissue retained at autopsy if not subject to coronial legislation or retained for criminal justice purposes
-public display requires consent from the deceased
Penalties: 3 years imprisonment and/or a fine

Question 14

Stages involved in an autopsy?

Answer 14

History/Scene
External examination*
Evisceration*
Internal examination*
Reconstruction

*Digital photography