Ethics in Death Investigations Flashcards
Who were Burke and Hare?
1827 - old man living in the same lodging house died, they sold his body to cover their debt and sold it to Dr. Knox’s anatomy school for 7 pounds
In the following months, they murdered over 15 people
They’d show up to the school, bodies warm and with trauma, but Dr. Knox wanted the bodies so didn’t comment
Burke was hung for murder and his body dissected by Knox’s rival
Body was exhibited at U of Edinburgh
Skeleton still on display today
What is the Coroner’s Act?
Legislative framework to investigate deaths, order autopsies, conduct inquests, authorize cremations and shipment of bodies outside of ON, and other related activities
When and why was the Coroner’s Act revised?
In 2009 with bill 115 following the public inquiry in Pediatric Forensic Pathology in ON
What changes were made to the Coroner’s act?
Establishment of an oversight system
Registry of pathologists for coroner’s autopsies
Improved death investigation services to First Nation communities
What are the two branches of the coroner system?
Office of the Chief Coroner (OCC)
Ontario Forensic Pathology Service (OFPS)
What are the roles and responsibilities of the OCC?
Death investigations
Inquests
Identification
Cremation certificates
What are the roles and responsibilities of the OFPS
Medicolegal autopsies
Registry of pathologists
Expert witness testimony
Outline the death investigation of a coroner
Exercise authority with warrants
Seize anything material to an investigation
Engage pathologists when autopsy or pathology-related opinion is required
Differentiate between hospital and coroner’s autopsies
Hospital:
Intended to investigate the extent of disease(s) and to confirm or revise the COD that is already known
Consent required from next of kin
Coroner:
Part of death investigation
For unexpected or unexplained deaths
No consent required
What are some ethical issues with autopsies?
Religious beliefs
Many believe no assault of any kind should be incurred by the deceased
Many believe body is God’s property
For some, interference of the deceased’s body will prejudice the future of the deceased in their next life
What does a coroner need to keep in mind when performing an autopsy?
Balance between need and religious beliefs
What are some benefits of autopsies?
Provide knowledge about a rare or contagious disease
Provides education
Provides information on how to prevent future deaths of a similar nature
Provides important medical information to family
May provide peace of mind to family
Why must effect of grief be taken into account during a death investigation?
In the immediate aftermath of bereavement, cognitive function is that of an 8 y/o. Can’t have any confidence that people are fully aware of what they are agreeing to
What are some issues with autopsies for Indigenous Canadians?
Large variety of beliefs regarding funeral and burial practices
Many believe entire body must be buried together otherwise it will affect afterlife
Explain the Pikangikum fire investigation.
Fatal house fire on reserve on March 30, 2016
9 victims, all died of smoke inhalation
OFPS began planning response
Difficulties included remote location, lack of cell phone access, respecting community
Bodies transported to Toronto by April 2, flown back by April 4.
Worked as fast as possible to get answers for family and provide bodies for proper burial service.
How does the Australian experience of autopsies differ?
Unlike other religious objections, Indigenous objections are very rare
Why might objections be different in Australia?
Long and well-documented history of poor relations with police
Wish to keep their cultural identity private
Feel powerless to have their objections heard
How are religious beliefs taken into account in coroner autopsies in ON?
Every effort is made to take family concerns and beliefs into account
In the end, decision regarding autopsy and organ retention is up to pathologist and coroner
How have autopsy practices changed over time?
More open approach
Ensuring new techniques undergo proper validation
Validate other methods that have not been previously validated
Compassion for the families (explanation)
Clear guidelines regarding tissue/organ retention
Process to assist those with strong religious beliefs
Virtual autopsy
What are some methods of virtual autopsies?
CT, MRI
What are some drawbacks of virtual autopsies?
Information about smell or texture can be lost
Explain the history of organ retention
Used to be seen as an integral, normal part of the routine
Explain the case of Samantha Rickard
1992 - 11 y/o died during open-heart surgery in UK
1996 - Mother learns of allegations of excessive mortality rates for children’s heart surgeries at the hospital
Demands copy of medical records and discovers letter from pathologist who performed Sam’s post-mortem to her surgeon, stating he kept her heart
1997 - return of heart after formal complaint
During this investigation, storage of infant hearts at another hospital was brought to light and another inquiry occurred
Explain the case of Jess Shipley
2005 - 17 y/o died in car accident
Family agreed to autopsy
Clear COD - blunt force trauma from car accident
Body returned for burial
On school field trip to ME’s office, school friends notice jar with a brain labelled Jesse Shipley
Family sued
What were some arguments for retaining Shipley’s brain?
Process necessary to rule out criminal activity, takes two weeks to process brain and other tissue in formalin
What is the current practice of organ/tissue retention?
To inform:
Give some semblance of peace and control
Delay funeral so that the organs and tissues can be returned to the body beforehand
Return retained organ or tissue to deceased after coroner’s investigations are complete
What are some rules regarding organ/tissue retention?
Must be justifiable and authorized by Chief Forensic Pathologist or Chief Coroner
Must provide time periods for retention
Family must be informed ASAP
What are some legitimate reasons for retention?
A specific organ must be retained for exam which cannot take place at site of autopsy
Needs specific expertise
Needs specific technique
NOT for research
When is misidentification of the deceased more likely?
In high trauma situations with multiple victims where the bodies of both the dead and living have been misfigured
What was the Humboldt tragedy?
Bus crash
Photos and info from team were initially used by coroner’s office and funeral home to match bodies with names
Xavier LaBelle was declared dead but had actually survived
Parker Tobin was thought to be alive but had died
What was the Indiana Tragedy?
Whitney Cerak misidentified as another girl, Laura VanRyn. Laura had actually been one of the five people killed in the car crash. VanRyn family sat with Whitney for weeks, thinking she was their daughter.
What was the Marchiones SS Disaster?
51 people killed
Many bodies trapped in water and difficulties retrieving the bodies quickly
Coroner used dental records, personal items and clothing descriptions to ID deceased
How were some victims of the Marchiones SS Disaster identified? What was the issue with this?
For those that could not be removed from the water quickly, fingerprinting was used. If it was impossible to do so without taking the bodies to fingerprint lab, the hands were severed. 25 pairs removed. 4 years later, cleaning staff fond bag of hands in fridge. Family members discovered from the media that hands had been removed and not returned
Outline one of the ethical dilemmas Dr. Miklos Nyiszli faced when working as Dr. Mengele’s assistant
o Performed an autopsy on two individuals who had died in camp. Medical information from some female physicians received with the bodies has “typhoid fever?” and “heart failure?” listed. His exam clearly showed signs of advanced typhoid fever
BUT
o If he listed diagnosis, the entire building that the prisoners came from would be liquidated immediately
o He gave the diagnosis: inflammation of small intestines caused by food poisoning
o Dr. Mengele’s response: “make the woman physicians responsible”
explain the case of Cindy Gladue
Murdered by Barton who said he hired her for sex
Says she consented to rough sex and started bleeding, he fell asleep when she went to the bathroom and woke to her body in the tub
Crown called ME to trial, who testified an 11 cm cut to Ms. Gladue’s vaginal wall had been caused by a sharp object
Vagina preserved and judge allowed prosecutor to display it, family was not notified beforehand
Referred to as “Native woman” by prosecutor throughout trial
