Ethics in Death Investigations

Question 1

Who were Burke and Hare?

Answer 1

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

Question 2

What is the Coroner’s Act?

Answer 2

Legislative framework to investigate deaths, order autopsies, conduct inquests, authorize cremations and shipment of bodies outside of ON, and other related activities

Question 3

When and why was the Coroner’s Act revised?

Answer 3

In 2009 with bill 115 following the public inquiry in Pediatric Forensic Pathology in ON

Question 4

What changes were made to the Coroner’s act?

Answer 4

Establishment of an oversight system
Registry of pathologists for coroner’s autopsies
Improved death investigation services to First Nation communities

Question 5

What are the two branches of the coroner system?

Answer 5

Office of the Chief Coroner (OCC)
Ontario Forensic Pathology Service (OFPS)

Question 6

What are the roles and responsibilities of the OCC?

Answer 6

Death investigations
Inquests
Identification
Cremation certificates

Question 7

What are the roles and responsibilities of the OFPS

Answer 7

Medicolegal autopsies
Registry of pathologists
Expert witness testimony

Question 8

Outline the death investigation of a coroner

Answer 8

Exercise authority with warrants
Seize anything material to an investigation
Engage pathologists when autopsy or pathology-related opinion is required

Question 9

Differentiate between hospital and coroner’s autopsies

Answer 9

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

Question 10

What are some ethical issues with autopsies?

Answer 10

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

Question 11

What does a coroner need to keep in mind when performing an autopsy?

Answer 11

Balance between need and religious beliefs

Question 12

What are some benefits of autopsies?

Answer 12

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

Question 13

Why must effect of grief be taken into account during a death investigation?

Answer 13

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

Question 14

What are some issues with autopsies for Indigenous Canadians?

Answer 14

Large variety of beliefs regarding funeral and burial practices
Many believe entire body must be buried together otherwise it will affect afterlife

Question 15

Explain the Pikangikum fire investigation.

Answer 15

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.

Question 16

How does the Australian experience of autopsies differ?

Answer 16

Unlike other religious objections, Indigenous objections are very rare

Question 17

Why might objections be different in Australia?

Answer 17

Long and well-documented history of poor relations with police
Wish to keep their cultural identity private
Feel powerless to have their objections heard

Question 18

How are religious beliefs taken into account in coroner autopsies in ON?

Answer 18

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

Question 19

How have autopsy practices changed over time?

Answer 19

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

Question 20

What are some methods of virtual autopsies?

Answer 20

CT, MRI

Question 21

What are some drawbacks of virtual autopsies?

Answer 21

Information about smell or texture can be lost

Question 22

Explain the history of organ retention

Answer 22

Used to be seen as an integral, normal part of the routine

Question 23

Explain the case of Samantha Rickard

Answer 23

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

Question 24

Explain the case of Jess Shipley

Answer 24

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

Question 25

What were some arguments for retaining Shipley’s brain?

Answer 25

Process necessary to rule out criminal activity, takes two weeks to process brain and other tissue in formalin

Question 26

What is the current practice of organ/tissue retention?

Answer 26

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

Question 27

What are some rules regarding organ/tissue retention?

Answer 27

Must be justifiable and authorized by Chief Forensic Pathologist or Chief Coroner
Must provide time periods for retention
Family must be informed ASAP

Question 28

What are some legitimate reasons for retention?

Answer 28

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

Question 29

When is misidentification of the deceased more likely?

Answer 29

In high trauma situations with multiple victims where the bodies of both the dead and living have been misfigured

Question 30

What was the Humboldt tragedy?

Answer 30

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

Question 31

What was the Indiana Tragedy?

Answer 31

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.

Question 32

What was the Marchiones SS Disaster?

Answer 32

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

Question 33

How were some victims of the Marchiones SS Disaster identified? What was the issue with this?

Answer 33

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

Question 34

Outline one of the ethical dilemmas Dr. Miklos Nyiszli faced when working as Dr. Mengele’s assistant

Answer 34

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”

Question 35

explain the case of Cindy Gladue

Answer 35

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