An autopsy represents a
postmortem surgical examination of a human body, but not all autopsies are
equivalent. There are two basic types of autopsies: forensic or medico legal
autopsies and hospital or medical autopsies. There are several very important differences
between the two. The first is that forensic autopsies fall under the
jurisdiction of the local governmental death investigation office (coroner or
medical examiner), whereas hospital autopsies do not. As such, forensic
autopsies do not require consent from the legal next-of-kin and the coroner or
medical examiner may, by law, order an autopsy. Hospital autopsies require a
properly executed and witnessed consent signed by the decedent’s (dead
person’s) legal next-of-kin before the autopsy can be performed.
Making certain that the person
being autopsied is, in fact, the person he/she is supposed to be is of utmost
importance, no matter what type of autopsy is being performed. In virtually
every hospital autopsy performed, the decedent’s identity is already known and
well-documented via identification bracelets and within the medical records that
accompany the body. In contrast, a very important aspect of every forensic
autopsy involves the positive identification of each decedent.
Depending on the structure of
the death investigation system, this very important task may be the official
responsibility of different entities. In certain jurisdictions, the legal
responsibility rests with non-pathologist death investigators (coroners or
non-pathologist medical examiners), while in other offices, the responsibility
rests with those performing the autopsies. In either case, all persons and offices
involved should work together to ensure positive identity in every case.
Frequently in hospital
autopsies, the cause of death is already known, and the autopsy is performed to
attempt to answer specific questions that family members or physicians have
regarding the case, such as disease extent, effectiveness of therapy, etc. For
these reasons, hospital autopsies are frequently limited to the examination of
certain body parts. In addition, the complete medical record is usually
available to the pathologist prior to hospital autopsy performance. As a result
of this the “background information” being readily available prior to autopsy,
a pathologist can perform the autopsy with specific focus. In contrast, while
the cause of death may be obvious in certain forensic cases and a certain
amount of background information may be available prior to examination,
forensic autopsies are usually performed with the intent of documenting all findings,
rather than being focused on a single issue or two. Frequently in forensic
work, all of the important background information, as well as all of the
questions that will eventually be asked regarding a specific case, are not known
when the autopsy is being performed.
In general, if resources allow,
the most thorough postmortem forensic examination involves a complete autopsy
(head, neck, and trunk), although different office and practitioner policies and
protocols may allow for limited dissections in specific case types.
Another major difference that
exists between hospital and forensic autopsies is the fact that, in many
hospital autopsies, the external examination is relatively unimportant, whereas
in forensic cases, the external examination can frequently be one of the most
important aspects of the case. As such, photography is a key component of the
forensic autopsy, whereas it is usually considered optional in the hospital
autopsy.
Certain other procedures and
tests are common in forensic cases, but quite rare in hospital cases. The two
most common are toxicology testing and radiography (X-rays). A significant
percentage of forensic cases will have positive toxicology tests (drugs are
detected), which will, in many cases, be an important factor in determining the
cause of death. Likewise, a significant percentage of forensic cases also
require radiography. Various specialized dissections can occur in either type
of autopsy, but are probably more common in forensic cases. These include
anterior (front) neck dissections, posterior (back) neck dissections, spinal cord
examination, eye removal and examination, dissection of the deep veins of the legs,
etc.
“Fixing” organs or tissues in
formalin (a preservative solution containing formaldehyde) prior to dissecting
them is a procedure that can occur with either type of autopsy, although it is
probably more common in hospital cases, where many pathologists were trained to
“fix” the organs prior to detailed dissection. In forensic cases, however, it is
not unusual in certain cases to choose to fix a particular organ prior to
sectioning, with the brain and heart being the most common organs in which this
is done. It is important to note here that formalin fixation will change the
appearance of tissues, usually causing a darker, less shiny appearance (this is
obvious when comparing photographs of “fresh” organs to those of “fixed”
organs), and will also cause the tissues to become more firm, thus making
dissection a bit easier.
A final difference between
hospital and forensic autopsies involves those who actually perform, or assist
with, the autopsy. In many hospital-based pathology practices, pathology
assistants (PAs) are employed to assist pathologists with many functions. In
some practices, they are responsible for performing the “gross” part of the
autopsy, with pathologists only performing histologic (microscopic) examinations.
However, this is not acceptable practice in forensic autopsies.
