Greetings from South Africa! In our country the pathologists do not determine and state the manner of death as this is done by the presiding officer in court. We do not have restrictions on performing autopsies and in all the "obvious" unnatural cases such as gunshot wounds a full post mortem will be conducted in nearly all the cases. In some of the cases which are admitted as sudden deaths, further investigation might reveal underlying medical conditions and in these we will at times only perform an external examination and then provide the probable cause of death wihtout performing an autopsy..

Good day dr mamdouh autopsy procedures in islamic eastern countries r strongly influenced by community yet within limits of proper ,complete,satisfying cause of death with through documentation by all available means after all the case should be fulfilled by any means whatever obstacles

In many countries, including non-Muslim, external examination is performed on subjects dying suddenly with a known medical history sifficient enough to explain the sudden death. In other countries, external examination is performed on subjects of un-natural death such as suicidal hanging, road traffic accidents and fire-death. In my opinion this by all means is not appropriate to reach the correct cause and manner of death. Virtual autopsy is currently employed as a substitute for cultural as well as financial reasons, but it is only limited to certain cases of violent death e.g. firearm fatalities. I believe so far there is no good substitute for a full autopsy examination.

Here we perform complete autopsy in sudden violent deaths to satisfy legal fraternity.

Good day to all!

In Bulgaria forensic pathologists perform full autopsy - external, internal, histological examination (if needed), toxicological analysis and DNA-analysis (if needed) in order to establish the cause and genesis of death. There are some cases (which are actually pathological cases) in which there are medical documents containing information about some clinically established medical conditions, that might explain the genesis and cause of death. On this cases not performing an autopsy is acceptable.

Good afternoon to all!

In Poland we (forensic pathologist) made full autopsy, with examination of of three body cavities (cranial cavity, chest cavity, abdominal cavity with pelvic cavity). If we need, we perform also histopathological, toxicological and DNA analysis.

I refer to the article published in J Clin Pathol 2013;66:1–7 " High risk medicolegal autopsies: is a full postmortem examination necessary?

Eve Patricia Fryer, Zoe C Traill, Rachel E Benamore, Ian S D Roberts

The article concludes that the use of minimally invasive techniques i.e. CT imaging, full toxicological screening, and external examination- in high risk autopsies; namely drug abusers- has reduced the number of full autopsies performed by two-thirds.

Pursuant to the applicable legislation in Slovakia body of the deceased shall be inspected by a physician. His/her task is to perform external examination and decide whether the body of deceased can be buried or an autopsy shall be performed. At the same time, the physician is required by the law to report all cases where the death is result of crime or suicide or there is such suspicion to the nearest police station. The same reporting duty applies to the death of foreign nationals. Moreover, there is a duty to report to the police any death of a person in inpatient where the treatment was a result of accident, injury caused by other person or poisoning.

There are situations defined by the law where autopsy is mandatory. E.g.:

- Death in hospital if there is a need to verify the underlying illness or treatment, death related to the surgery and during surgery

- Death in cases where suspicion for contagious illness arises

- Death where there is suspicion for radioactive contamination of deceased

- All cases of sudden/unexpected death where by external examination or by other means was not possible do specify the cause of death

- All post mortem organ donors

- suspicion of maltreatment by medical staff or even healers

- suspected poisoning including professional exposition to such agents

- death related to works and occupational diseases

- Violent death including suicide

- Death in jail/custody

Any person has the right, to refuse by a written declaration its own autopsy. If a body delivered for autopsy, the staff is required to check the registry where the person did not refuse the autopsy in and electronic registry. However in certain cases such declaration will not be taken into account. These cases are:

- Forensic autopsy required by police or prosecution office

- Death in cases where suspicion for contagious illness arises

- Death where there is suspicion for radioactive contamination of deceased

- physician performing external examination has a reasonable doubt as to the circumstances and cause of death

- organ donors

- violent deaths

The physician who did not request autopsy where the law provided so could face administrative fine.

As for autopsies - we never perform a partial autopsy. We always open all three body cavities and take samples for histopathological examination (at least from all parenchymnatous organs and important finding should be examined). Furthermore we take samples of blood and urine for toxicology.

For all coroners related deaths. Post-mortems are generally required here in the UK.

Stating to confirm or find out what is the true cause of death in relation of the mode or traumatic lead up to death. I've been to Hospital mortuaries where the cause is found and so, the head is not opened and brain not examined. But there again in other parts of the country. Everything is examined regardless to the cause of death. Samples for Histology as much now as was in the past, I put this down to cutbacks and money, but there again, do we really need Histology when we clearly see the cause of death?

As for high profile deaths, forensics cases, murders etc then it is the pathologist and his team that call the shots and so a full post-mortem is carried out in detail. Reason, to establish the true and full cause of death and a requirement for legal cases where the court, prosecution, defence would question and get a complete answer and not an assumed answer.

Steve.

in India , if body is sent for medico-legal autopsy , complete external and internal examination is must.

Even some time external examination may be misguiding and in such cases cause of death can be given but manner of death may be misinterpreted.

Dear Dr Mamdouh Zaki,

In Singapore, hospitals report cases to the State Coroner for the preliminary inquiry and if need be (where no natural cause of death can be ascribed to the death in that case) if there is the possibility of some iatrogenic contribution being ascribed to the death. All 'unnatural deaths' have to be reported to the Coroner, so all trauma, poisonings, suicides, homicides, accidents, therapeutic accidents, etc. are automatically reported.

The Coroner expects the Forensic Pathologist's input as to whether there is sufficient grounds to ascribe a 'natural cause of death' (arising from a natural disease process) which can be given as the cause of death ,and this is not disputed in a case of a medically unattended death.

In all other cases, we Forensic Pathologists do a complete postmortem examination - both external and all internal body cavities' examination with ancillary investigations like toxicology, and additional lab investigations - histology of all organ systems, microbiology, virology, & DNA & metabolic studies, etc, where relevant, .

At the end of the postmortem examination the coroner is informed through the investigating officer (IO) - the Cause of Death, and whether it is from a natural disease process, or not. Also sometimes a comment of the pattern of injuries, whether consistent with those seen in a vehicular accident or a fall from height, etc. is also appended when clearly evident, to guide the IO and the Coroner.

The manner - verdict is given by the State Coroner after an open inquiry in his court after the preliminary inquiry by the IO is complete, while natural deaths are disposed off as a paper exercise by him//her, as per the Singapore's Coroner's Act 2010, unless the family have expressed unhappiness and are for an open inquiry into his/her medical treatment (nearly always in a dath whose postmortem examinat ws also done).

In Croatia forensic pathologists perform full autopsy and, if needed histological, toxicological and DNA-analysis in order to establish the cause and genesis of death. If there is sufficient medical documentation and there is no legal or medical reason for an autopsy it is not done.

In Egypt we perform complete autopsy in all cases of suspected deaths to satisfy legal fraternity.

Oh by the way, in Singapore, I forgot to add, in those so-called 'natural' deaths, with long medical histories but no one to certify the death at home, or fainted while walking, sitting in a public place or with family, with ample witnesses, where, after preliminary external examination, we are confident that there aren't any circumstances of suspiciousness or injuries, etc on the body to suggest the same, these cases are recommended by the Forensic Pathologist after a PMCT scan is done, to find findings consistent with the clinical history, and absence of any other 'unnatural' cause, viz. past history of hypertension, with CT signs of marked left ventricular hypertrophy, etc.

All cases for autopsy have full autopsies, with mandatory toxicology, and histology where necessary. We do not conduct limited or partial autopsies in medico-legal cases

Sir very nice and important question asked.

My question to all the persons whether religious, authoritarian or by any other, will on external examination they will allow any treatment in which surgery is required without any surgery?. The answer will be probably a big NO...

So why are such partial or only external examination should be done for reaching cause of death, manner of death or any opinion which is out of the jurisdiction of science.

we are the man of science and not man of fiction to do such partial or no autopsy. we should counsel the relatives and tell them why a thorough autopsy is required.

wherever necessary a full autopsy with toxicological, histopathological and any other investigations required be done for giving opinion regarding cause, manner or any other matter of death in medicolegal autopsies should be done.

Regarding manner of death unless very obvious it is the authority of Jury or presiding officer of court to give their opinion regarding it.

In my country all the medico-legal autopsies  must be: complete, methodical, systematical and illustrated and we do not determine and state the manner of death, same that in South Africa. 

As you say: "Sometimes, a cause of death is evident e.g. firearm to the head or severe cut throat ... etc." but, for example, in a gunshot wound to the head it could be an homicide or an suicide and how can you determinate the range of fire without an autopsy  ???

Regards from Argentina

PS: sorry for my bad English.