A post-mortem examination, more commonly known as an autopsy, is a systematic medical investigation of a body performed after death. This procedure is conducted by a specialized medical doctor, called a pathologist, to determine the exact nature of the disease or injury that led to the person’s passing. The examination aims to provide definitive answers about the physiological processes that occurred in the body, which may have been unclear during life.
Determining the Need for Examination
The decision to perform a post-mortem examination falls into one of two distinct categories: clinical or medicolegal. A clinical or hospital autopsy is typically requested by the attending physician or the family of the deceased to better understand the progression of a disease, assess the effectiveness of medical treatments, or identify a previously undiagnosed condition. This type of examination is performed solely with the consent of the next of kin and serves a purely academic or medical quality-assurance purpose. The family may also choose to limit the scope of a clinical autopsy to a specific organ system, such as only the chest cavity, if they wish.
A medicolegal or forensic autopsy, however, is not a matter of consent but a requirement mandated by law. This procedure is ordered by a public officer, such as a Medical Examiner or a Coroner, when a death is sudden, unexpected, suspicious, violent, or otherwise falls outside of a natural and anticipated progression of a known illness. In these situations, the pathologist works for the legal system to uncover evidence related to the death, which is necessary for public safety and criminal justice. The legal authority assumes jurisdiction over the body, meaning family permission is not required for the examination to proceed.
The Autopsy Procedure
The examination itself is a meticulous, phased process that begins with a comprehensive external review of the body. The pathologist first documents and photographs the body’s condition, noting identifying features like scars and tattoos, as well as any signs of injury, trauma, or medical intervention. Measurements of height and weight are recorded, and specific evidence like trace materials or clothing are collected, particularly in a forensic context.
Following the external inspection, the internal examination begins with a major incision, commonly a Y-shaped cut, to access the chest and abdominal cavities. The internal organs are then systematically inspected, often removed from the body, weighed, and dissected one by one to check for any abnormalities, disease processes, or signs of trauma. During this process, the pathologist takes note of the size, consistency, and appearance of organs like the heart, lungs, liver, and kidneys, looking for macroscopic evidence of disease.
The procedure also includes an examination of the head, requiring an incision across the scalp to remove the skull cap and allow access to the brain. The brain is carefully weighed and later sectioned after being preserved in a fixative to allow for better structural analysis. Small tissue samples from various organs are routinely collected and preserved in formalin for subsequent microscopic analysis, which is known as histology.
Ancillary testing is performed concurrently with the physical examination to gather specialized data. This often includes collecting samples of blood, urine, or other bodily fluids for toxicology screening to detect the presence of drugs, alcohol, or poisons. Microbiological samples may be taken to identify any infectious agents, and X-rays or other imaging techniques might be used to locate foreign objects or internal fractures not visible on the surface.
Analyzing and Communicating Results
After the physical examination is complete, the pathologist synthesizes all the collected data, including the gross observations, the microscopic findings from histology slides, and the results from any toxicology or microbiology tests. This comprehensive review allows the pathologist to construct a medical narrative of the person’s death. The final determination is articulated in a formal report that defines two distinct but related concepts: the cause of death and the manner of death.
The cause of death is the specific disease or injury that resulted in the person’s demise, such as a myocardial infarction or a gunshot wound to the chest. The manner of death provides the context for how the cause occurred, and it is categorized into one of five classifications: natural, accident, suicide, homicide, or undetermined. For example, a severe head injury may be the cause of death, but the manner of death could be classified as an accident if it resulted from a fall, or a homicide if it was inflicted by another person.
The final, detailed autopsy report is a formal medical and legal document that can take several weeks to complete, as the results of the ancillary tests are awaited. Once finalized, the report is communicated to specific parties depending on the type of examination performed. In a clinical case, the report is shared with the attending physician and the family to provide closure and medical insight. For a forensic case, the report is delivered to the Medical Examiner or Coroner, law enforcement agencies, and the judicial system to aid in any ensuing investigation or legal proceedings.