An autopsy is a systematic medical examination of a body after death, performed to determine the cause, manner, and mechanism of death, or to evaluate any disease or injury. The procedure involves a network of highly trained physicians, legal officials, and administrative authorities. The individual who physically conducts the examination is always a medical doctor with specialized training, but the authority who orders it and the context in which it occurs are determined by different governmental and medical systems.
The Essential Expertise: Anatomic and Forensic Pathologists
The person who performs the dissection and analysis during an autopsy is a physician specializing in pathology, the branch of medicine that studies the causes and effects of disease. To reach this level, the physician must complete four years of medical school, earning a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. This is followed by a multi-year residency program, typically in Anatomic Pathology or a combined Anatomic and Clinical Pathology program, to gain expertise in the analysis of tissues and organs.
Anatomic Pathologists primarily diagnose disease from tissue samples like biopsies, but they also perform clinical autopsies in hospital settings. These procedures focus on confirming a diagnosis or better understanding a disease process for medical education and quality assurance. Their training emphasizes identifying natural diseases and documenting their progression within the body.
Forensic Pathologists complete a one-year fellowship after their general pathology residency. Their training focuses specifically on investigating sudden, unexpected, or unnatural deaths for legal purposes. This specialization provides them with expertise in areas like toxicology, wound ballistics, and the effects of trauma on the body. They perform medicolegal autopsies, examining the body for evidence and providing expert testimony in court proceedings.
The Authorizing Authority: Coroner Versus Medical Examiner
While the pathologist performs the technical examination, the procedure must be authorized by a governmental official responsible for death investigation. This authority is held by either a Medical Examiner or a Coroner, depending on the jurisdiction’s system, which is where the training and responsibilities diverge significantly.
A Medical Examiner is an appointed official who is always a licensed physician, and in most major jurisdictions, they are required to be a board-certified Forensic Pathologist. They have the authority to investigate deaths and conduct autopsies in cases that are suspicious, violent, or unattended by a physician.
The Coroner system often involves an elected official who may not be a physician or have any formal medical training. The Coroner’s role is primarily administrative and legal, tasked with investigating the death, identifying the deceased, and notifying next of kin. If a non-physician Coroner determines an autopsy is necessary, they must contract with a Forensic Pathologist to perform the procedure and provide the medical expertise.
Two Contexts of Performance: Clinical and Medicolegal Autopsies
The specific purpose and setting of the examination dictate which type of pathologist is involved and under whose authority they operate. Autopsies fall into two main categories: clinical and medicolegal.
The Clinical Autopsy is performed in a hospital setting, focusing on medical education, quality improvement, and clarifying a patient’s cause of death for their family and treating physicians. Family consent is required for this type of post-mortem examination. This procedure is performed by an Anatomic Pathologist who is part of the hospital staff.
The Medicolegal Autopsy is conducted to determine the cause and manner of death for public health and legal purposes, such as in cases of homicide, suicide, or unexpected death. These are performed at a government facility or a Medical Examiner’s office under the authority of the Coroner or Medical Examiner. Family consent is not required, as the law mandates the examination for investigative reasons. The physician performing this examination is a Forensic Pathologist, providing the medical findings necessary to complete a legal death investigation.