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Autopsy : Medico Legal vs Clinical

Introduction

The term autopsy in medical practice refers to a surgical procedure which is performed on the corpse or body to find or identify the cause of death. (DBP, 2013). Other commonly used words in referring an autopsy are post-mortem and necropsy.

Autopsy is derived from the Greek word meaning autopsia ‘to see’ (to see for oneself). According to Albreacht von Haller (1756), an anatomist and medical practitioners Switzerland ‘autopsy is an act of a person to understand and explain based on an observation’ (Sezer, 2005). The observation is done on the body or bodies.

According to the guidelines set by the of the Ministry of Health Malaysia (MOH), post-mortem means an inspection carried out by the Government Medical Officer on the dead body. This inspection involves internal and external examination to determine the cause and manner of death or how the changes produced by the disease, chemical, radiation, accidents, injuries, etc. (Ministry of Health Malaysia, 2008).The main goal of the post-mortem is to answer questions that arise about how and why an individual may die. (Erer, 2006).

Laws of Malaysia

Malaysian laws have special provisions under Criminal Procedure Code (Act 593) refers to Section 329 that empower a police officer (sergeant and above ) to investigate any reported deaths . Section 330 empowers the police officer to refer the nearest government medical officer to carry out a post mortem examination if there is doubt or criminal conduct on reported deaths. And Section 331 (1) states as soon as information is received from the police investigating officer, a post mortem examination to be carried out as soon as possible. (The Commissioner of Law Revision, Malaysia, 2012). Therefore it is the duty of the Government Medical Officers at government hospitals to carry out a post mortem examination upon request by the investigating police officer.

Islamic law

Although an autopsy is generally considered inappropriate act according to Islamic law, however it is still allowed if they meet the conditions outlined by the Department of Islamic Development Malaysia (JAKIM) as long its fulfill the agreed guidelines titled ‘Guidelines on Post Mortem from Islamic Perspective’. This guidelines was published after two decrees issued by the National Fatwa Council in 1989 and 2004 (JAKIM,2005) : –

Muzakarah Jawatankuasa Fatwa Kebangsaan ke-25 (13 Disember 1989):

“Pembedahan mayat orang Islam hanya boleh dilakukan jika keadaan benar-benar memerlukan (darurat) sahaja seperti terlibat di dalam kes-kes jenayah yang sangat memerlukan post mortem atau tertelan benda yang berharga atau si mati yang sedang mengandung sedangkan kandunganya masih hidup”.

Muzakarah Jawatankuasa Fatwa Kebangsaan ke-61 (27 Januari 2004):

“Hukum asal pembedahan mayat adalah haram tetapi dibolehkan sekiranya dalam keadaan darurat dan terdapat keperluan yang mendesak seperti membuat kajian terhadap penyakit, mengenalpasti punca kematian dan penyelidikan serta pendidikan khususnya dalam bidang perubatan”.

Post-Mortem Examination

The basic principle of the post-mortem examination which is carried out on the dead body is to obtained information on the most probable manner and cause of death.

This is because of a death can be caused by various factors and ways. Therefore there is a need to determine the correct and accurate cause of death. For example deaths due to disease of known and yet known, naturally occurring diseases or even death involving elements of medico-legal.

The post-mortem examinations are normally categorized into two types clinical and medico-legal.
Postmortem examinations of both these categories are performed by a qualified government medical officer with different level of expertise.

This is because clinical post-mortem examinations are performed to obtain and expanding knowledge in the field of medicine whereas medico-legal post-mortem examinations are carried out to fulfill legal system requirements.

The need of Post-Mortem

Malaysians in general have different views on the needs of the post-mortem examination. Some are positive and some are negative. Whatever the view, the post-mortem examination has needs and interests and among them is;

  1. Meet legal requirement
  2. To confirm the identity of the deceased.
  3. To determine the cause of death.
  4. To determine the cause, manner and time of death.
  5. To remove doubt about the cause of death.
  6. To demonstrate disease and disability.
  7. To trace , draw and document diseases and injuries outside and inside of the body
  8. Obtaining a sample for review as the study of germs , abnormal tissue and others.
  9. To take photographs and video footage for evidence / exhibits in court.
  10. For a full written report of the findings in the autopsy.
  11. To provide expert services on the interpretation of the findings during autopsy
  12. To restore the badly injured bodies as possible before being handed over to the next of kin /family members.
  13. For academic research, studies and research in the medical field.
  14. To enhance the skills and expertise.
  15. To review the treatment of a disease.

Clinical Post-Mortem

The main objective of the clinical post-mortem examination is to study and identify the main reasons that lead to the death of an individual after appropriate treatments and interventions that have been given fails to recover or save the individual. Clinical post-mortems are conducted in cases usually not under the investigation of police officers.

There are also situations post-mortem examination will be carried out even if the cause of death was known. This is mainly due to the requirements of further research on the characteristics of the disease to increase knowledge and understanding of the medical field towards the disease.

The information and knowledge gained from a post-mortem examination will be used to treat and save patients who face the same problem in the future.

Clinical post-mortem examination can only be carried out once relative or close family members given written consent to do so. The next of kin must sign on the special form to give consent to the hospital management to perform an autopsy after receiving clarification or briefing from the treating physician of the patient.

The next of kin has all the right to reject the application of the hospital for an autopsy if they feel no need or not in interest to allow the autopsy. The next of kin is advice must make final decision after a thorough assessment by taking into account all relevant aspects.

There are also may rise situations where a post-mortem examination will be still carried out without the consent of the next of kin, this is subjected to only if the death was proved to be caused by infectious or deadly diseases based on the interest of the public safety (section 16, Prevention and Control of Infectious Diseases Act 1988). In such cases the permission to carry out the post-mortem is subjected to power given to the Director General of Health Malaysia by relevant governing laws.

In Malaysia clinical post-mortem is performed by a pathologist and assisted by a doctor / surgeon who treated the patient. Facilities used are Forensic Medicine Department / Unit of Forensic Medicine (formerly known as the morgue) facilities. Forensic Medicine Department support staff will also involve in the examination of the post mortem examination.

Examples of cases that are under the category of clinical post-mortem are: –

  1. Death due to infectious diseases such as the H1N1 outbreak , Severe Acute Respiratory Syndrome (SARS ) , AIDS , Anthrax’s , Japanese Encephalitis ( JE ) and the like
  2. Death in the ward known why but needs more information about the death of the extent to which an organ is damaged / infected.
  3. Death of the mother (maternal death).

Medico legal Post-Mortem

Medico legal post-mortem will be conducted only if the autopsy application (Form Requesting Post-Mortem Examination on Body), Police 61 Amendment 4/86  received by the medical officer in charge of the Department / Unit of Forensic Medicine in assisting the police investigation.

Based on the provisions of the law under the Criminal Procedure Act the authority to grant permission to perform post-mortem examination by a qualified and registered medical officer are given to the magistrate and police  (applicable for police cases only).

The cases often involve in medico-legal post-mortem can be classify into deaths due to

  • Accidents ,
  • Suicide ,
  • Murder ,
  • Natural death
  • The suspicious death
  • Sudden death.

Examples of cases which required medico-legal post mortem examination are:

  1. Unusual sudden death, suspected non- normal cases, the consequences of criminal acts such as murder, abuse or punishment.
  2. Death of knowing the unknown cause of death in medical terms.
  3. Accidental death in a vehicle or machinery.
  4. Death at workplace; disease and poisoning accidents at work.
  5. Deaths from poisoning ( eg alcohol Intoxication, insecticides etc ).
  6. Deaths from suicide.
  7. Deaths due to the use of these gases during surgery, medical investigative procedures, equipment and technologies used by the hospital / clinic and so on.
  8. Deaths from accidents in the home, hospital / institutional / public areas.
  9. Death is believed to be caused by the negligence of a medical officer or employee of the hospital / clinic as negligent use of medical procedures , devices, drugs, treatments and so on .
  10. Death during police custody, remand prisoners
  11. Death in the Mental Institution, the asylum and others.
  12. The death of a newborn found.
  13. Child deaths due to asphyxiation
  14. Deaths related to foster children.
  15. Any death due to fire and explosion.
  16. Drowned.
  17. Any death outside residential areas such as streets, rivers, waters, etc., in which the residence of the deceased is not known.
  18. Death as a result of chemical and industrial radiation as toxic, acid, radioactive and so on.

Cancellation of a Post-Mortem

The question that is often directed by the public towards to the forensic medical services; can the post-mortem examination be canceled even after issuance of form P 61 by the police personnel?
The request for post-mortem will be only issued once there is a reasonable requirement appears to a police officer or magistrate who investigated the death. It is in accordance with the provisions of law (Criminal Procedure Code) in our country.

If the beneficiary decides not to have the post-mortem examination on the basis of respect or comply with the requirements or religious beliefs, then they can do so by referring to the magistrate and make ??an application to strike out the post-mortem examination request .If the police or the magistrate decides to cancel or withdraw, then they are held responsible to give the cause of death, how and when the death occurred.

Conclusion

Post-mortem examination will only be done if there is a reasonable requirement as to obtain the information necessary to identify and unlock the event that lead to death. Every cause of death should be known, especially if it involves the element of violence or crime.

References

  1. Institut Perubatan Forensik Negara : http://ipfn.moh.gov.my/
  2. MOH 2008: Garis Paduan Bedah Siasat Mayat Di Hospital-Hospital Kementerian Kesihatan Malaysia
  3. DBP 2013 : Kamus Dewan Bahasa dan Pustaka
  4. JAKIM 2005 : Garis Panduan Bedah Siasat Mayat Menurut Perspektif Islam
Last Reviewed : 16 May 2014
Writer : Saravanakumar a/l Maniam
Accreditor : Dr. Siew Sheue Feng