Medicolegal death investigation, as you would expect, involves both medical and legal elements. A medicolegal autopsy occurs “pursuant to a medical investigation of death for legal purposes” (Houck & Siegel, 2006, pp. 158–159) in cases where the medical examiner/coroner responsibilities are defined by law.
Medicolegal death investigations are conducted by either a medical examiner or a coroner, depending on the jurisdiction. Some states require such investigation be performed by a medical examiner, who is a “government official, always a physician and often a forensic pathologist, charged with investigating sudden and unexpected deaths or deaths from injuries” (James & Nordby, 2005, p. 726). Other states, by contrast, allow death investigations to be performed by a coroner, an elected official who is rarely a physician. Later in this module, we will explore some of the differences between these systems, and we’ll discuss the potential shortcomings of allowing medicolegal autopsies to be performed by someone other than a forensic pathologist.
The medicolegal death investigator’s primary responsibility is to investigate deaths under the direction of a medical examiner or coroner (James & Nordby). Although in this module we will focus on autopsies, keep in mind that death investigations have many other elements that are also important.
The processing of the death scene; determination of events surrounding the death; police reports; and evaluation of the medical, social, and mental history of the deceased precede the actual external and internal autopsy. The medicolegal autopsy results are then correlated with the toxicology analysis and other analyses, as well as the other investigative information, to produce a final cause-of-death determination. A competent and comprehensive medicolegal autopsy is pivotal to a final death determination, but preautopsy and postautopsy processes and investigations must be integrated into the final determination.
The forensic (medicolegal) autopsy performance standards determined by the National Association of Medical Examiners (NAME) define a medicolegal autopsy as
an examination and dissection of a dead body by a physician for the purpose of determining the cause, mechanism, or manner of death, or the seat of disease, confirming the clinical diagnosis, obtaining specimens for specialized testing, retrieving physical evidence, identifying the deceased or educating medical professionals and students. (Peterson & Clark, 2006, p. 224)
The same standards distinguish the forensic autopsy as “an autopsy performed pursuant to statute, by or under the order of medical examiner or coroner” (p. 224).
State legislatures have a vested interest in understanding and resolving deaths. Public health, welfare, and security, as well as the criminal and civil justice systems, depend on accurate and reliable death investigations. The autopsy is one of the chief tools of the investigator and medical examiner in a homicide investigation, and the medicolegal investigation begins with information from the crime scene. Medical examiners ultimately determine the cause of death and use all of the scene and other investigative information to determine the cause and manner of death. These determinations are critical to the ultimate successful resolution of a death or homicide investigation.