Clinical versus Forensic Autopsy


In the United States, autopsies are most often performed by a specialized medical doctor called a pathologist. Clinical, or hospital, autopsies serve to determine the medical cause of death and are used for research purposes; these are appropriate when no legal investigation is associated with the death. Autopsies are performed in about 12 percent of the deaths that are not associated with medicolegal investigations.

Medicolegal death investigations occur in approximately 20 percent of all deaths, but only half of these investigations include an autopsy. Medicolegal autopsies are conducted by forensic pathologists, who have had specialized training in forensic and criminal matters. Forensic pathologists complete four years of medical school, plus at least a three-year pathology residency, followed by a year-long forensic pathology fellowship. Board certification in forensic pathology is one of the standards for persons conducting medicolegal autopsies. A pathologist without board certification can work in a medical examiner’s office but would qualify only as an assistant examiner until he or she has passed the required examinations.

A complete medicolegal autopsy includes all of the following elements (Geberth, 2006, p. 639):

· examination of the crime scene

· identification of the body

· external examination of the body

· internal examination of the body

· toxicological examination of body fluids and organs

The focus of this module will be the medicolegal autopsy, with some in-depth considerations for gunshot wounds and toxicology reports from the forensic autopsy.

History of Autopsies in the United States

Records indicate that coroners’ inquests (judicial inquiries) were undertaken and autopsies performed in the 1600s in what is now the United States. Those autopsies were, of course, not complete by today’s standards; they lacked modern elements such as detailed records, toxicological testing, and fingerprint or dental identity verification. However, chest cavities were opened and skulls were sectioned to determine the cause of death, most often when there was some question as to the manner of death (Haglund & Song, 1997).

After the establishment of state governments and constitutions, at least some states officially recognized coroners. For example, the 1777 Georgia Constitution required that

All causes, of what nature so ever, shall be tried in the supreme court, except as hereafter mentioned; which court shall consist of the chief-justice, and three or more of the justices residing in the county. In case of the absence of the chief-justice, the senior justice on the bench shall act as chief-justice, with the clerk of the county, attorney for the State, sheriff, coroner, constable, and the jurors; and in case of the absence of any of the aforementioned officers, the justices to appoint others in their room pro tempore. (University of Georgia, Article XL)

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