Medico-legal Postmortem/Autopsy in India: Purpose & Benefits
The term ‘Autopsy’ originates from ancient ‘Autopsia’ which is derived from ‘Autos’ i.e. ‘Oneself’ and ‘Opsis’ i.e. ‘to see for oneself’. An autopsy is frequently done in cases of sudden death where a doctor is not able to give a death certificate or when death is believed due to an unnatural cause . Section 174 and 176 Code of Criminal Procedure (Cr.P.C.) mention the concept of a medico-legal autopsy during the investigations of a sudden, suspicious, unnatural death . The objective of medicolegal post-mortem examination is to establish the identity of a body, when not known; to ascertain the time since death and the cause of death; and whether the death was natural or unnatural and if unnatural, whether it was homicidal, suicidal or accidental. In case of new born infants, the question of live birth and viability assume importance and should be determined . The term “postmortem examination” is often used as a simile for “autopsy.” Basically, it is not . A postmortem examination means only what it says that the body was examined after death. It can mean and often does mean that the physician merely looked at the body, fully clothed, or that he “viewed” the body at a funeral home or in a morgue. A complete autopsy involves opening all body cavities and all organs of the trunk, chest, and head .
PURPOSE OF MEDICO-LEGAL AUTOPSY
Purpose of postmortem examination in a particular case of unnatural or suspicious death is to find out the following : –
- To know the exact cause of death.
- To find out the circumstances of death
- To find out the postmortem interval.
- In case of the unidentified dead body, to establish the identity of the deceased or to help to do so.
- The period for which the deceased survived after sustaining injuries or exposure to the poison.
- To know the nature or the manner of death, whether natural, suicide or homicide.
- Type of weapon or the poison used.
- Whether one or more than one person was involved, in case of homicide.
- Whether any natural disease process contributed in any way, to cause the death.
- Whether any other offence was related with the death e.g. rape.
- Is the injury, which has caused death, expected to cause death in ordinary course of nature.
- Whether the dead body has been displaced from the original place of disposal.
- To know whether more than one method or weapon were used or if more than one person were involved in the crime.
- Whether the deceased received any treatment before death.
- Whether there is anything on or with the dead body which may help identification of the assailant
- In case of death due to assault, the relative positions of the victim and the assailant.
THE MEDICO-LEGAL AUTOPSY
There is no clear idea in the minds of many, including professionals such as lawyers, doctors and police officers, as to the objective of a medico-legal autopsy. The general belief is that a postmortem examination is conducted to ascertain the cause of death only. Thus, when a person dies of a head injury following a vehicular accident, a question is often raised as to the need for an autopsy, as the cause of death is already known. The fact is that in quite a number of medico-legal postmortem examinations, the cause of death is already known. It is mostly in natural sudden deaths where the cause of death is usually not known or not certain prior to autopsy. A pathologist who conducts a medico-legal postmortem examination aims at the following, besides ascertaining or confirming the cause of death 
SOCIAL BENEFITS OF AUTOPSIES
The wealth of knowledge acquired in the course of postmortem investigations not only contributes towards a more accurate database of all forms of mortality but also towards the introduction of measures to prevent them or to reduce their incidence. Many safety devices that are in use today such as seat belts, high back seats with head rests, crash helmets and so on are the result of these examinations. Innovations in automobile designs such as the laminated windscreen, padded dashboard, collapsible steering column, anti-burst doors, buried door handles, all have basis in these studies. Postmortem examinations of victims of bums and other forms of home accidents have contributed greatly towards designing safer buildings. Accurate statistics of disease patterns and deaths help to formulate a more effective and efficient health care system. Equally important are the investigations of crimes which not only help to apprehend the criminals but may also serve to protect the innocent who have been wrongly implicated .
RESOLVING MEDICO-LEGAL ISSUES
Pathologists are well aware of minor trauma sometimes leading to death either immediately or shortly after. Careful examination of such cases may reveal some other underlying conditions, such as an existing disease or a vascular abnormality that had contributed to or aggravated the death. A punch on the front of the chest may kill a person who is suffering from advanced coronary artery disease, and this can only be established by a postmortem examination. It is a well-established fact that alcohol and drugs have not only contributed to all types of accidents but even to death. A body lying on a rail tract or a highway with injuries does not necessarily mean that the victim had died of an accident. A body found burnt inside a building does not always mean that the death was due to bums.” The following example illustrates the need for a postmortem examination in road accidents. A private bus crashed into a tree in the night. The occupants consisted of the driver, conductor and a few passengers. The conductor died as a result of the accident while the others survived. At autopsy, the distribution and pattern of injuries found on the conductor suggested that he was actually driving the vehicle, and without a seat belt as well. In addition he had alcohol in his blood, which was above the legal limit. On the other hand, the injuries found on the driver who survived were that of an unrestrained front seat passenger. It became evident that the actual person who drove the bus at the time of the accident was the conductor. A cover up story had been made by interested parties because the conductor, who actually drove the bus, not only did not possess a driving license but had consumed alcohol. These facts when made known would naturally interfere with the insurance payment. The fact that a seat belt was not used also result in reduced insurance payment as it could be considered as contributory negligence .
FACTORS AFFECTING MEDICO-LEGAL PERFORMANCE
The medico legal work these days like modern day life is very much complicated. Disputing a scientifically correct but unfavorable report has become a part and parcel of the medico legal culture. Trend to get the medico legal results hurriedly in a desired fashion that too authoritatively, is as common as it is to reject an unfavorable opinion. The medico-social issues related to medico-legal performance include :
- Risky: Medico legal work at times is very difficult and risky because there are more probabilities of one’s being disputed, criticized and challenged by many on many occasions for many reasons.
- Controversy: The medico legal work is highly controversial. Both the aggrieved and the opposite party seem to be keen to interpret the medical observations to their benefit and interests and mismatching of the medico-legal opinions with the desires and expectations of the people is therefore not uncommon with emergence of many types of disagreements and disputes.
- Delicate: Medico legal work is very delicate because if an innocent is involved unnecessarily or a crime goes unnoticed due to faulty application of the medical knowledge would mean different to different persons. It will irk all kinds of people including police, judiciary and the departmental peers.
- Public outcry: Political workers and social activists are often up in arms in the so called cases of police torture, hospital or dowry related deaths especially when the medical opinion is different and contrary to the populous opinion and the doctor’s failure to act in their favor brought a charge that the doctor for his ulterior motives had worked in collision.
- Administrative hypocrisy and juggleries: The legal presumption is that the hospital and the district administrators of health department who are senior to those doing medico legal work by virtue of their age in the department are superior for all practical purposes. This sense of superiority seems to be on the basis of seniority of service and not the specialization and the experience in a particular line. Problems may arise when they either respond inadequately or do not respond in a manner, as they should while giving opinions.
RULES OF MEDICOLEGAL AUTOPSY IN INDIA
- Written order from the Police Officer.
- Day time.
- In the Hospital Where the dead body lies.
- Identity of the deceased to be established.
- The great cavities opened (Cranial, Thoracic and Abdominal).
- Writing post mortem report on the spot.
CONTENTS OF POST MORTEM REPORT
- Name of the deceased and identification
- Place, date and time of post mortem
- External Examination
- Internal examination
- Viscera and samples collected for analysis
- Opinion as to cause the manner of death
Postmortem re-examination or second autopsy of a dead body at times may be required under certain circumstances before cremation or after exhumation. The interpretation of the findings of a second autopsy, performed on a previously autopsied body, is not an easy task for the autopsy surgeon due to various artifacts and alterations resulting from the first autopsy and it is usually demanded or ordered under public cry or political overtones .
- Safely handling of human remains during autopsy procedure to prevent transmission of viruses.
- For eye protection, goggles and face shield should be used.
- Double surgical gloves with interposed layer of cut-proof synthetic mesh gloves should be used.
- Before leaving the autopsy suite dispose in accordance with the facility policies and procedure.
- Vij k ,Text book of forensic medicine and toxicology , 4thedn , 2008 24-25.
- Sections 174& 176 of the Code of Criminal Procedure, 1973. In: Basu’s Criminal Court Handbook containing Criminal Major Acts, 10thed 2007. Orient Publishing Company, New Delhi: pp. 134-36, 112-13.
- Kannan K, Mathiharan K. Ed. In: Modi-A textbook of Medical Jurisprudence and Toxicology. 24thEd 2012. LexisNexis Butterworth’s Nagpur: p. 293, 295,297, 360.
- Curran WJ. The Medico-legal autopsy and Medico-legal investigation. Bull N Y Acad Med July 1971; 47(7): 766-75.
- The Punjab Medical Manual, 2nded. 1933. Superintendent, Government Printing, Punjab, Lahore; App. XXXVII: CII, Chapter X, p. 154, Para 595.
- Nandy A. Principles of Forensic Medicine; 1st Edition 1995: 175.
- Knight BH. The Forensic Autopsy. In: Forensic Pathology. Edward Arnold, 1995: 1-46.
- Kasinathan NADESAN MRCPath, FRCPA, “The importance of the medico-legal autopsy” Malnysian J Path01 1997; 19(2): I05 –
- Sharma SK. What ails Medico legal Performance: JFMT Vol. XII; No.1&2; 28-32.
- D.S.Bhullar et;al “MEDICO-LEGAL AUTOPSY BY PANEL OF DOCTORS PRESENT SCENARIO”, JIAFM, 2004; 26(3). ISSN 0971-0973.
Mahipal Singh Sankhla, M.Sc. Forensic Science. He is intern at Forensic Research & Development Cell at Legal Desire Media and Publications
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