How is technology changing how post mortems are performed?

The purpose of an inquest is to answer four key questions: who the deceased was, where they died, when they died and how they died. In order to reach these conclusions the coroner will frequently order a post-mortem examination of the deceased’s body and in my experience of representing families following the unexpected death of a loved one, it is often the idea of this examination which can be particularly distressing to come to terms with.

A post mortem, sometimes known as an autopsy, is an examination of a body after death with the aim of determining the cause of death. Traditionally these have been a very invasive procedure, requiring surgical exploration of organs and tissues.

In recent years there has been increased use of CT scanners and MRI scanners by pathologists in order to ascertain the cause of death without having to mark the body in any way, make any incisions or remove any body parts. Non-invasive methods are often preferred by family members of the loved one, and especially those from certain faith groups.

During his tenure, the immediate past Chief Coroner of England and Wales, HHJ Peter Thornton QC identified  that the number of post-mortem examinations performed in England and Wales is very high compared to other countries with a coronial system. He notes that there was evidence to show that the autopsy rate was between 2 and 3 times higher than the rates of other comparable countries.

In a guidance sheet ‘The Use of Post-Mortem Imaging (Adults)’ updated in January 2016, then Chief Coroner welcomed a reduction in the number of autopsies being performed and acknowledges that the use of CT/MRI scanners is a potential way of doing this.

However, it has to be acknowledged that a non-invasive post-mortem is not appropriate in every case. There are differing views as to the effectiveness of non-invasive methods in some circumstances and it appears clear that a traditional post-mortem would still be required in many instances.  Furthermore, there are practical issues in terms of the availability and cost of non-invasive post-mortem approaches as use has not become widespread.

When is a non-invasive post-mortem likely to be used?

The Chief Coroner’s guidance on when CT or MRI imaging is to be used advises:

• Where an examination of the body of the deceased is required, the coroner must decide on what type of examination is appropriate. This decision will be made with the assistance of the pathologist and, where appropriate, a radiologist too.
• The coroner should bear in mind the wishes of the deceased (if known) and the wishes of the bereaved family.

If there is an established religious belief that an invasive post-mortem is to be avoided then the coroner should be guided by the stages set out in the High Court case of R (Rotsztein) v HM Senior Coroner for Inner London North from 2015:

• There must be an established religious tenet that invasive autopsy is to be avoided
• There must be realistic possibility that non-invasive procedures will establish the cause of death and permit the coroner to fulfil their duties.
• The whole post-mortem examination must be capable of being undertaken without undue delay.
• The performance of a non-invasive or minimally invasive procedure must not impair the effectiveness of an invasive autopsy if one is ultimately required.
• There must be no good reason to require an immediate invasive autopsy in any event (for example in a homicide case a forensic autopsy will almost always be required).
• The non-invasive procedure must be capable of being performed without imposing an additional cost.

If the coroner considers a CT scan (or alternative non-invasive approach) is appropriate then a radiographer or trained mortician carries out the scan. The results are then reviewed by a specially trained radiologist or a pathologist specially trained in interpreting post-mortem imaging.

Other investigations can then be performed as appropriate, for example taking samples for toxicology and biochemistry. CT coronary angiography is a minimally invasive procedure which will be undertaken in some cases as it can assist in establishing a cardiac cause of death that is not evident on normal imaging.

The pathologist and radiologist prepare a joint report for the coroner with the pathologist determining a cause of death or proceeding to a full autopsy if so instructed by the coroner.

A step forward for bereaved families?

Whilst the use of non-invasive post-mortem imaging ought to be encouraged where appropriate, it is not suitable in every case and may not be available in every coroner’s district.

If your loved one has died and you would like the pathologist to adopt a non-invasive method, then we suggest that you make this known to the coroner at the earliest opportunity. Post-mortems are usually performed very soon after the death so I would recommend acting quickly if you have any concerns about the traditional invasive post-mortem approach.