A post mortem is performed by a pathologist. They are usually performed in the hospital (either where the person died or where they were taken immediately after their death) or at the public mortuary linked to the Coroner’s Court for the local area.
Post mortems are not performed for every death. They are conducted in specific circumstances, such as where the cause of death is unknown or where the cause of death is suspected to be unnatural. The pathologist will be appointed by the coroner where they feel it is appropriate for a post mortem to be performed.
What is done in a post mortem?
The post mortem process typically involves removal of internal organs for examination and samples may also be taken for testing.
A post mortem can leave marks on the body which can be distressing for family members.
What is the difference between a post mortem and an autopsy?
An autopsy is just another way of referring to a post mortem examination. They are the same process.
What is a non-invasive post mortem?
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 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.
In the Chief Coroner’s guidance sheet ‘ updated in January 2016, then Chief Coroner HHJ Peter Thornton KC, welcomed a reduction in the number of traditional/surgical post mortems being performed, and the reliance on pathologists where there is a recognised shortage, and acknowledges that the use of CT/MRI scanners is a potential way of doing this.
However, it is important to recognise that a non-invasive post mortem is not appropriate in every case as CT/MRI scans are only effective at identifying certain things. 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 yet become widespread. Over time it is hoped that use of non-invasive post mortems will actually help reduce waiting times but this is some way off currently.
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 specialisradiologist or a pathologist 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 would then 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.
How do I request a non-invasive post mortem is carried out?
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 I 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.
An individual does not have the right to prevent a post mortem that has been ordered by the coroner so you should make your wishes clear at the earliest opportunity if you do not wish for an invasive post mortem to take place so your views can be taken into consideration. We recommend you contact inquest specialist lawyers for advice urgently to maximise your chance of making a successful application.