Forensic pathology is a field of medicine that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Duties Forensic pathology is an application of medical jurisprudence. A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology. The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below (see § Education).
The forensic pathologist performs autopsies/postmortem examinations with the goal of determining the cause of death as well as the possible manner of death. The autopsy report contains conclusions made relating to the following: The pathological process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called the mechanism of death), such as a bullet wound to the head, exsanguination caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.) The manner of death, the circumstances surrounding the cause of death, which, in most jurisdictions, include the following: Homicide Accidental Natural Suicide Undetermined
The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased. Autopsies are performed when a death occurs, when an unexpected death occurs, when someone dies while not under the care of a physician, to solve criminal cases, when a mass disaster occurs and requires the identification of the victims and upon request by the family or loved ones of the deceased. Typically, autopsies can cost anywhere from $3,000 to $5,000, however the price can vary from country to country.
The forensic pathologist examines and documents wounds and injuries, along with the possible causation of those injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.
Forensic pathologists collect and examine tissue specimens under the microscope (histology) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound. They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).
It is highly important for the verdict of an autopsy to be accurate and unbiased. The manner of death determined by the medical examiner influences greatly the investigative process. Cognitive bias poses a problem for its unconscious influence on decision-making, hence the importance of filtering irrelevant contextual information.
In mass disaster settings, forensic pathologists will work alongside Forensic Odontologists, Forensics Anthropologists as well as other forensic specialties with the goal of identifying the victims of the disaster. The process of identification involves the recovery of the victims, the collection of antemortem data, the initial examination along with the collection of any postmortem evidence, and finally the comparison of the antemortem and postmortem data gathered in order to identify those victims.
They serve as expert witnesses in courts of law testifying in civil or criminal law cases.
In an autopsy, the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).
Forensic physicians sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty.
In the United Kingdom, membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert. Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009, which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.
Forensic pathologists make contributions to public health and preventative medicine by studying the dead. By using their findings during autopsies, they can use their knowledge to prevent the death of another person.
Investigation of death
Pathologists determine the cause of death through postmortem examination or autopsy. There are three stages of death investigation: examination, correlation, and interpretation. Deaths where there is an unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.
Methods Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. Some of these methods require various identification techniques, including immunohistological studies, which can be valuable for determining the time of injury and assessing axonal damage resulting from traumatic brain injury When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body. While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.
Terminology inconsistencies across jurisdictions In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.
Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.
Canadian coroners In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systemsThe Coroner System. USW. http://www.usw.ca/program/content/3179.php . Accessed on: 7 June 2007.Coroners' law resource. King's College London. http://www.kcl.ac.uk/depsta/law/research/coroners/canada.html . Accessed on: 7 June 2007.
Coroners and medical examiners in the United States In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).
In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.
History Forensic pathology was founded by Rudolf Virchow, a German pathologist, who developed the Virchow method which is one of the main and popular techniques still used by forensic pathologists today. The Virchow method is of doing autopsies as well as instituting cell theory which would shed light on the effects and damage of disease on the human body. Rudolf Virchow began the practice of regulated autopsies where the entire body would be inspected rather than a particular area of interest which would expose additional damage that injuries and ailments inflicted on the human body. In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu, Johann Ludwig Casper and Carl Liman made great efforts to develop forensic pathology into a science based on empirics.
Ambroise Paré is also considered one of the fathers of modern forensic pathology and surgery. His inventions in the early 16th century include surgical instruments and techniques. He pioneered battlefield medicine and treatments of wounds. One technique he used was pouring boiling oil into wounds.
This history of forensic pathology can be traced all the way back to the fourth century BC in Babylonia but instead of practicing on deceased human bodies, the practice of forensic pathology was strictly practiced on animals. This was said to be done only to animals since humans during this era were believed to be sacred. Later on, in forensic pathology history, forensic pathology would be practiced among those who live in Asia. Muslim doctors would discover infectious diseases and as a result, would operate on deceased bodies; one of those doctors being Ibn Zuhr. Zuhr would go on to performing autopsies on bodies in postmortem and research diseases such as leprosy, mange, and sexually transmitted diseases.
While Zuhr was busy learning about contagious diseases, Yee Siung, a Chinese government official was assembling a group of physicians who were in charge of dissecting criminal murder victims. These victims’ cause of death would be investigated alongside the actual case itself and this would be the first time pathology would be used to help solve criminal cases.
Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959 after toxicology and pathology had been used to solve thousands of criminal cases worldwide for years.
In Canada, it was formally recognized in 2003, and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.
Education In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country; however, it is common for pathologists to study at a medical school and then go on to study pathology. Many forensic pathologists practice as a histo (hospital) pathologist before moving on to forensic science. Another requirement for forensic pathologists is having a working knowledge of specific fields of study like toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology.
Australia