Post-Mortem Fact Sheet
A comprehensive guide to understanding post-mortem examinations, your rights, and the legal procedures involved.
What is a Post-Mortem?
A post-mortem examination, also known as an autopsy, is the examination of a body after death. The aim of a post-mortem is to determine the cause of death.
Who carries out a post-mortem?
Post-mortems are carried out by pathologists (doctors who specialise in understanding the nature and causes of disease).
When are post-mortems carried out?
A Post-mortem examination will be carried out if it's been requested by:
A coroner – because the cause of death is unknown, or following a sudden, violent or unexpected death
A hospital doctor – to find out more about an illness or the cause of death, or to further medical research and understanding
Performed by qualified pathologists with specialized medical training
Coroner's Post-Mortem Examination
What is a Coroner?
A coroner is a judicial officer responsible for investigating deaths in certain situations.
Qualifications
Coroners are usually lawyers or doctors with a minimum of 5 years' experience.
Referral Process
In most cases, a doctor or the police refer a death to the coroner.
A death may be referred to the coroner:
- It's unexpected, such as the sudden death of a baby from sudden infant death syndrome (SIDS)
- It's violent, unnatural or suspicious, such as a suicide or drug overdose
- It's the result of an accident or injury
- It occurred during or soon after a hospital procedure, such as surgery
- The person was not seen during the last 28 days before they died or any time after they died by a doctor who can issue a medical certificate of cause of death (MCCD), which is a document that allows the death to be registered • the cause of death is unknown
- The cause of death is unknown
Purpose of Coroner's Post-Mortem
The main aim of a post-mortem requested by a coroner is to find out how someone died and decide whether an inquest is needed.
An inquest is a legal investigation into the circumstances surrounding a person's death.
Important Notice
The main aim of a post-mortem requested by a coroner is to find out how someone died and decide whether an inquest is needed.
An inquest is a legal investigation into the circumstances surrounding a person's death. If someone related to you has died and their death has been referred to a coroner, you won't be asked to give consent (permission) for a post-mortem to take place.
This is because the coroner is required by law to carry out a post-mortem when a death is suspicious, sudden or unnatural.
- In homicide cases and violent deaths this is called a forensic post mortem. This is an intrusive examination, the organs are taken out and dissected to see if the organs (e.g the heart, lungs, stomach, intestines, brain) have any trauma or other signs that may determine the cause of the death.
- In certain cases the organs may not be returned straight away as they need to be medically examined. Timescales depend on many factors, and burials/funerals may be delayed if bereaved families want these organs returned with the body. (Seek advice from local religious leader for religious rulings)
Retention of Samples
If the death occurred in suspicious circumstances, samples may also need to be kept by the police as evidence for a longer period.
In some cases, samples may need to be kept for a number of months, or even years.
The coroner's office will discuss the situation with you if, following an inquest, tissue samples need to be retained for a certain length of time.
What happens during a post-mortem?
Timing
A post-mortem will be carried out as soon as possible, usually within 2 to 3 working days of a person's death.
Location
The post-mortem takes place in an examination room that looks similar to an operating theatre. The examination room will be licensed and inspected by the HTA.
Examination
During the procedure, the deceased person's body is opened and the organs removed for examination. A diagnosis can sometimes be made by looking at the organs.
Detailed Investigation
Some organs need to be examined in close detail during a post-mortem. These investigations can take several weeks to complete.
After the Examination
If you wish, you'll usually be able to view the body after the examination. Once release papers have been issued, the undertakers you have appointed will be able to collect the body from the mortuary in preparation for the funeral.
Licensed and inspected by the Human Tissue Authority (HTA)
Non-Invasive Post-Mortem Examinations
Traditionally, most post-mortem examinations have been carried out by a pathologist and have involved an “invasive autopsy that is opening and examining the body internally and examining and weighing the internal organs. However recent advances in computerised scanning means that internal examinations can now be carried out using a scanner that produces digital images that are then looked at by a doctor without needing to open the body.
This is called enhanced computerised tomography or ‘CT scanning’. Specialist doctors (Consultant Radiologists) interpret the CT images and are able to provide a cause of death in over 90% of cases without the need for a traditional autopsy.
This type of post-mortem examination, based on CT scanning, is known as a “non-invasive post mortem examination”.
When & Where?
A non-invasive post-mortem will usually be performed within 48 hours of death or sooner if there are particular reasons to speed up the process. The scanning will take place at a specialist CT scanning facility. An intrusive post-mortem will take place at a Mortuary.
The Process
All the staff involved in the non-invasive post-mortem examination will be NHS employees. NHS staff will deal with the bodies in the mortuary, prepare the bodies for scan, undertake the scan and report on the scans.
Reporting
A NHS Consultant Radiologist will examine the scan images and consider all of the other available information before providing a report to the coroner on the cause of death. Where the CT scan procedure reveals a medical cause of death an invasive autopsy will therefore, usually, have been avoided.
Detailed Process
A specially trained NHS anatomical pathology technologist (‘APT’) will receive the body at the mortuary along with a written report from the coroner’s office giving the brief circumstances of the death. The APT will conduct an external examination and take photographs if necessary before preparing the body for scanning.
Need for Surgery
In up to 10% of cases the radiologist may be unable to give a cause of death after the CT scanning procedure. In those cases the coroner may need to ask a pathologist to conduct a limited or full invasive autopsy examination.
Hospital Post-Mortem Examination
Post-mortems are sometimes requested by hospital doctors to provide more information about an illness or the cause of death, or to further medical research.
Hospital post-mortems can only be carried out with consent.
Consent Required
Prior Consent
Sometimes a person may have given their consent before they died. If this isn't the case, a person close to the deceased can give their consent for a post-mortem to take place.
Limited Examination
Hospital post-mortems may be limited to particular areas of the body, such as the head, chest or abdomen. When you're asked to give your consent, this will be discussed with you.
Your Control
During the post-mortem, only the organs or tissue you have agreed to can be removed for examination.
Time to Decide
The Human Tissue Authority recommends you should be given at least 24 hours to consider your decision about the post-mortem examination.You should also be given the details of someone to contact in case you change your mind.
The Law
Chief Coroner's Guidance
The Chief Coroner encourages coroners to consider the use of less invasive forms of examination in appropriate cases, especially where the bereaved family has a strong objection to invasive examination.
Post-mortem imaging may not be the appropriate technique to determine the cause of death in all cases. Facilities vary across the country and are not present in every jurisdiction.
Legal Precedent
The correct approach to be taken to a request by a bereaved family for less invasive examination was considered in the case of Rotsztein v H M Senior Coroner (2015) for Inner North London which laid down guidelines.
Coroners are encouraged to refer to that case when they receive such a request.
Homicide Cases
- In homicide or deaths being investigated by the police a Family Liaison officer would be assigned to the bereaved family, they liaise between the family and the investigation team and best placed to liaise with the coroner.
- In Homicide cases the defendant has a right to request a second PM. This is carried out by another pathologist to challenge the conclusion of the first PM. However the coroner has to decide if this is permissible and it is a judicial decision.
Your Rights
Bereaved families cannot ask for the Post-Mortem not to be carried out if a coroner is instructed, however you can make your request for non-invasive Post-Mortem known to the coroner straightaway. The coroner then should consider the bereaved family views, especially for religious reasons.
It may not be possible for a non-invasive Post-Mortem to be done, however you are encouraged to request a non-invasive Post-Mortem.