MEDICO-LEGAL AUTOPSY

DR MOHD SHAH MAHMOOD

PAKAR PERUNDING FORENSIK
HOSPITAL KUALA LUMPUR
 LEGAL PROCEDURES
 Declaration of death;
– cessation of respiration
– BP / pulse unrecordable
– pupils fixed and dilated
– absent heart sounds on auscultation
– ‘Flat’ ECG tracing
MEDICO-LEGAL AUTOPSY
 Autopsy:-
– examination of a dead body, usually to
determine the cause of death.
– Also called necropsy or postmortem
examination
– 2 types : medico-legal and clinical /
hospital
 Autopsy
Medico-legal Clinical
Objective Legal Medical /
academic
Police / judicial Yes No
bodies
Police or court Yes No
orders
Consent Not required Mandatory
Cause of death Yes Yes
Manner of death Yes No
 Autopsy
Medico-legal Clinical
Time of death Yes No
Reconstruction of Yes No
events
Samples Legal & Police Clinical
collection investigations diagnostic and
therapeutic
purposes
Reports Medico-legal Clinical
Testimony in Common Rare
court
Conducted by Government M.O. Government M.O.
Laws Relating To Medico-legal
Autopsy
 Section 329 Criminal Procedure Code
– Police officer Not below than a sergeant
investigate and draw up a report on the apparent
cause of death and what manner that death has
taken place.
– Those types of death are :
 suicide

 Killed by another, or animal or machinery or

accident
 Suspicious circumstances

 Body found dead and death is unknown

 Sudden death
 Section 330 CPC
 If a Police Officer has reasons to believe or suspects
that death is
– sudden
– Unnatural manner
– Death by violence
– Death by unlawful act or ommision
 Must inform the nearest Government Medical Officer
and send the body to a nearest government hospital
or any convenient place for the purpose of
postmortem examination by a Government
Medical Officer.
 Provided that the Government M.O. is satisfied as to
the cause of death and the deceased came by his
death by accident he may order the body to be
buried.
Criminal Procedure Code
 S 331(I)
– A government Medical Officer as soon as
practicable make a postmortem examination
 S 331 (II)
– If necessary to ascertain the cause of death, shall
extend the examination to the dissection of the
body and the analysis of any portion of the body.
 S 332
– Transmit a report certifying the cause of death
and conclusions to the police officer in charge.
Powers of the Magistrate
 S 333 Hold an inquiry
 S 334 Hold an inquiry any death of a person
in custody - prison, police lock up, rehabilitation
centres or mental hospital.
 S 335(I) Same powers as holding an inquiry
into an offence
 S 335(II) Issue an order to a
Government Medical Officer to make a
postmortem examination and may for such
purpose order the body to be exhumed
whether or not examination has been made
under S 331.
 Powers of the Magistrate
 S 336 May view the body and may order
the body to be exhumed for holding an
inquiry
 S 337 An inquiry to determine when,
where, how and what manner of death and
whether any person is criminally involved.
 Registration of Birth and
Death Act 1957
 S 19 Duty to report death to any person
who was present at the time. Include relative,
next of kin, passer by, doctors etc. Within 12
hours.
 S 22 Any medical practitioner, the last in
attendance of the deceased must register the
death within 12 hours.
 S 23 Report 12 hours after a postmortem
examination.
 S 36 Offence in giving false information in
the death certificates :- Penalty is RM 2000/=
or 12 months imprisonment or both.
 Control of the spread of Infectious
Disease
 Prevention and control of Infectious Disease
Act 1988
– S 10(1) Any person to notify the authorities regarding
any person infected or any death from an infectious
disease.
– S 10(2) Duty of medical practitioner to notify.
– S 11 Power of the Magistrate to declare an infected
local area. Measures to treat, immunised, isolate,
control of any infected articles or animals or persons
and any measures necessary.
– S 16 An authorised officer may order any person
who died of an infectious disease to be conveyed to
such appointed place to be examined.
– S 17 Only the authorised person can give direction
on manner or burial or cremation.
 Control of the spread of Infectious
Disease
 Registration of Birth and Death Act 1957
– S 22(3) Any medical practitioner can refuse to
sign the death certificate if he suspects that death was
from an infectious disease and not satisfied with any
diagnosis written, unless the problem has been
rectified.
 Destruction of Disease-Bearing Insects Act
1975
– S 10(1)c The Director General or a Medical Officer
of Health may:- cause a postmortem examination to be
made on any corpse where death is suspected to have been
caused by any insect-borne disease.
– S 10(2) Any person having custody of any corpse who
refuses or obstruct the postmortem examination shall be
guilty of an offence and liable to a fine not exceeding RM
2000/=
The Medico-Legal Autopsy
 The aims of death investigation are to
answer the following questions:
– Who died? (identification of the deceased)
– Where? (place of death)
– When? (time of death)
– Why? (cause of death)
– How? (manner & mechanism of death)
The Medico-Legal Autopsy
 Autopsy is only one part of death
investigation. Body, history and scene are
equally important. Each of the three aspects
of the death investigation process are equally
important.
 Scene:
– Attendance by police officers, forensic pathologist,
forensic scientist.
– The aim is to collect the maximum information
with the minimum disturbance.
– Photography, videos, trace evidence.
The Medico-Legal Autopsy
 History:
– Social - from relatives, friends, police
– Medical - from GP, hospital notes. Often indicates
the likely cause of death.
– Psychiatric - from GP, hospital notes. May indicate
possibility of suicide.
 Autopsy authority:
– Police or Coroner (Magistrate)
– ‘Police 61’ form (Permintaan Pemeriksaan Mayat)
The Medico-Legal Autopsy
 Identification
– visual (relatives)
– Circumstantial (address, car, papers, cards, keys,
clothes)
– Medical (scars, teeth, x-rays, DNA)
– Fingerprint
The Medico-Legal Autopsy
 Personal effects and clothing
– By contrast with the hospital autopsy, the
examination of personal effects and clothing is
an integral part of the medico-legal autopsy
providing information on life style, events
leading to death, and often the actual cause of
death.
– Clothing findings are correlated with historical
and scene information, e.g. appropriateness of
clothing,source of stains, trace materials.
Clothing findings must also be correlated with
other autopsy data, e.g. injuries, source of
blood stains.
 The Medico-Legal Autopsy

 External Examination
– This is a detailed head to toe examination
of a naked body, documenting stains and
soiling, general and specific individualising
characteristics, postmortem changes
(temperature, lividity, rigor mortis,
putrefaction)
– The location, extent and type of staining or
soiling of the body are described.
 The Medico-Legal Autopsy
 Injuries
– All injuries are described systematically either
by grouping them according to anatomical
location or in numerical order.
– Injuries are described as to their type, (bruise,
abrasion, laceration, incised wound, puncture
or stab wound, gunshot wound, burn,
fracture), location, size, shape and colour.
– Internal injuries are described in continuity
with the related externally apparent injuries.
– Old injuries are segregated from recent
injuries.
The Medico-Legal Autopsy
 Signs of medical intervention
– Medical intervention is described under a separate
heading. This includes all medical equipment
attached to, or accompanying the body.
– External surgical incisions are described in
continuity with internal evidence of surgery.
The Medico-Legal Autopsy
 Internal examination
– The internal examination is systematic description
of natural disease and recent injuries. Negative
observations are included, e.g. no pulmonary
thrombo-emboli, no significant coronary
atherosclerosis, etc.
 Other examinations
– Any special dissections, (neck dissection), or
further examination of organs (brain after formalin
fixation), together with microscopic, biochemical
and toxicological studies should also be described.
 The Medico-Legal Autopsy
 Definition
– Cause of death: the disease process or injury for
initiating the train of events, brief or prolonged, which
produces the fatal end result.
– Mechanism of death: the physiological or
biochemical derangement produced by the above
cause, which is incompatible with life; i.e. how the
disease or injury leads to death.
– Manner of death: explains how the cause of death
came about; i.e. whether natural, accident, suicide,
homicide, or undetermined / unascertained. The
manner of death as determined by the forensic
pathologist is an opinion based on the facts concerning
the circumstances leading up to and surrounding the
death in conjunction with the findings at autopsy and
the laboratory tests.
The Medico-Legal Autopsy
Cause Mechanism Manner
Atherosclerotic Electrical arrhythmia Natural
coronary artery or heart failure
disease

Stab wounds Internal or external Homicide,

blood loss Suicide, or
Accident
Hanging Asphyxia Suicide

Strangulation Asphyxia Homicide

The Medico-Legal Autopsy
 Opinion (conclusion or commentary)
– This section is interpretative and subjective, representing
the opinion of the pathologist. It includes the cause of
death as appearing on the death certificate. The
commentary is in simple layman’s term and brings together
all the relevant information obtained from examination of
the body, the scene of death and the history of the
deceased. Information obtained second-hand (hearsay)
may be included i.e. from police reports, medical records,
etc. The relevant issues are addresses i.e. what happened,
to who, when, where, why, and how. It is directed to the
law officer investigating the death and any legally interested
parties who may obtain access to the report subsequently.
 Why is it important?
 Medico-legal autopsy
– the use of medical knowledge to assist the police in death
investigation especially unnatural deaths (accident, suicide
and homicide).
– To confirm the identity of the deceased (visual, fingerprint,
radiology, dental and DNA).
– To determine the estimated time of death.
– Toxicology (alcohol & drugs of abuse)
– To ascertain the cause of death.
– The autopsy reports can be submitted as evidence in the
court of law (civil or criminal).
 Difficult Autopsy
 Body found in water
 Body found by the road-side
 Decomposed body
 Skeletonised body
 Body fragments
 Severely charred body
 Mass disaster
 Anaesthetic and post-operative deaths
 Child deaths
 Deaths in young adults
 Maternal deaths
Death referable to coroner
 In Malaysia, all deaths in custody must
be referred to the coroner ( usually a
magistrate acting as a coroner).
 Death in custody = death occuring in
police lock-up, in prison, in immigration
detention camps, in military detention
camps, in psychiatric ward, etc.