Autopsy Legal Medicine

Dr. Sergio Paguio

Autopsy 4 Types of Evisceration Techniques
Greek En Masse
eye witness (auto - self; opsis - view) Organs are removed as a single bulky
Necropsy aggregate.
Post-mortem En Bloc (Ghon)
thoracic pluck, coeliac pluck, intestines,
Postmortem examinations provide factual, objective urogenital pluck
information to the decedents families that negate their Virchows
suspicions and obviate their desire to pursue a lawsuit. organs individually removed
(Bove 2002) Rokitansky (in situ)
dissection occurs in situ with little actual
Two Types of Autopsies evisceration
Medico-legal or Forensic Autopsy
o Manner of death Local Regulations
o External death Code on Sanitation of the Philippines (P.D. 856)
o No consent from kin Implementing Rules and Regulations of Chapter
o Forensic pathologist XXI --> Disposal of Dead Persons
o Crime scene
Hospital Autopsy
o Cause of death
o Internal exam more important
o Consent from next of kin
o Any pathologist
o Clinical history
Benefits of the Autopsy to the Public
1. Provides reassurance to the family.
2. Identification of any contagious or familial
disease.
3. Evaluation for insurance benefits and workmans
compensation benefits.
4. The autopsy as an educational tool.
5. Identification of new or previously unrecognized
disease.
6. The autopsy as a quality control tool
The Autopsy as a Quality Control Tool
Keep track of competence
Develop clinical craftsmanship
Sharpen diagnostic skills
Increased diagnostic accuracy
Check appropriateness of intervention

Discrepancy between clinical diagnosis and autopsy Death Certificate Requirements

diagnosis: No remains shall be buried or cremated without a
10 45% death certificate
The D.C. must be issued by the attending
government or private physician
When no physician is in attendance, it shall be
issued by:
o city/municipal health officer
o mayor
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o secretary of the municipal board

o councilor of the municipality where the
death occurred.
The basis of the Death Certificate shall be an
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affidavit duly executed by a reliable informant

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Dr. Sergio Paguio
stating the circumstances regarding the Cause of Only adult members of the family permitted to
Death. attend the funeral
The death shall be reported to the Local Health Placed in a durable, air tight and sealed casket
Officer within 48 hrs after death and the Death Not granted permit for transfers.
Certificate shall be forwarded to the local civil
registrar concerned within 30 days after death for Autopsy & Dissection of Remains
registration. Authorized to perform:
Health officers - provincial, municipal, city
Shipment or Transfer of Cadaver Medical officers of law enforcement
Death certificate agencies such as PNP, NBI
Transfer permit from local health authority of Members of the medical staff of
point of origin accredited hospitals.
Properly embalmed remains
Transfer permit from places the remains will pass Autopsies shall be performed when:
Abroad: rules and regulations of the National When required by special lawsare those
Quarantine Office enforced and presently practiced by the
authorities.
Medicolegal Cases Upon orders of a competent court, a mayor and a
If the LHO who issues a D.C. has reasons to believe provincial or city prosecutor
or suspect that the COD was due to violence or Upon written request of police authorities
crime, he shall notify immediately the authorities Whenever the solicitor general, provincial or city
of the PNP or NBI concerned. prosecutor as authorized by existing laws, shall
deem it necessary
Violence or Crime Present When: Upon request of the next of kin
Stab wounds
gunshot wounds Requirements for autopsies in accredited hospitals:
suicide The director or chief of the hospital shall notify in
strangulation writing the next of kin of the death of the
accident resulting to death deceased and request permission
actual physical assault inflicting injuries upon a when permission is granted or no objection is
person resulting in death raisedwithin 48 hrs
sudden death of undetermined cause If no next of kin, secure from local health
In case the cause of death was due to violence or authority
crime mentioned in the preceding subsection, the
deceased shall not be buried until permission is HOUSE BILL NO. 1899 - Proposed Mandatory Autopsy Bill
obtained from the provincial or city prosecutor death where the criminal violence appears to have
where the death occurred. taken place;
In the absence of the city or provincial prosecutor, death by any accident or unintentional injury;
permission shall be obtained from: suicide;
municipal or city judge death under suspicious, unusual, unnatural, or
municipal or city mayor questionable circumstances;
chief of police death following an illegal abortion;
death related to occupational illness or injury;
Dangerous Communicable Diseases: death while in custody, in any jail or correctional
AIDS facility or in any mental health or social welfare
cholera facility;
Ebola death where suspicion of abuse of a child, family
hepatitis or household member, older or disabled person
Plague exists;
Yellow Fever death due to poison or acute or chronic use of
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Meningococcemia drugs, alcohol and other similar or related

substances;
The remains: (with communicable disease): death associated with diagnostic or therapeutic
Buried within 12 hrs after death procedures;
sudden death when the decedent was in apparent
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Not taken to any place of public assembly

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Dr. Sergio Paguio
death in any public or private conveyance; Medical negligence is based on standard-of-care
fetal and infant deaths; issues rather than accuracy of clinical diagnosis.
death in any emergency treatment facility, Misdiagnosis indicates lack of advanced medical
medical walk-in center or clinic; technology.
deaths occurring under such other circumstances No significant relationship between accuracy of
as the government' pathologist or medico-legal clinical diagnosis and outcome of the suit.
officer may include in the implementing rules and
regulations. LIABILITIES OF PHYSICIANS
1. Administrative
SEC, 14. Unlawful Issuance of Death Certificate. -- It shall Administrative liability
be unlawful for any person to issue a death certificate of a The practice of medicine is
person who died in a violent, suspicious, questionable, service to mankind irrespective of
unusual and/or unnatural circumstances without race, creed or political affiliation.
complying with the required autopsy In its practice, reward or financial
gain should be a subordinate
INTERNAL EXAMINATION consideration.
a large and deep Y-shaped incision can be made
starting at the top of each shoulder and running 2. Criminal
down the front of the chest, meeting at the lower 3. Civil
point of the breastbone. This is the approach most
often used in forensic autopsies so as to allow Sources of Liabilities of MD:
maximum exposure of the neck structures for 1. Ethics of the Medical Profession in the Philippines
later detailed examination. This could prove 2. Medical Act of 1959 as amended
essential in cases of suspected strangulation. 3. Civil Code
a T-shaped incision made from the tips of both 4. Revised Penal Code
shoulder, in a horizontal line across the region of 5. Special laws
the collar bones to meet at the sternum
(breastbone) in the middle. This initial cut is used
more often to produce a more aesthetic finish to
the body when it is re-constituted as stitching
marks will not be as apparent as with a Y-shaped
incision
a single vertical cut is made from the middle of
the neck (in the region of the 'adam's apple' on a
male body)

Ethical value of the Human Cadaver

The person is intimately identified with his/her
body, to the point that they are practically
inseparable
The way we treat the human cadaver influences
the way we treat the person alive; to treat the
dead body as a simple carcass, as a waste product,
would mean implicitly to lower the evaluation
standards applied to the person alive
Desire to respect the memory of the deceased.
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The cadaver is the material carrier of an amount

of events regarding the deceased person that
persist in our memory. Disrespecting the cadaver
would mean in a way to disregard the deceased
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person him/herself
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Dr. Sergio Paguio
Moral-ethical imperative to respect the familys
mourning
An improper attitude towards the
cadaver would mean thus disregarding
those close to the deceased one
Moral-religious significance of the human body.
Christian religion
From a Christian point of view,
the practice of allowing autopsies
and ones body for scientific
research is acceptable and even
to be encouraged if a true need
exists.
The teaching of Islam does not allow for
voluntary autopsy because it is
considered a desecration of a human
person who was associated with the
body. If the law requires it, however, then
the next of kin may acquiesce to it.

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