Understanding Medico-Legal Autopsy During the Times of COVID-19

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A medico-legal autopsy is as a tool used for investigating sudden, suspicious, criminal, and unnatural deaths. It helps to ascertain the cause of death, the time of death, manner of death and other related information that can be useful in solving the case or documenting the required information of the deceased.

In India, the process starts with an inquest. The Code of Criminal Procedure (CrPC) entails the necessary provisions in Sec 174 of the CrPC and Sec 176 of the CrPC.

To sum up the process, only a legal authority (having jurisdiction) can order a medico-legal autopsy. The police or the magistrate conduct an inquest. A requisition is then handed to a forensic expert who then conducts the medico-legal autopsy. The body is then handed back to the authority.

General Steps 

There exists a protocol to conduct autopsies. The general steps to conduct the procedure include:

1. External Examination

This is the first step and deals with the identification of the body, examination of clothing. It also includes a total examination of the body along with documentation of the observations (injuries, damage)

2. Internal Examination

Internal examination of the body begins with incisions marked on the body (can be ‘I shaped’, ‘Y shaped’, ‘Modified Y shape’) which help dissect it.

3. Removal of Organs

A thorough investigation is a result of an examination of removed organs. Various methods like Virchow method, Letulle method, Ghon method are available for this step. 

4. Determination of:

i) Cause of death

Thorough autopsy determines the cause of death. This is usually determined by the forensic expert that is handling the case.

ii) Manner of death

Based on the report of autopsy received, crime scene study and other investigation findings, the police or the investigator officer determines the manner of death. Medico-legal autopsy provides with essential forensic information, which more than often lead to breakthroughs in criminal investigations.

The need for medico-legal autopsy is clear. It also then creates a need to look into some of the issues that are creating a downward trend of post-mortem investigations.

Prominent Issues About Medico-Legal Autopsies

1) Risky and delicate 

Professionals always handle the procedure, but one cannot deny the fact that sometimes an autopsy carries more than once and often by different professionals. This makes it very difficult for the second professional as a lot of marking and disfigurements have already taken place on the body. It establishes the fact that reassembling of the body is not possible in the same manner as it was brought in, after a thorough and invasive autopsy has already performed on it. A separate analysis for the forensic pathologists cannot produce efficient results.

It is undeniable that it becomes tough to arrive at an accurate decision upon the second autopsy and then to compare with the first one. But, the differences in opinions can cause much harm too, which can derail the investigation.

2) Involvement of religious principles and sentiments

Religious prohibition is an essential factor that restricts the possibility of essential autopsy related steps that may help guide an investigation. For example – in Orthodox Judaism, there is a principle of strict prohibition of disturbing the dead and also organ removal though some leniency is present in cases where such action may save others (to save the innocent).

Followers of Islam to have strong beliefs against any defilement or exposure of the body (considered as disrespect) of the deceased.

3) Maintaining records

Making a report of the autopsy conducted is an essential step. Physical evidence like tissue sections of the body are also an integral part of the forensic investigation derived from autopsy and form a part of the record. 

Therefore, investigations which carry on for a long time, in reopening of cold cases required to understand that the physical evidence is difficult to store and that the lack of such evidence can again hamper investigations.

4) Infectious diseases

In a world that is fighting a pandemic currently, a lot of our day to day life processes are being changed to adapt. Hence, focusing on medico-legal autopsy, it is crucial to acknowledge that being near and contact with dead bodies, and especially with the increasing number of COVID-19 patients is harmful and dangerous.

The possibility of eradication of all such infectious diseases is uncertain (for example- SARS still has no cure). Thus, it highlights the issue of conducting future autopsies and the risk factor involved for the professionals.

As a temporary measure, AIIMS has waived autopsy due to death caused by COVID-19. Adaptation of a futuristic approach is the need of the hour, to incorporate development and cut down the shortcomings of the medico-legal autopsy. 

Virtual Autopsy or Virtopsy 

Virtopsy uses technological aids like CT and MRI to scan the bodies and provide with the specific and accurate result than that of a conventional autopsy. It is a far superior tool in identifying pattern of wounds, fracture patterns, gross tissue injuries. Virtopsy can resolve the shortcomings of the existing medico-legal procedure.

1.) Many examinations possible

Technological advancements have now made it possible to perform many autopsies on the same body. In addition to that, the innovation of ‘virtual-autopsy table’ has aided the process by transforming the data from scans into a 3D image which the professionals can dissect layer-wise through mere gestures. This can help them analyze from different aspects, gain further professional opinions as well as make it available for the medical students for knowledge and practice.

2.) Not in contravention to any religious principles

Lack of physical contact and dissection has ensured that the religious beliefs of individual communities are also protected. Cultures which do not support conventional autopsies can adopt to Virtopsy.

3.) Maintainability of records secured

Easy storage (physical, digital), retrieval, archival of data for future access. 

4.) A solution in dealing with infectious diseases

Bodies that infected, toxic, or even deformed beyond primary reconstruction examined without any fear or danger of any contamination or danger to the life of professionals.

One of the significant drawbacks in the debate about Virtopsy is that they are not cost-effective. In addition to that, the expenses of equipment and personnel are not in every facility’s budget. Therefore, making it imperative to bring  to notice that most of the hospitals have facilities like scanning devices. Also, the incorporation of development takes some time. Technological advancement has helped in creating the path for a futuristic approach of the virtual autopsy. Thus,  aiding autopsy and thus law. Thus, improvement and accuracy in autopsy can only ensure smoother, better and quicker results for investigations.

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