As part of her series of blogs considering all aspects of inquest law, Ali Cloak, considers the increasing use of post mortem imaging to determine a cause of death as an alternative to an invasive surgical autopsy.
By Ali Cloak
The purpose of an Inquest is to ascertain who the deceased was, where the deceased came by his or her death, when the deceased came by his or her death and how the deceased came by his or her death. In order to reach these conclusions the Coroner will frequently order a post-mortem examination of the deceased’s body and in my experience of representing families following the unexpected death of a loved one, it is often the idea of this examination which can be particularly distressing to come to terms with.
My recent blog on post mortem examinations mentioned the potential use of alternative methods of performing a post mortem. CT scanners and MRI scanners can be used by pathologists in order to ascertain the cause of death without having to mark the body in any way, make any incisions or remove any body parts. Non-invasive methods are often preferred by family members of the loved one, and especially those from certain faith groups.
The present Chief Coroner of England and Wales, HHJ Peter Thornton QC (who is due to complete his term in this role at the end of September 2016) has identified that the number of post mortem examinations in England and Wales is very high compared to other countries with a coronial system. He notes that there was evidence to show that the autopsy rate was between 2 and 3 times higher than the rates of other comparable countries.
In a guidance sheet ‘The Use of Post Mortem Imaging (Adults)’ updated in January 2016, the Chief Coroner welcomes a reduction in the number of autopsies being performed and acknowledges that the use of CT/MRI scanners is a possible way of doing this.
However, it is acknowledged that a non-invasive post mortem is not appropriate in every case. There are differing views as to the effectiveness of non-invasive methods in some circumstances and it appears clear that a traditional post mortem would still be required in many instances. Furthermore, there are practical issues in terms of the availability and cost of non-invasive post mortem approaches.
The Chief Coroner has provided guidance on when CT or MRI imaging is to be used. The key points are as follows:
Where an examination of the body of the deceased is required, the Coroner must decide on what type of examination is appropriate. This decision will be made with the assistance of the pathologist and, where appropriate, a radiologist too.
The Coroner should bear in mind the wishes of the deceased (if known) and the wishes of the bereaved family.
If there is an established religious belief that an invasive post mortem is to be avoided then the Coroner should be guided by the stages set out in the High Court case of R (Rotsztein) v HM Senior Coroner for Inner London North from 2015:
If the Coroner considers a CT scan (or alternative non-invasive approach) is appropriate then a radiographer or trained mortician carries out the scan. The results are then reviewed by a specially trained radiologist or a pathologist specially trained in interpreting post mortem imaging.
Other investigations can then be performed as appropriate, for example taking samples for toxicology and biochemistry. CT coronary angiography is a minimally invasive procedure which will be undertaken in some cases as it can assist in establishing a cardiac cause of death that is not evident on normal imaging.
The pathologist and radiologist prepare a joint report for the Coroner with the pathologist determining a cause of death or proceeding to a full autopsy if so instructed by the Coroner.
Whilst the use of non-invasive post mortem imaging ought to be encouraged where appropriate, it is not suitable in every case and may not be available in every Coroner’s district. If your loved one has died and you would like the pathologist to adopt a non-invasive method, then we suggest that you make this known to the Coroner at the earliest opportunity. Post mortems are usually performed very soon after the death so I would recommend acting quickly if you have any concerns about the traditional invasive post mortem approach.
If you have any other questions about post mortems, or the inquest process more generally, then please do not hesitate to get in touch.