What is a post-mortem examination?
A post-mortem examination is a medical procedure where a body is examined to find out what caused the death. It is not a common procedure and is only conducted in some circumstances, for example when the cause of death is unnatural or unknown.
The procedure involves extensive cutting of the body and removal of the internal organs for examination before replacing them in the abdominal cavity, not where they would have originally been located. Families should be aware that if they view a body after a post-mortem there may be marks which look like bruises which will have been caused by the post-mortem procedure. There can also be marks caused if there was an attempt to resuscitate the person prior to their death.
In some parts of the country and in some circumstances it may be possible to ask for a post-mortem to be conducted by using a MRI scan, so that the body does not have to be physically damaged. This is a very new method of undertaking post-mortems and there are mixed views about whether it is always a good idea. If you feel strongly about this, for example, for religious reasons, you can ask the coroner if it is possible but you will be expected to pay for it.
When does it happen?
A post-mortem is carried out as soon as possible after the death on behalf of the coroner as part of the investigation to establish the cause of death. It usually takes place within one or two days of the death.
The coroner is only required to inform the relatives of the deceased of the time and place at which the examination is to be made, if the relatives have told the coroner that they wish to be informed. The relatives have the right to be represented at the post-mortem by a medical practitioner or other representative (see below). In reality this very rarely happens and many families are not aware of their rights until it is too late and the post-mortem has already taken place. You should be aware that if you do have a representative attend the post-mortem on your behalf, you may be responsible for any of their related costs. In some exceptional circumstances these costs could be met by legal aid funding. You will need to discuss this with a specialist solicitor to see if it would apply to your situation.
Where the police are investigating the death because they think a crime may have been committed, and when someone has been or may be charged with causing the death, the coroner may delay giving permission to bury the body so that the lawyers acting for the accused can arrange their own post-mortem. This can be very distressing for the family, but the coroner has a duty to protect the rights of the accused in this way.
If someone is charged with an offence and there is to be a criminal trial there will not usually be a full inquest as well. The coroner can hold an inquest after a trial but in practice this is very rare. If you think that there should be an inquest as well as a criminal trial, you will need to make sure the coroner knows your views and you may need to take legal advice.
Who may be present at the post-mortem examination?
The following people are entitled by law to be present at the post-mortem examination:
- • A relative or their medically-qualified representative; a lawyer and anyone else representing the family.
• A pathologist representing the family if they have instructed one early enough. In many cases this will not occur at the initial examination but the family’s pathologist may hold a second examination at a later date.
• The GP of the person who has died.
• A representative from the hospital where the person died.
• A representative of the Health and Safety Executive if the death was caused by an accident or disease following the issuing of a ‘warning notice’ as set out in the relevant legislation.
• Any government department which has notified the coroner that it wishes to attend.
• The chief officer of police.
• Any legally-qualified doctor representing any of the above.
• Any other person invited by the coroner.
Can I stop it?
Bereaved relatives do not have to give consent for a coroner’s post-mortem examination to take place. However, if you feel strongly about this you should speak to the coroner.
If the coroner decides a post-mortem examination is necessary, the only means of stopping it is by a complicated legal procedure called a judicial review. It would be necessary to demonstrate that the coroner’s decision was unreasonable, i.e. because the grounds for wanting a post-mortem were in some way insubstantial. In reality the post-mortem is often carried out very soon after the death and the family may not have sought advice that quickly, or they may not have been informed that it is taking place. The coroner will not release the body for the funeral until the procedures required have been carried out.
Who carries out a post-mortem examination?
A pathologist, who is a doctor specialising in this particular area. The coroner will appoint the pathologist.
Where will it take place?
Usually in the hospital where the person died or was taken immediately after death or at the public mortuary linked to the coroner’s court.
Will any samples be kept?
At the post-mortem examination the pathologist may need to carry out some specialist tests in order to discover the cause of death, or be asked to carry out specific examinations by the coroner.
Sometimes very small pieces of tissue are kept for the pathologist to examine under the microscope at a later date. In some cases it may be necessary to keep the whole or parts of the organs to undertake particular tests. You can ask for information about this from the coroner or pathologist. You can also discuss delaying the funeral until the tests are completed so that the organs or tissue can be returned.
The coroner must tell you if organs or other samples are being kept after the post-mortem. You should also be told how long they will be kept and you will need to decide whether you want to have them returned to you, whether you wish to donate them for research, or whether they should be disposed of when the coroner decides they are no longer needed for the investigation. Further information about this is available online from the Human Tissue Authority.
Can I see the post-mortem report?
Under rule 57 of the Coroners Rules 1984, the relatives of the deceased may apply to the coroner for a copy of the post-mortem (pathology) report, for which you may have to pay a small charge.
There is no right to see the report before the inquest actually takes place, but it is the practice of most coroners to release it. This is sometimes made more difficult when there are controversial circumstances surrounding the death. It may take several weeks, or even longer, for the post-mortem report to be completed, especially where extra tests are taking place. Some coroners prefer to send the post-mortem report to the family GP so that the GP can explain the contents to the family. Some families find it too distressing to read the post-mortem report, but if you have instructed a solicitor this is something they can do on your behalf.
Can I have a second post-mortem examination?
Yes, with the consent of the coroner. In practice this is very rarely denied. If it is denied it can be challenged by judicial review.
If you consider having a second post-mortem you must be aware of the need to have a solicitor to instruct the pathologist and also of the cost involved. It will probably delay the funeral. But if you are not happy with the information you have received about the cause of death and you have worries about the circumstances of the death, you should consider a second post-mortem. It is important to use a pathologist with specialist expertise and you will need to take advice on this. You also need to ensure that the body is properly preserved. After a few days a body will start to deteriorate and if it needs to be kept for longer, the body will be frozen in order to preserve it.
What is a toxicology report?
A toxicology report is a report done on blood and tissue to establish whether there were any toxic substances in the body which may have contributed to the death. The toxicology report will detail prescription drugs, illegal drugs, alcohol and any other chemical substances which the toxicologist has been instructed to test for. It will usually take 6-8 weeks for the toxicology report to be completed. You can ask for a copy of this with the post-mortem report.
What will the body look like after a post-mortem?
A body will begin to deteriorate and this will become obvious if it has to be kept for any time. This can be very distressing for family and friends particularly if they want to have an open casket at the funeral or perform other rituals with the body. You will need to talk to your funeral director and take their advice about whether it is going to be possible to have an open casket.
