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All about an autopsy

image of a chalk outline of a bodyThat word. You gotta love it. Just the way it hisses out of our mouths deliciously chilling autopsy.

Literally, it means see for yourself, if almost two dozen television shows on autopsy and forensic science count as evidence. According to the Nielsen Ratings, there aren’t enough Desperate Housewives in all of suburbia to compete with two intrepid medical examiners, three CSI shows and a dozen new Cold Case Files.

(Not to mention the recently deceased Six Feet Underwhich put the fun in funeral home.)

But a real autopsy can’t be ordered by the dead guy’s girlfriend. A real autopsy can’t identify the villain’s DNA between two commercial breaks. And a real autopsy can’t pinpoint 4:32 AM as the exact time of death.

And, most disappointing, according to Elizabeth Devine, script consultant to two CSI shows and a 15-year veteran of the LAPD, no one really draws chalk lines around dead bodies. And never has. Apparently, it’s a Hollywood forensic practice, probably started by Alfred Hitchcock.

Anatomy of an Autopsy

Inside is a respectful written guide of procedure during autopsy, meant to demystify the process and separate fact from fiction.

Most autopsies are hospital-based and have nothing to do with foul play. But would you know what to do if you believed that a recently deceased family member warranted one? Who would you call? When does it become a forensic autopsy? What is the law surrounding autopsy?

How is an autopsy performed, when it’s not happening on a Hollywood soundstage?

FAQs on Autopsy

Who asks for an autopsy at a hospital? An attending physician may ask a patient’s family for permission to do an autopsy or the patient’s family may ask the doctor to request one. Only the attending physician can order one.

Forensic
Fact vs Fiction

What percentage of patients is autopsied? The number has fallen drastically over the last 40 years. In 1950, about half of all patients who died in hospitals were autopsied. Now it varies between 5-13 percent, due in large part to modern imaging techniques like CAT scans and MRIs. They tell the picture of a person’s disease so well that invasive procedures aren’t warranted. Who gets charged for it? Autopsies are expensive, ranging from $1,000 to $3,000, and most insurance plans do not pay for them. Hospitals generally absorb the costs.

Why would a family member want one if they didn’t suspect foul play and the reason for death was medically clear? Often the family needs peace of mind about the death of a loved one -- that there was nothing the family could have done to save their loved one’s life, for instance.

Also, many mysterious diseases, such as SIDS (Sudden Infant Death Syndrome) are better understood because of autopsy and also serve to remove any guilt from the family members. Autopsy has helped identify negative effects of certain prescription drugs and has defined certain conditions, such as asbestosis, as occupational hazards.

Finally, the value of autopsy as a medical teaching and discovery tool is incalculable. In about a quarter of all autopsies, major disease that was undiagnosed in life is discovered.

Can every hospital do autopsies? Most major hospitals have some means of obtaining an autopsy. Smaller hospitals may have to transport the body elsewhere to perform the procedure.

Why would a family object to the procedure?

  • They might not want further invasive procedures performed
  • They might object to the delay in making funeral arrangements
  • Some worry about disfigurement of the body
  • Some object for religious reasons

How disfigured is the body after autopsy? Performed properly by a qualified mortician, there shouldn’t be any visible disfigurement once the body is dressed for the funeral.

So, you can have an open-casket funeral after autopsy? Yes. Incisions made on the body are covered by clothing. The incision that allows a pathologist to get to the brain is made at the back of the head and is not noticeable after a body is prepared for viewing.

How long does an autopsy take? Typically, two to three hours.

How soon after death is an autopsy performed? Usually within 24 hours after next-of-kin has given permission.

Can you do a partial autopsy, like on just one organ? Yes. The next of kin can request that the pathologist examine only the liver, for example, in the case of liver disease. Pathologists prefer though, to have access to the entire body because of disease states or conditions that change the picture or cause of death.

But the pathologist is only allowed to do what the next of kin permits, except in cases of foul play (see forensic autopsy).

What does a full autopsy examine? The brain, all of the internal organs, and sometimes the spinal cord is removed for evaluation. Limbs are not dissected unless there is a specific reason for it.

Can you still do an autopsy after organ donation? Yes.

Can you do an autopsy after embalming? Yes, but results aren’t optimal. Embalming fluids alter the body and body fluids tell a story, also.

The Forensic Autopsy

What is a forensic autopsy?

  • Forensic autopsies are performed when foul play is suspected
  • When a person dies outside of a hospital unexpectedly and hasn’t been under the care of a physician
  • Suspected suicide or accidental death such as a drowning or electrocution
  • Laws vary dramatically by state and even by county
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What is the difference between a medical examiner and a coroner? A coroner is often a non-medical lay person who is elected to office to oversee the examination of bodies. Coroners are usually not empowered to perform autopsies.

How does the forensic autopsy differ from the hospital autopsy? Much more attention is paid to the external body surfaces and clothing, which might yield insights into the crime. X-rays might be used to detect foreign objects like bullets. A forensic autopsy may need to answer additional questions like the location of the place of death or if the victim was sexually molested. Great care is taken to collect samplings from the surface of the body, such as soil, blood and body fluids.