Indigenous communities and the forensic autopsy

Abstract

More and more often forensic pathologists and medical examiners are encountering cultural and religious groups whose background is non-Western and who may not have previously had to deal with issues related to autopsy examinations. Handling of the naked body of the deceased by members of the opposite sex, with incisions and tissue and fluid removal, may be completely foreign concepts perceived by certain groups to be both mysterious and highly offensive. Other significant issues arise when the standard time taken for a medicolegal examination results in serious delays for religious rituals and burials, and when there has been retention of organs for further examination. Traditional beliefs often require that a body is quickly taken to a special place for viewing and the performance of specific rituals [1]. The body may then be buried or cremated with sometimes quite elaborate mourning ceremonies. All of this may be significantly disrupted if a body has been removed to another site for an autopsy examination. It may also be believed that tissue removal precludes the deceased from entering into the next stage of his or her journey into the afterlife and thus every effort may be made traditionally by family members to ensure that the body is kept intact. The opportunity for subsequent interment of organs that were removed prior to burial may not be possible, as there may be no tribal rituals to deal with such a situation. A similar problem may arise with smaller blocks of tissues that have been removed at autopsy to create microscopic slides that are required for diagnostic purposes. The question then arises as to how tribal needs can be best met without jeopardising the medicolegal process? In certain cases an external examination with a full body CT examination may be sufficient to determine the cause of death without having to undertake organ dissection [2]. This possibility emphasizes the need for all modern forensic units to have ready access to CT/MRI facilities, however it must be recognized that the identification and evaluation of a number of conditions, including subtle cardiovascular disease, will still require standard dissection. If an autopsy is undertaken, whole organ retention for specialized examinations may be required for formulation of the cause of death. The delay in performing such examinations may be considerable, and so early dissection with sampling and return of the organ(s) to the body should be encouraged. The issue of tissue block and slide retention is a difficult one, as most pathology quality assurance programs specify a minimum period for the retention of such material, to permit review, or re-evaluation with additional staining. However, it could be argued that the instances where re-examination and staining of sections has been required in clearly defined cases of natural death, suicide or accident are quite rare. A possibility that has not been generally explored is to scan slides onto computer databases prior to return of these materials to families, so that some morphological information is retained if re-examination is required. While this will not help if restaining of tissues is needed, it would mean that valuable microscopic information could be available for access without the necessity of having actual stored material. An example of how an acceptable outcome can be achieved in the face of quite distressing circumstances R. W. Byard (&) Discipline of Anatomy & Pathology, The University of Adelaide, Level 3 Medical School North Building, Frome Rd, and Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia e-mail: roger.byard@sa.gov.au