The Toolbox Approach to Forensic Pathology

Abstract

Medical examiners are physicians tasked with conducting medicolegal death investigations to determine cause and manner of death. Although the autopsy is the most frequent tool utilized in these investigations and the one most often associated with the practice of forensic pathology, there is a wide variety of tools available to the medical examiner, whose statutory duty mandates death certification. We discuss the evidence supporting the usage of these myriad tools, ranging from the older techniques of scene investigation, microbial cultures, and toxicology to the cutting edge of medicine such as advanced imaging, molecular genetic studies, and biochemical analysis/metabolic testing. The forensic pathologist must select the correct tools for a particular investigation based on the evidence supporting their usage and a medical judgment of each tool's pretest probability to produce a useful result, its appropriateness for the case, and the resources required for its utilization. The incorporation of these techniques into the forensic pathologist's toolbox improves our ability to conduct thorough medicolegal death investigations beyond that which can be accomplished by invasive autopsy alone.