Zur Phänomenologie des Obduktionsguts der Rechtsmedizin Göttingen 1969 - 1978 und 1998 - 2007

Abstract

Changes in our society may potentially lead to shifts in the profile of forensic autopsies. A retrospective evaluation of autopsy protocols (nges= 5.190) at the Insitute of Legal Medicine Göttingen was performed, comparing the period of two decades (1969-1978, n1= 2.501, and 1998-2007, n2= 2.689). Most of the cases evaluated (95 %) accounted for judicial autopsies, whereas the number of administrative autopsies decreased by 94% during the time span analyzed. In 59 % (-16, %) of cases an unnatural cause of death was found, while 33% (+30 %) of deaths had a natural cause. In 7% (+29 %) the cause of death remained unclear. The gender distribution further remained almost unchanged (m= 66%; f= 34%). The average age at death increased by nine years from 37.8 to 46.8 years. Regarding cases with natural cause of death, a decrease of respiratory diseases (-85 %) and infections (-46 %) was documented. Rising numbers were observed for cardiovascular diseases (+70 %), gastrointestinal disorders (+127 %), fatal embolisms (+157 %), and tumors (+175 %). Among unnatural causes of death, fatal intoxications increased by 38 %. Fatal poisonings with methadone, amphetamines, and cocaine were observed only in the recent period. Opioid intoxications furthermore increased significantly (+724 %). A strong decrease was seen for fatal intoxications with cyanide, E605, barbiturates, and hypnotics. The frequency of homicides fell by 58 %, and falling numbers were also determined for occupational accidents (-59 %) and traffic accidents (-39 %). Suicides, on the other hand, increased by 35 %. Autopsies which had been performed due to suspected medical malpractice increased (+334 %) but did not result in more confirmed errors. During the recent period, the judicial practice regarding forensic examination was mainly limited to autopsies (+60 %). Additional histological examinations (-74 %), blood alcohol analyses (-54 %), and combined histological and blood alcohol examinations (-96 %), however, were performed less often. Due to recent legal practice arrangement, a growing indifference regarding comprehensive case solutions seems to have developed. Our results for the periods examined are mainly in concordance with those of other institutions (Frankfurt, Magdeburg, Hamburg, Munich, Dresden); yet need to be considered in a differentiated manner, as the case detection rate is very strongly associated with the legal practice arrangements and the discretion authority of individual prosecutors. The results collected within a 40-year period allow for conclusions regarding the impact of changes in health policy which are reflected in the autopsy data. On the other hand, there are developments within our autopsy material which form the basis for legislative adjustments (especially in coroner´s inquest and autopsies) and should be implemented politically. With respect to increasing costs and austerity programs in healthcare and judicial system as well as the closing down of forensic institutes, the evaluation of forensic autopsy data, as part of a possible nationwide multi-center study, may preventively protect society (eg undetected homicides, drug safety, drug cases, drug-related deaths, medical malpractice, traffic safety, unrecognized hazard sources, etc.) and ensure legal certainty.