Introduction to forensic pathology

Forensic pathology is a medical specialty of death investigation. Almost all other doctors, one way or another have obligations to patients. Obviously, we don’t have patients. Our obligations are to truth, to justice and to the families of the deceased, who may be considered as our patient, I suppose. Who rightly want to know what has happened to their now deceased family member. And we also should think of ourselves as answerable to the family for looking after the remains of their loved one who’s been taken out of their control by the state for the overall public interest in ensuring a proper death investigation, in the pursuit of accountability for possible unlawful deaths and also actually for other public health purposes.

At the outset, it’s worth saying that, generally speaking, forensic pathology is the what happened specialty, not the who did it specialty or the who done it specialty. So the overall duties of a forensic pathologist are set out in paragraph 149 of the Minnesota protocol. I strongly suggest you get a copy. Firstly, to help ensure that the identity of the deceased is established. This is a crucial first step. Secondly, to help ensure that the cause and circumstances of the death are revealed. And thirdly, to exercise care and skill in this work. The underlying cause of death is the disease, condition, injury and/or circumstance, which initiates the chain of events resulting in death.

This might precede through intermediate or immediate causes, making two or three logically linked statements, which taken together constitute the cause of death. The most immediate cause of death is stated first and the underlying cause last. Thus, expressed in the format approved by the World Health Organization, the cause of death of a young man who was driving a car that crashed into a tree, is best expressed as, 1(a), which is the immediate cause haemorrhage. Due to 1(b), the intermediate cause multiple factors and a ruptured liver, for example. Due to 1(c), the underlying cause being the driver of a car which crashed into a tree.

There’s also a section two, which is other significant conditions contributing to the death and that’s not relevant here.

The manner of death is the summary of the circumstances of death. So that is homicide, suicide, accident, natural or undetermined. In the example above, it was most likely an accident. In some jurisdictions it is the forensic pathologist who determines this. These categories are not mutually exclusive, as most people think. For example, an intravenous drug addict dying on the point of a needle could be an accident or suicide.

Mechanism of death. This can be a bit more complicated. This phrase is used in two different ways. First, it might be used to describe the physical or other means by which the manner of death in the above example accident or the underlying cause of death in the above example, being the driver of a car which crashed into a tree, led to the immediate and intermediate cause of death. Used in this way, the mechanism of death is blunt trauma. The second way the phrase is used is to represent the pathophysiological or biochemical means by which the underlying cause of death leads to death. Used in this way, the mechanism of death in the above example is haemorrhage or blood loss.

And used in this way, the mechanism of death is sometimes called the mode of death. Occasionally the mechanism of death is important, but only occasionally. Understanding the cause of death and the manner of death are important and these are the core outputs of the forensic pathology work in a death investigation.