Types of post mortems
Hospital post mortem
This is usually asked for by the patient’s doctor, either to provide information about the illness or cause of death, or to advance medical research. Hospital post mortems can only be carried out with consent from the next of kin.
Next of Kin
In this context, next of kin is defined by the Human Tissue Act 2004 and refers to people who were in a qualifying relationship to the person who has died.
Next of kin (highest priority first):
a) spouse or partner (including civil or same sex partner)
b) parent or child (in this context a ‘child’ can be any age)
c) brother or sister
d) grandparent or grandchild
e) niece or nephew
f) stepfather or stepmother
g) half-brother or half-sister
h) friend of long standing.
Sometimes, a relative of the person who has died will ask for a hospital post mortem to find out more about the cause of death.
Hospital post mortems are important in helping to understand how people die. For example, some illnesses are passed down through families and a post-mortem examination may provide you with this information if you wish to know. A post mortem can also help doctors to understand illnesses and may also contribute to the development of new ways of treating patients with similar problems.
Hospital post mortems can be limited to certain areas of the body, such as the head, chest or abdomen, and this will be discussed with you when you are asked for your consent. Only the specific organs or tissue which you give your consent can be removed for examination.
The Human Tissue Authority recommends that you should be given 24 hours to consider your decision about the post-mortem and that you will be given details of someone to contact if you change your mind.
A family can request a hospital post mortem by approaching the clinical team who cared for their relative.
In England, Wales and Northern Ireland, a ‘medico-legal’ (involving both legal and medical aspects) post-mortem examination can be instructed by a coroner in certain circumstances. This is called a ‘coroner’s post mortem’ and is the most commonly performed type of post mortem. It is carried out under the authority of a local coroner to find out how someone has died. Coroners are usually lawyers or doctors with a minimum of five years' experience.
The police or a doctor may report the death to a coroner if the:
- cause of death is unknown
- person who died was not seen by a medical practitioner during their final illness
- person who died wasn’t seen by the doctor who signed the medical certificate within 14 days before death or after they died
- death was violent or unnatural
- death was sudden and unexplained
- death occurred during an operation
- death occurred before the person came out of an anaesthetic
- medical certificate isn’t available
- the medical certificate suggests the death may have been caused by an industrial disease or industrial poisoning.
You will not be asked for your consent for a coroner’s post mortem. However, the coroner must tell you when and where the post-mortem will take place, if you ask. You have the right to be represented at the post mortem by a medical practitioner. This could be your GP or another pathologist.
The pathologist who undertakes the post mortem is chosen by the coroner to establish the cause of death on the 'balance of probability'. This means the cause of death given in the post-mortem report is that which the pathologist feels is the most likely, given the information that is available to him or her at the time of writing the report, and taking into account what they found out during the post mortem. The cause of death given by the pathologist may be altered by the coroner at a subsequent inquest if more information comes to light.
Once a post-mortem has been carried out and the relevant paperwork is completed, the body will be released and returned to the undertaker selected by the family. The coroner must release the body to the family as soon as possible. In the event that the body cannot be released for more than 28 days, the coroner will inform you.
In some circumstances, a coroner may open an inquest into the death of an individual after a post-mortem examination.
The Crown Office and Procurator Fiscal Service in Scotland
In Scotland, responsibility for investigating these types of deaths lies with the Crown Office and Procurator Fiscal Service instead of the coroner. The process is very similar to a coroner’s post mortem and the Procurator Fiscal will release the body as soon as possible. Inquests are not held in Scotland, but in a very limited number of circumstances, a Fatal Accident Inquiry (FAI) will be held.