Introduction

The term autopsy in medical practice refers to a surgical procedure which is performed on the corpse or body to find or identify the cause of death. Other commonly used words in referring an autopsy are postmortem and necropsy.

Autopsy is derived from the Greek word meaning autopsia ‘to see’ (to see for oneself). According to Albreacht von Haller (1756), an anatomist and medical practitioners Switzerland ‘autopsy is an act of a person to understand and explain based on an observation’ (Sezer, 2005). The observation is done on the body or bodies.

According to the guidelines set by the of the Ministry of Health Malaysia (MOH), postmortem means an inspection carried out by the Government Medical Officer on the dead body. This inspection involves internal and external examination to determine the cause and manner of death or how the changes produced by the disease, chemical, radiation, accidents, injuries, etc.The main goal of the postmortem is to answer questions that arise about how and why an individual may die.

Laws of Malaysia

Malaysian laws have special provisions under Criminal Procedure Code (Act 593) refers to Section 329 that empower a police officer (sergeant and above) to investigate any reported deaths. Section 330 empowers the police officer to refer the nearest government medical officer to carry out a post mortem examination if there is doubt or criminal conduct on reported deaths. And Section 331 (1) states as soon as information is received from the police investigating officer, a post mortem examination to be carried out as soon as possible. Therefore, it is the duty of the Government Medical Officers at government hospitals to carry out a post mortem examination upon request by the investigating police officer.

Islamic Law

Although an autopsy is generally considered inappropriate act according to Islamic law, however it is still allowed if they meet the conditions outlined by the Department of Islamic Development Malaysia (JAKIM) as long it fulfils the agreed guidelines titled ‘Guidelines on Post Mortem from Islamic Perspective’. This guideline was published after two decrees issued by the National Fatwa Council in 1989 and 2004 (JAKIM,2005):

Muzakarah Jawatankuasa Fatwa Kebangsaan ke-25 (13 Disember 1989):

“Pembedahan mayat orang Islam hanya boleh dilakukan jika keadaan benar-benar memerlukan (darurat) sahaja seperti terlibat di dalam kes-kes jenayah yang sangat memerlukan post mortem atau tertelan benda yang berharga atau si mati yang sedang mengandung sedangkan kandungannya masih hidup”.

Muzakarah Jawatankuasa Fatwa Kebangsaan ke-61 (27 Januari 2004):

“Hukum asal pembedahan mayat adalah haram tetapi dibolehkan sekiranya dalam keadaan darurat dan terdapat keperluan yang mendesak seperti membuat kajian terhadap penyakit, mengenal pasti punca kematian dan penyelidikan serta pendidikan khususnya dalam bidang perubatan”.

Postmortem Examination

The basic principle of the postmortem examination which is carried out on the dead body is to obtained information on the most probable manner and cause of death.

This is because of a death can be caused by various factors and ways. Therefore, there is a need to determine the correct and accurate cause of death. For example, deaths due to disease of known and yet known, naturally occurring diseases or even death involving elements of medico-legal.

The postmortem examinations are normally categorized into two types clinical and medico-legal.

Postmortem examinations of both these categories are performed by a qualified government medical officer with different level of expertise.

This is because clinical postmortem examinations are performed to obtain and expanding knowledge in the field of medicine whereas medico-legal postmortem examinations are carried out to fulfil legal system requirements.

The need of Postmortem

Malaysians in general have different views on the needs of the postmortem examination. Some are positive and some are negative. Whatever the view, the postmortem examination has needs and interests and among them are:

1. Meet legal requirement
2. To confirm the identity of the deceased.
3. To determine the cause of death.
4. To determine the cause, manner, and time of death.
5. To remove doubt about the cause of death.
6. To demonstrate disease and disability.
7. To trace, draw and document diseases and injuries outside and inside of the body
8. Obtaining a sample for review as the study of germs, abnormal tissue and others.
9. To take photographs and video footage for evidence / exhibits in court.
10. For a full written report of the findings in the autopsy.
11. To provide expert services on the interpretation of the findings during autopsy
12. To restore the badly injured bodies as possible before being handed over to the next of kin /family members.
13. For academic research, studies, and research in the medical field.
14. To enhance the skills and expertise.
15. To review the treatment of a disease.

Clinical Postmortem

The main objective of the clinical postmortem examination is to study and identify the main reasons that lead to the death of an individual after appropriate treatments and interventions that have been given fails to recover or save the individual. Clinical postmortems are conducted in cases usually not under the investigation of police officers.

There are also situations postmortem examination will be carried out even if the cause of death was known. This is mainly due to the requirements of further research on the characteristics of the disease to increase knowledge and understanding of the medical field towards the disease.

The information and knowledge gained from a postmortem examination will be used to treat and save patients who face the same problem in the future.

Clinical postmortem examination can only be carried out once relative or close family members given written consent to do so. The next of kin must sign on the special form to give consent to the hospital management to perform an autopsy after receiving clarification or briefing from the treating physician of the patient.

The next of kin has all the right to reject the application of the hospital for an autopsy if they feel no need or not in interest to allow the autopsy. The next of kin is advice must make final decision after a thorough assessment by considering all relevant aspects.

There are also may rise situations where a postmortem examination will be still carried out without the consent of the next of kin, this is subjected to only if the death was proved to be caused by infectious or deadly diseases based on the interest of the public safety (section 16, Prevention and Control of Infectious Diseases Act 1988). In such cases the permission to carry out the postmortem is subjected to power given to the Director General of Health Malaysia by relevant governing laws.

In Malaysia clinical postmortem is performed by a pathologist and assisted by a doctor or surgeon who treated the patient. Facilities used are Forensic Medicine Department / Unit of Forensic Medicine (formerly known as the morgue) facilities. Forensic Medicine Department support staff will also involve in the examination of the post mortem examination.

Examples of cases that are under the category of clinical postmortem are: –

1. Death due to infectious diseases such as the COVID 19, H1N1, Severe Acute Respiratory Syndrome (SARS), AIDS, Anthrax’s and Japanese Encephalitis (JE).
2. Death in the ward known why but needs more information about the death of the extent to which an organ is damaged / infected.
3. Death of the mother (maternal death).

Medicolegal Postmortem

Cancellation of a Postmortem

The question that is often directed by the public towards to the forensic medical services: Can the postmortem examination be cancelled even after issuance of Pol 61 by the police personnel?

The request for postmortem will be only issued once there is a reasonable requirement appears to a police officer or magistrate who investigated the death. It is in accordance with the provisions of law (Criminal Procedure Code) in our country.

If the beneficiary decides not to have the postmortem examination based on respect or comply with the requirements or religious beliefs, then they can do so by referring to the magistrate and make an application to strike out the postmortem examination request. If the police or the magistrate decides to cancel or withdraw, then they are held responsible to give the cause of death, how and when the death occurred.

Conclusion

Postmortem examination will only be done if there is a reasonable requirement as to obtain the information necessary to identify and unlock the event that led to death. Every cause of death should be known, especially if it involves the element of violence or crime.

References