10 Things to Know About Forensic Medicine

Forensic medicine covers a range of fields and professions, from coroners to forensic pathologists and medical examiners. Take a look at some of the common questions asked about forensic medicine to get a behind-the-scenes view of the medical examination field.

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1: What is a coroner?

Answer - A coroner is an appointed or elected public official whose official duty is to make inquiries into deaths in certain categories. The office of the coroner, or "crowner," dates back to medieval days, when the crowner was responsible for looking into deaths to be sure death duties were paid to the king. The coroner's primary duty nowadays is to make inquiry into the death and complete the certificate of death.

The coroner assigns a cause and manner of death and lists them on the certificate of death. The cause of death refers to the disease, injury or poison that caused the death. The coroner also decides if a death occurred under natural circumstances or was due to accident, homicide, suicide, or undetermined means or circumstances.

Coroners are called upon to decide if a death was due to foul play. Depending upon the jurisdiction, the coroner may or may not be trained in the medical sciences. In some jurisdictions, the coroner is a physician, but in many places the coroner is not required to be a physician or even be trained in medicine.

2: What is a pathologist?

Answer - Pathologists are physicians trained in the medical specialty of pathology, which is the branch of medicine that deals with the diagnosis of disease and causes of death by means of laboratory examination of body fluids (clinical pathology), cell samples (cytology) and tissues (pathologic anatomy). The autopsy is the procedure utilized to study the dead. It is primarily a systematic external and internal examination for the purposes of diagnosing disease and determining the presence or absence of injury. In modern times, chemical analysis of body fluids for medical information as well as analysis for drugs and poisons would be part of any autopsy on a dead body coming under the jurisdiction of the medical examiner or coroner.

3: What is a forensic pathologist?

Answer - The forensic pathologist is a subspecialist in pathology whose area of special competence is the examination of persons who die sudden, unexpected or violent death. A forensic pathologist is specially trained to perform autopsies to determine the presence or absence of disease, injury or poisoning; to evaluate historical and law-enforcement investigative information relating to manner of death; to collect medical evidence, such as trace evidence and secretions, to document sexual assault; and to reconstruct how a person received injuries.

Forensic pathologists are trained in multiple nonmedical sciences as well as traditional medicine. Other areas of science that the forensic pathologist must have a working knowledge of the applicability of are toxicology, firearms examination (wound ballistics), trace evidence, forensic serology and DNA technology. The forensic pathologist acts as the case coordinator for the medical and forensic scientific assessment of a given death, making sure that the appropriate procedures and evidence collection techniques are applied to the body. In jurisdictions where there are medical examiner systems, forensic pathologists are usually employed to perform autopsies to determine cause of death.

4: Where do forensic pathologists work?

Answer - Forensic pathologists are employed by states, counties, groups of counties or cities, as well as by medical schools, the military services, and the federal government. In medium-sized and smaller counties, the forensic pathologist may work for a private group or hospital that contracts with the county to perform forensic autopsies.

5: What is the difference between a hospital autopsy and a medical examiner autopsy?

Answer - The hospital autopsy is often performed on individuals in whom the disease causing death is known. The purpose of the autopsy is to determine the extent of the disease and/or the effects of therapy and the presence of any undiagnosed disease of interest or that might have contributed to death.

The next-of-kin must give permission for the autopsy and may limit the extent of the dissection (for example the chest and abdomen only, excluding the head).

A medicolegal (forensic) autopsy is ordered by the coroner or medical examiner as authorized by law with the statutory purpose of establishing the cause of death and answer other medicolegal questions. The next of kin do not authorize this and may not limit the extent of the autopsy. Common questions include the identity of the deceased person, the time of injury and death, and the presence of medical evidence (for example bullets, hair, fibers, semen). Observations made at autopsy elucidate how and by what weapon lethal injury was inflicted. During the course of the forensic autopsy, blood and other body fluids are routinely obtained to check for alcohol and other drugs. The forensic autopsy should be complete (including the head, chest, abdomen and other parts of the body as indicated).

6: What is forensic facial reconstruction?

Answer - Forensic facial reconstruction is the process of re-creating the face of an unidentified individual from their skeletal remains through an amalgamation of artistry, forensic science, anthropology, osteology and anatomy. It is easily the most subjective - as well as one of the most controversial - techniques in the field of forensic anthropology. Despite this controversy, facial reconstruction has proved successful frequently enough that research and methodological developments continue to be advanced.

In addition to remains involved in criminal investigations, facial reconstructions are created for remains believed to be of historical value and for remains of prehistoric hominids and humans.

7: Why perform an autopsy when the cause of death is obvious?

Answer - The importance of examining people for whom the cause of death appears obvious is severalfold. In the case of shootings or other fatal assaults the forensic pathologist, during the course of the examination, may recover bullets or other important trace evidence. In the case of motor vehicle occupants, it is important to determine who was driving and to assess driver factors, vehicle factors, or environmental factors that might have caused or contribute to the crash. Forensic autopsies may identify inherited diseases that constitute a risk for next of kin. Examples include certain types of heart disease and kidney disease. Notifying the family of their presence in the deceased would be an important service to the living.

8: How does the forensic pathologist determine the cause and manner of death?

Answer - The pathologist begins the investigation by taking the patient history and is of utmost importance in determining cause of death. The scene investigation may disclose drugs or toxins, which may be related to the cause of death. Some poisonous agents are not detected on a routine drug screens; therefore the pathologist must have knowledge of medications and toxins in order to request the specific analytical tests needed to detect them. An example would include the "sniffing" of aerosol propellants, a risky activity that has been frequently reported in teenagers. Sniffing of propellant substances can cause sudden death by precipitating lethal cardiac arrhythmias.

A special analysis is required to detect the chemicals in the blood. In other cases, there may be sufficient natural disease to account for death, but the individual may in fact have died of a drug overdose or other subtle cause. In the case of drowning and suffocation, the autopsy findings may not be specific and police investigation may be critical to the understanding of the death. Data developed by coroners, medical examiners and pathologists is studied by medical epidemiologists and heath and safety agencies to develop strategies to prevent disease and injury, thereby saving lives. The data developed about motor vehicle injuries and fire deaths led to legislation requiring seat belts in vehicles and smoke detectors in building construction.

In the examination of skeletons or severely decomposed remains, the forensic pathologist needs a working knowledge of multiple methods of identification, including forensic anthropology, to establish identity. If sufficient skeletal parts remain, the pathologist may be able to determine the age, race and sex of the individual and sometimes estimate the length of time since death. Occasionally, specific markings on the bones may enable the pathologist to come to a conclusion as to the cause of death.

9: What's it like to be a medical examiner?

Answer - If you are interested in a career as a medical examiner, you need to keep many things in mind. You will be on call and must often work weekends, evenings and at odd hours. The physical demands are difficult: bodies are cold, may be stiff, difficult to maneuver, the smells may be atrocious, injuries gruesome; the scenes may be bass, dangerous and chaotic. The workload is intense, because a corpse deteriorates rapidly. There is a lot of standing, measuring, weighing of body parts and internal organs, along with photographing and accurate record keeping.

10: What is a typical salary for a coroner?

Answer - Salaries for coroners vary widely, depending on the size, expected workload and crime rate of the area in which they are employed. In some areas, coroners earn in excess of $200,000 per year, and in others the annual pay for coroners can be as low as $40,000.

For more information about death, dying and the medical field, see the links on the next page.

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