The Importance Of Autopsies

Why Autopsies Matter

Thinking about what happens after death is part of human nature. We want to know what will happen to our loved ones – and ourselves – after we die. This consideration includes what happens to our physical bodies after we pass.

One topic that comes up often is the autopsy. What is an autopsy? Why are they performed? How do I know if it’s the right thing for a loved one?

When a person dies – especially if it's unexpectedly or violently – their loved ones want answers. Many questions accompany these types of deaths. The autopsy is an important key to finding these answers.

For many, the information we have about autopsies comes from popular media (especially crime dramas). It involves a forensic investigator using a body to find clues about a heinous murder or some horrible crime. We might be familiar with some of the specific terminology in basic terms but don’t have a great understanding of how and why.

Unfortunately, the pop culture CSI view of the topic is flawed and often comes with misinformation and misunderstanding about this scientific procedure.

With this article, we want to give you an in-depth look at what an autopsy entails, when the procedure occurs, and answer any questions you might have about the process.

What Is An Autopsy?

An autopsy is a medical examination of a human body after death. Most often, they are a form of surgical dissection. Autopsies determine the cause of death, answer questions regarding the death, or – in other cases – identify the body.

The procedure has many names, including postmortem, necropsy, dissection, and pathological examination. The external and internal exam involves – but is not limited to – the chest, internal organs, brain, teeth, and bones. Performing an autopsy can be crucial to understanding how – and why – our loved one has passed on.

More than that, autopsies have also been paramount in discovering diseases or previously unknown afflictions and medical conditions.

While they may seem invasive, they are helpful, positive scientific tools that help families find closure and peace. Not only that, they can give a voice to victims of violence and bring justice to them even after death.

A BRIEF HISTORY OF AUTOPSIES

The word autopsy comes from the Ancient Greek autopsia which means “to see for oneself.” It appears to have originated sometime in the 17th century in the context of internal examinations of a dead body for medical and investigational purposes.

While some dissections of the human body were performed earlier, it wasn't until the late 2nd century that Galen of Pergamum, an early Greek physician and medical theorist, began associating patient symptoms with evidence seen in examining the body after death. This was the groundwork for the modern autopsy.

Human dissection was banned during the Middle Ages. However, during the Renaissance era, the study of anatomy flourished. So too, did the medical study of deceased individuals.

Doctors began examining bodies to increase our knowledge of anatomy, physiology, and disease. Scientists looked for causes of death in the physical remains of their patients.

In 1761, Giovanni Morgagni, the father of modern pathology, published the first book comparing symptoms to anatomical observations seen during autopsy. From there, autopsies began to filter into the standard procedure for understanding how and why the death occurred.

WHO PERFORMS AUTOPSIES?

Medical examiners perform autopsies, often assisted by an autopsy technician. They may also have the assistance of a coroner to help with non-medical tasks. These three roles are similar but come with some important distinctions.

Medical Examiner

A medical examiner is a physician with specializes in forensic pathology. Pathologists are medical doctors with additional training in human diseases and body tissues. Forensic pathologists specialize in death investigations.

The medical examiner's duties incorporate the postmortem examination, death investigations, handling toxicology (and any other laboratory test results), collecting and documenting evidence, and providing testimony in court cases.

A medical examiner is an appointed position, though this usually does not have a term limit. Many medical examiners keep their position for the entirety of their careers.

Coroner

By contrast, a coroner is a locally elected official (typically serving a 2 to 4-year term) who begins an inquest into the manner of death. This position does not require medical training or qualifications outside their election.

Because they are not necessarily doctors, they do not perform medical examinations. Instead, they usually have to outsource autopsies to qualified pathologists. Their responsibilities include completing the death certificate, identifying the body, and starting the inquiry into any legal investigation. Coroners often work in smaller counties where having a full-time pathologist is not feasible for budgetary reasons.

While some regions rely on coroners to determine the cause of death, some may only use a medical examiner system. Some use a combination of the two to investigate the cause of death. Each state and county determine their system of death inquiry.

Autopsy Technician

Autopsy technicians are individuals trained to assist in autopsy procedures. They may help prep for the procedure, clean, do paperwork, and assist with the actual autopsy. Most technicians have a four-year degree in biology, chemistry, or another related field.

Are There Different Types Of Autopsies?

Today, autopsies follow a standard procedure with some variation depending on the type of autopsy and the purpose. There are four main types of autopsies: a medicolegal or forensic autopsy, a clinical or pathological autopsy, an anatomical or academic autopsy, and the most recent virtual autopsy. However, only two of these are considered traditional autopsies done for investigational purposes after death. The other two are done for educational or diagnostic purposes.

MEDICOLEGAL/FORENSIC AUTOPSY

Forensic autopsies are the most common type of autopsy seen in popular culture. These are the type that most people are familiar with. Forensic, or medicolegal, autopsies, are performed to determine the cause and manner of death. They are part of larger medicolegal investigations, which conduct inquiries into the cause and manner of unnatural or unexplained deaths.

Forensic autopsies apply forensic science (the application of science to answer questions relevant to the legal system) to determine important aspects surrounding death. This includes the time of death, the exact cause of death, and possible events that led up to them.

In the case of violent deaths, forensic autopsies often provide critical evidence in criminal cases, leading to the apprehension and conviction of those responsible.

CLINICAL/PATHOLOGICAL AUTOPSY

In clinical autopsies, the focus shifts from purely medicolegal investigations. Instead, they investigate disease, general health, and other factors that may have contributed to the death. Instead of looking for evidence as to how the person died, clinical autopsies look at disease processes and how they affect the body.

This type of autopsy is an important aspect of medical care. Clinical autopsies ensure a standard of care in hospitals, hospices, and other long-term care facilities.

They ensure that no misdiagnosis occurred and that all patients were given adequate care. Moreover, clinical autopsies also provide caregivers more information about future treatments for diseases and genetic conditions.

ANATOMICAL/ACADEMIC AUTOPSY

There is no better way to understand the human body than to study it. This includes what happens to the body after death. That is the purpose of anatomical (or academic) autopsies. These are conducted by students or researchers as part of academic advancement. Most academic autopsies are performed by future doctors, surgeons, and physical therapists.

In most cases, anatomical autopsies occur due to deceased individuals who have donated their remains after death.

There are many reasons people donate their remains. However, if you are struggling to pay for funeral expenses, you may want to read How to Have a Funeral When You Don’t Have Any Money for more information about body donation and funeral planning.

VIRTUAL AUTOPSY

As a newer form of an autopsy, virtual autopsies are performed by using computer imaging methods. These noninvasive autopsies use a CT Scanner to create a 3D graphical model of the body.

Also called a “virtopsy,” this type provides several advantages to traditional methods, including the fact that a digital examination can be conducted years after the initial death.

Unfortunately, they also come with the disadvantage of lacking many physical senses (touch, feel, color, etc) that forensic personnel rely on to make determinations.

What Does An Autopsy Tell Us?

For many, the entire concept of an autopsy is invasive and may seem completely excessive. This feeling is often amplified by grief and loss in the early days after a loved one’s death. In the most clinical sense, autopsies are a diagnostic tool to determine important factors in the death of a person.

On a personal level, they are much more. In truth, autopsies reveal important information to doctors, medical professionals, and especially grieving families that might otherwise go unknown without this procedure. If you have ever wondered what an autopsy can tell you, here is the most relevant information they reveal.

PHYSICAL CHARACTERISTICS

The most basic knowledge provided by an autopsy is the equivalent of a doctor's physical examination of the body. A medical examiner will document pertinent information about the individual, including height and weight at death, estimated age, sex, and race. They will also look at hair color, eye color, and other physical characteristics to verify the identity if there is a question. Any obvious dental work, tattoos, or unusual body modifications will also be noted.

CAUSE OF DEATH

This is, of course, the most important aspect of forensic autopsies. The medical examiner’s main goal is to investigate the specifics of a person’s death to provide closure to the family and answer any lingering questions.

The most common causes of death in the United States include cardiopulmonary failure (heart failure), myocardial infarction (heart attacks), diseases (such as pneumonia or cancer), blunt force trauma. Causes of death can be categorized into an accident, suicide, homicide, natural causes, and undetermined (if the results of the autopsy are inconclusive).

TIME OF DEATH

As important as the cause of death, time of death is an approximation based on many factors, including physical attributes of the body. This is another crucial element in forensic autopsies, as they can help establish a timeline and gather evidence that can support or deny the stated actions of suspects at the time of a crime. Medical examiners also look to determine the PMI, or postmortem interval, which is the time between the death and discovery of the body.

THE STATE OF HEALTH BEFORE DEATH

This determination is important to discover the cause of death as well as look into the effects of medical treatments that may have been ongoing before the person passed. This can help determine how effective and appropriate medical treatments proved to be if the person was suffering from a disease or condition.

It can also give information about any factors that could have led to their death. For example, where they suffering from malnutrition, lingering trauma from previous injuries, or any other health problems. Autopsies can find evidence of undiagnosed medical conditions as well as lingering ones that may have been undetectable while the person was alive.

Why Are Autopsies Important?

One of the most important things an autopsy can do for a grieving family is providing closure. Autopsies can help us understand more about the death of our loved ones beyond what is instantly available after death. They give answers and – in many cases – a voice to those who are unable to advocate for themselves.

Sometimes, autopsies can help medical professionals, too. They may learn more about disease processes and perform procedures impossible to do while a person is still alive. In the case of infectious diseases or possible outbreaks, they may discover evidence that allows them to stop or slow the spread more quickly.

With this knowledge, they can broaden their knowledge about diseases such as certain forms of cancer, dementia, heart failure, and chronic illnesses. This gives them better tools to help others suffering from these conditions in the future, developing more effective and painless treatment plans. If you or a loved one have been diagnosed with a terminal illness, we recommend reading this guide to coping with a terminal illness.

As seen most often in popular culture, autopsies are a way to gather legal evidence in criminal investigations. Autopsies provide important information – including the cause of death, time of death, and even identification of the body – that can directly lead to arrests and convictions of perpetrators before they can harm others.

In short, autopsies give doctors the tools to better serve their communities and the general health and wellbeing of populations.

Who Can Request An Autopsy?

Not just anyone can request an autopsy after a person passes away. There are state laws regarding these requests, though there are typically three avenues to make the request:

NEXT OF KIN

If you are the next of kin or legally responsible for the deceased person, you can request an autopsy. This is the most common type of request outside of a legal inquest. In this case, you sign a consent form from the doctor to permit the procedure.

THE DECEASED

It is possible to request an autopsy before your death. For some, this involves adding a provision into their will. In that case, the executor of the will is in charge of making those arrangements with the doctor. This is relatively rare but it does happen.

LEGAL AUTHORITIES

Sometimes, autopsies are legally required for any number of reasons. If that’s the case, legal authorities will request an autopsy be performed before the body is turned over to the family for funeral arrangements.

Do You Have To Have An Autopsy?

While autopsies might seem ubiquitous in popular culture, they are not a medical necessity after every death. Only around 5% of deaths result in autopsies, including forensic investigations. When a person dies in a hospital, that rate is even lower. Overall, autopsies are relatively rare in the United States. Unless an autopsy has been requested by legal authorities as part of a medicolegal investigation, it is not required.

While a physician may recommend an autopsy for specific purposes, only the next-of-kin can order a voluntary autopsy to be performed. No family should feel pressured to have one done, especially when considering the cost they’re likely to shoulder in the process.

There are many legitimate reasons for not wanting a loved one autopsied. The most common lies in religious beliefs. Objections may include concerns about the delay in preparation and burial, restrictions of religious laws or traditions, and even concerns about desecration or disturbance of the body after death. If this is the case, most coroners and medical staff will be willing to work with the family about these concerns.

However, it must be said that religious exemptions are unlikely in the face of criminal investigations, including violent deaths or one where medical misconduct is suspected. In these cases, the autopsy may be vital to protecting others, providing evidence, and giving definitive answers after death.

For more information about funeral practices, including religious exemptions, visit our Complete Guide to Funeral & Burial Traditions.

When Are Autopsies Required?

As we've outlined above, certain types of death require autopsies to be performed. Most of the time, these are linked to medicolegal investigations. However, there are some other situations where they might be mandatory. Here are the most common among those.

SUSPECTED CRIMINAL ACTIVITY

If a person dies due to suspected violence or foul play, then an autopsy is always required. While the cause of death might seem outwardly obvious, the medical examiner employs methods that will allow for a more detailed examination that reveals details crucial to understanding how and why the death occurred. They are often able to find evidence within the body that can bring justice to their deaths.

SUSPECTED MEDICAL MALPRACTICE

Often tied to criminal investigations, autopsies can determine whether the deceased received appropriate medical treatment before their death. Was the diagnosis accurate? Were the doctors treating them appropriately?

UNEXPLAINED OR UNEXPECTED

Sometimes, our loved ones can die without warning and without any indication that something is wrong. If that happens, it can leave the family reeling from grief, loss, and the devastating question of why it happened. If an unexplainable death occurs in a person not under direct physician’s care (as in a hospital or hospice), an autopsy may be requested to discover what underlying causes might have led to the loss.

INFECTIOUS DISEASE & PUBLIC SAFETY

In cases where an individual has – or is suspected of having – an infectious disease, an autopsy may be requested by medical authorities. This is done to determine the risk to public health and safety, especially if the disease is relatively new, unknown, or requires more research than is currently available.

UNEXPLAINED OR UNEXPECTED DEATH OF A CHILD

The death of a child is always a tragedy. But an unexpected death is even more tragic, especially for the families involved. Autopsies can provide answers to this tragedy that might not seem obvious. Autopsies have been crucial to understanding SIDS (sudden infant death syndrome) and other natal and neonatal deaths.

DEATH DUE TO WORKPLACE INJURIES

If someone dies as a result of their employment or in the line of duty – as in firefighters, police officers, construction workers, etc – then it is likely an autopsy will be required. This can determine whether workplace negligence played any part in the death or if there were other factors in play.

UNWITNESSED OR SUSPECTED DROWNING

In cases where a body is discovered in any body of water or adjacent to water, an autopsy will be performed to determine whether drowning played a role in the death. It can determine if the drowning was accidental or if criminal intent was involved. In some cases, it might be relevant to determine if the body was moved after death to hide evidence.

WHEN THE IDENTITY OF THE DECEASED IS UNKNOWN OR IN QUESTION

When an unknown individual is discovered, authorities may need assistance in discovering their identity as well as the cause of death. In this case, an autopsy can discover physical clues to their identity that might not be immediately obvious. They can determine any trauma, disease vectors, or even previous medical procedures that may lead to a positive identification of the person.

SKELETONIZED REMAINS

Sometimes, recovered human remains have deteriorated beyond an external examination. Much like in the case of unknown individuals, skeletonize remains require additional methods for recovery and identification. Oftentimes, pathologists consult other forensic scientists who specialize in the identification of bones (forensic anthropologists) and teeth (forensic dentists). This is also the case in situations where the body has been burned or otherwise damaged.

WHEN FORENSIC PATHOLOGY IS NECESSARY

There are other circumstances in which the forensic pathologist might see the need for an autopsy. This is based upon their discretion. If this is the case, then it’s considered a standard part of medicolegal investigations.

What Happens During An Autopsy?

For most of us, what we know about autopsies comes from popular culture. As we’ve addressed, popular crime dramas and suspense films may feature sequences addressing mortuary procedures and even offer some idea of what happens within an autopsy room. However, many times these fictional portrayals feature outlandishly expensive or impossible technology or procedures that simply are not done.

In this section of the guide, we will try to walk you through the autopsy procedure. Please take note that this does describe the dissection of the human form so please, be advised.

EXTERNAL EXAMINATION

Before any incisions are made, the medical examiner makes a physical inspection of the body. This includes taking notes of physical characteristics like age, race, and any unusual tattoos or scars. Any clothing and personal items are removed, examined for relevance in the procedure, then secured to be returned to the next-of-kin or legal authorities.

The body is examined for evidence of physical trauma: bruising, cut marks, gunshot wounds, or any other signs of injury. Medical examiners also look for unusual substances or marks.

At this stage, they may take x-rays of the body, focusing on the chest, head, and teeth. They may take hair or blood samples at this stage as well.


INTERNAL EXAMINATION

After the external examination is completed, the physician will begin examining the inner organs and tissue of the individual. This begins with a standard Y-shaped incision beginning at each shoulder, connecting at the front of the chest, and then finishing below the navel.

The chest cavity is opened and the front ribs removed, allowing the medical examiner to inspect the organs while they are still in the body.

A full autopsy includes an examination of the brain, though this is not always necessary depending on the situation. If that occurs, an incision is made at the back of the skull and the crown of the head. The skin is pulled forward to reveal the skull, allowing cuts to be made so that the brain is accessible.

After each organ is examined, it is removed from the body, weighed, and then placed aside. Dissection of certain organs may be necessary and tissue samples may be taken at this time. These samples will be sent to a laboratory for further tests (like toxicology reports to determine if any substances were in the body at the time of death).


RECONSTITUTION

Once the examination has been completed, the medical examiner – or autopsy technician – will place the organs in a bag and then return them to the chest cavity (or place them aside for cremation, depending on the family’s funeral arrangements) and suture all incisions.

If certain organs are needed for further testing – like the heart, lungs, or brain – then those are set aside and typically preserved. The body is washed and removed from the examination room.

After The Autopsy

At this point, the medical examiner will contact either the deceased next-of-kin or the mortuary services contracted by the family. They will store the body in a temperature-controlled facility – often called a morgue or mortuary – until pick-up for the body is arranged by a third party.

The entire process for an autopsy only takes a few hours. At that point, the medical examiner will record their findings and type up their report. Even after an autopsy, families are still able to arrange an open casket funeral.

Are Autopsies Covered By Insurance?

Typically, voluntary autopsies are not covered by most forms of insurance, including Medicare or Medicaid. Fortunately, in any case where they are questions related to the case the attending medical professional will often request one themselves. If that happens, the family does not need to pay. However, private autopsies are not covered by insurance or any medical institutions.

Unless an autopsy is requested by medical professionals or law enforcement, the full cost falls upon the family making the request. Autopsies can be expensive, as many run between $3000 – 5000 depending on the region and procedures involved.

When Will I Know The Results Of An Autopsy?

The full autopsy can be completed in somewhere between 2-3 hours depending on the type of procedure. In most cases, the initial findings will be available within a few days of the autopsy. This time does depend on the schedule and workload of the medical examiner.

The initial findings can offer basic anatomical information as well as potential causes of death. However, if the medical examiner must send any blood or tissue samples off for laboratory testing, this can delay the full autopsy report for several weeks.

Once the medical examiner or coroner has all information, then they can release an autopsy report that includes all physical evidence as well as clinical evidence to back up the initial findings for cause of death.

Autopsy Frequently Asked Questions

Given that an autopsy is not an every day occurrence for families we understand there are bound to be questions. Here are some of the more frequently asked questions about autopsies.

Should I have an autopsy done on my loved one?

Autopsy decisions can be a painful, personal process if you aren't prepared for them. It can seem invasive or disrespectful to your loved one but more often than not, it is an important procedure that can help you and your family have a greater understanding of your loss. They offer information about the death and factors leading to it, especially if it is unexpected or suspicious.

If the physician or local authorities request an autopsy, then it is likely that the decision is out of your hands, especially if there are any questions about the manner of death. For these types of deaths, it is a legal requirement.

If you are not comfortable with the hospital autopsy for any reason (or feel that there should be one even if it is not required), you can hire a pathologist to do a private autopsy for you. However, only next-of-kin can permit one. Additionally, pathologists charge for private autopsies.

What will the doctor look for when they do an autopsy?

When a medical examiner conducts an autopsy, they typically begin their examination by looking for a standard set of evidence and information. As the autopsy progresses, they might narrow their investigation as they discover new information. Medical examiners look for evidence to discover many things, including:

  • External and internal trauma to the body, including disease
  • Physical characteristics of the individual, including age, race, sex, height, and weight
  • Biological specimens to be used in laboratory tests
  • Cause of death
  • Time of death
  • Events directly preceding the death (including signs of struggle)

Can I have an open casket funeral if my loved one had an autopsy done?

Usually, you can have an open casket funeral after an autopsy. The purpose of an autopsy is to investigate the manner of death and while it is invasive, coroners and medical examiners use methods designed with traditional funeral practices in mind. Most morticians are highly skilled in preparing a body after it’s been autopsied.

Whether or not an open casket is feasible depends more upon the manner of death than whether an autopsy has been done. If the body has undergone serious trauma or there has been an extended period between the death and move to the mortuary, an open casket may not be possible.

Do hospitals do their own autopsies? 

While historically hospitals performed the bulk of their autopsies, that isn't always the case today. If a person dies under the direct care of a physician or in a hospital, the autopsy usually takes place in that facility. When the family chooses to do an autopsy outside of an official inquest, a private autopsy can be requested from pathologists. With this, the body will be transported off-site for the procedure.

This is also the case with autopsies for medicolegal investigations (where there is some question about the manner or circumstances of the death). Most coroners or medical examiners work in separate facilities designed exclusively for these investigations.

The location of the autopsy varies depending on local facilities. Some smaller, regional hospitals may not have the space or facilities to do their own autopsies and the body may be transferred to a medical examiner’s office by default.

Where is a body stored before an autopsy?

Most bodies are stored in a morgue (or a mortuary) after death. These can be located within hospitals or at a secondary, off-site location. Typically, morgues hold human remains while they are awaiting identification, are released to family or next-of-kin for funeral services, or as a temporary holding location before an autopsy is performed. Morgues are equipped with temperature-controlled chambers to keep remains refrigerated. This is done to delay decomposition.

What is the room called where the autopsies are performed?

While many people think the mortuary or morgue is the place where autopsies take place, they are typically moved to another room (or other location) for this. Typically, these are simply called “autopsy rooms” or “examination rooms,” though they are uniquely designed for the procedure.

How long after death can an autopsy be performed?

An autopsy can be done any time after a person’s death. While medical professionals can gain more information from a freshly deceased body (preferably within the first 24 hours after death), autopsies are routinely done days, weeks, or even months after death. Decomposition does limit many other factors, but forensic pathologists can still collect important data for up to years after a person’s death.

Who pays for an autopsy when someone dies?

If an autopsy is legally required, then there is no charge for the service. The county, state, or federal government will pay for the autopsy. However, families and loved ones can request a private autopsy to be performed if they would like. These do come with additional charges and will be billed to the party making the request.

Is an autopsy required if you die at home?

Not always. The circumstances of the death determine if an autopsy is required after the death. If it is determined the person has died of natural causes, then an autopsy may not be needed. If the death is considered unusual or suspicious, then it is like it will be legally required.

How much does a full autopsy cost?

Autopsies required by law (as may be the cause in some circumstances – see below for details) are free. However, private autopsies done at the request of family or next of kin can cost anywhere from $3000 – 5000. There may also be an additional fee for transportation, additional tests, and other aspects of the procedure.

How long does it take for a body to be released after an autopsy?

Typically, bodies are released within 24 hours after the autopsy is completed. If there is a criminal investigation underway, that time may be increased by a few additional days.

When is an autopsy required?

Contrary to what popular culture tells you, autopsies are not always required after someone dies. If the death is ruled as natural causes due to a known medical condition or shows no signs of foul play, then typically medical examiners will not perform an autopsy.

Autopsies can be legally required, however, for several reasons, including:

  • When the death is sudden or unexpected. This includes sudden infant death (SIDS) or in an otherwise healthy individual who has not been under a doctor's care.
  • When the death may be a public health concern, such as an infectious disease
  • When a person dies suspiciously or unusually. Suspicious death includes suspected violent crime, electrocution, intoxication from drugs, alcohol, or poison, or by suspicion of other collected evidence.
  • When the dead person is unidentified, and an autopsy may aid in the identification of the deceased.
  • When a person dies under the custody of a state, local, or federal institution.

In the United States, laws differ from state to state. Some states may have more strict legal requirements for autopsies. If you have further questions, you may want to check with your local medical examiner's office.

What is an autopsy report?

An autopsy report is a document written by the pathologist detailing their findings from the autopsy. The report includes the results of any tests done (like toxicology reports). It is a medicolegal document, meaning that it can (and often is) be part of any legal proceedings. Typically, photographs are not included in the basic report.

Autopsy reports are subject to the same patient-doctor confidentiality as any other medical procedure except in the cases of medicolegal investigations. If that is the case, it means that copies can be retrieved by family members, authorities, and other parties.

Autopsies: A Total Body Investigation

No one enjoys thinking about what happens to our loved ones after they pass, including various medical and physical procedures that may come from it. Autopsies are one of those possibilities, especially in case of sudden or unexpected death. 

Most of the best things we can do to combat our fears and concerns about death are to educate ourselves to the best of our ability. The most we understand about the medical and legal processes that face us at the end of life, the better prepared we are to make the best decisions for ourselves, our families, and our deceased loved ones.

September 30, 2021 by Frances Kay