How a person is cut open. Forensic examination of a corpse (autopsy)
An autopsy is a medical procedure performed in a morgue to determine exact reason death of a person. If there is no suspicion of criminal or medical reasons death, refusal of an autopsy is POSSIBLE by law. Therefore, if the deceased was taken to the pathological morgue (PAO), refusal of an autopsy is possible, since the bodies of those who died from natural causes.
Refusal to autopsy the deceased
Often the relatives of the deceased are faced with the question: “Is it possible to refuse an autopsy of the deceased?”, since for many, refusing an autopsy is relevant. The reasons for refusing an autopsy can be different: the religious beliefs of the deceased, his will and testament, the wishes of his family members. Federal Law No. 323-FZ (Article 67.3) states that refusing an autopsy is fundamentally possible. At the same time, the same law clearly defines situations in which an autopsy must be performed.
Presumption of consent to organ removal in Russia
In Russia, at the legislative level, there is a presumption of consent of relatives to the removal of organs of the deceased (transplantation). This means that permission from relatives is not required to remove organs. If the family of the deceased has provided a notarized application of the deceased to refuse the autopsy or has themselves issued a written application to refuse the transplant, the procedure will not be carried out (except for situations where it is impossible to refuse the autopsy - see the paragraph below “In what cases is it impossible to refuse the autopsy? ").
How to refuse an autopsy?
Many people are interested in how to refuse an autopsy. You can refuse an autopsy by submitting an application addressed to the head of the morgue. An application for refusal to open is written in free form, but you must specify:
- Full name and passport details of the applicant
- Full name, date of birth, date and place of death of the deceased
- reason for refusing to open
- a notarized copy of the will (if the deceased has stated a refusal to open it in his will)
The final decision to perform or not to perform an autopsy is made by the pathologist based on the available medical indications.
Reasons for refusing to open
The fundamental possibility of refusing an autopsy is established by federal and local legislation. The opportunity to refuse an autopsy is spelled out in Article 67 No. 323-FZ “On the fundamentals of protecting the health of citizens” and paragraph 1 of Article 5 of Federal Law No. 8 “On burial and funeral business.”
The main reasons for refusing an autopsy are the will of the deceased and religious prohibitions. For example, in Judaism it is forbidden to dissect the remains of the dead.
Morgue with more likely will accept a refusal to open it if:
- The deceased was ill and died under the care of doctors;
- Eat outpatient card with data on the illness/illnesses of the deceased, including those leading to death;
- Death occurred due to long illness
- There are results histological analysis in case of death from oncology (cancer).
How much time do you have to refuse an autopsy?
You have 3 days to refuse opening. There are two main reasons:
- An autopsy in a morgue must be performed within three days after the body is delivered to the morgue
- Burial in accordance with the norms of confessional funeral rites is allocated from 1 to 3 days
Therefore, if the relatives of the deceased want to refuse an autopsy of the deceased, they should not hesitate to submit an application to the morgue.
Who applies for an autopsy waiver?
- relatives (burial organizer on the part of relatives)
- funeral agent
In addition to relatives, an application for refusal of an autopsy can be submitted by the funeral agent of the funeral service organizing the funeral.
Sample application for refusal to open
A sample application for refusal to open an autopsy can be downloaded
In what cases is it impossible to refuse an autopsy?
The law establishes situations when a mortuary may refuse an application to waive an autopsy - even if the deceased has recorded a refusal to perform an autopsy in his will. Federal Law No. 323 provides a list of situations when it is impossible to refuse an autopsy.
- Suspicion of violent death (incl. traffic accident, accident)
- Suspected death from drug overdose
- Suspected death due to drug intolerance
- Death from infection (or suspicion of it)
- Death from oncology (if there is no histological analysis)
- Death associated with blood transfusion
- Death of a pregnant woman during childbirth, shortly after birth
- Death of a child under one month of age or stillborn
- Death from an environmental disaster
- It is impossible to determine the cause of death without an autopsy.
- Before death, the deceased was in hospital for less than 24 hours
In order No. 1064 (dated December 29, 2016), the Moscow Department of Health clarified and supplemented this list with the following cases:
- The will of the deceased or the request of his relatives to conduct an autopsy
- Death of an unidentified person
- Death within a month after discharge from hospital
- Death as a result of preventive measures medical procedures
- Death from acute surgical pathology
If the body has been sent to the medical examiner's office, you cannot refuse an autopsy.
If the body arrived at the forensic morgue (FME), and not the pathological morgue (PAO), it is impossible to refuse an autopsy. In addition to the suspicion of death due to external circumstances, refusal of an autopsy is impossible if the deceased died on the street.
If, after the death of a person, his relatives first called the police, and not the funeral service or ambulance, then the body with high probability will be taken to the forensic morgue. In this case, refusal of a pathological autopsy is impossible.
An application for refusal to open an autopsy may not be considered on time. What to do?
Due to the heavy workload of hospitals, an application to waive an autopsy may not be reviewed in time for an autopsy to be performed. There is always such a risk.
Entrust refusal of opening to the website service
It is better to delegate the task of refusing to open an autopsy funeral agent official city funeral service website, as it has established contacts with Moscow city morgues and will help not only in organizing the funeral, but also in negotiations with the morgue.
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Epigraph:
I don't complain
That God took away the baby,
And it hurts why they
Did you scold him?
Why, how black are the crows,
Parts of the body are white
Tormented?.. Really?
Neither God nor the king will intervene?
Vikenty Veresaev, "Notes of a Doctor"
When is a pathological autopsy ordered?
In any case of death. Violent, from illness or from natural causes. That is, a person dies in a hospital from known diagnosis, at home, if he gets into an accident or is killed, an autopsy will most likely be performed.
Why don’t loved ones want an autopsy?
I just don’t want to, that’s all. This person, this corpse belongs to them and to God, but not to the doctors, dissectors, or pathologists who perform the autopsy. There are “religious reasons” too. Some religions do not allow autopsies.
Why do you need to perform an autopsy?
To try to find out the real reason death, illness. Assess the correctness of treatment, identify and punish those responsible. “Here the dead teach the living” - absolutely yes. When the attending physician goes to the pathology department and sees the organs of the person whom he tried to treat, puncture, palpate, prescribe pills, a serious experience for the future is formed in the doctor’s head, and an opinion appears about the correctness of his actions. He looks at the patient differently. In case of similar symptoms can draw more accurate conclusions.
And further. If the patient’s relatives decide after a couple of months that the doctors are murderers, it will be very difficult to prove anything without an autopsy. Warring clans of heirs can take advantage of this when dividing property.
What happens if medical errors are discovered?
Usually nothing. The hand washes the hand. In the medical history, the pathological diagnosis differs from the clinical one, the case is examined at a clinical-anatomical conference (if the death is in the hospital) and that’s all. Diagnosis discrepancy. They were treated for something else. This information does not reach the relatives of the deceased. The pathological diagnosis is written on the death certificate. And rightly so. The fact is that usually more accurate diagnosis does not change anything in a person’s fate. Oh, if only... no. If a person must die, he will die. There are, of course, serious mistakes, but they are rare. And, as far as I know, even in cases of obvious mistakes, doctors do not write letters to the prosecutor’s office against themselves.
What do they tell the relatives of the deceased when asked “not to open them?” And how to proceed?
The doctor hesitates, says that this is how it’s supposed to be, and an autopsy is necessary. In this case, the aesculapians do not have a deeper understanding of the topic of legislation and send people to the administration of the medical institution. There, if you really want to prohibit an autopsy, a statement is written:
“I ask you not to perform an autopsy on my **** who died at that time, in such and such a department, for religious reasons. I understand that if an autopsy is refused, the opportunity to accurately determine the cause of death may be lost; I have no complaints against the hospital.”
All. If such a statement is written and a forensic autopsy is not ordered, pathologists will not touch the corpse. And no one will ask what exactly “Religious reasons” are, and if they ask, you can answer “It’s none of your business.” In this case, the refusal of the hospital administration is a violation of the law.
Forensic autopsy.
Conducted in special morgues. It is prescribed if there is a suspicion of violent death, be it injury, poisoning or any other reason. This opening cannot be avoided under any circumstances.
Economics of pathological anatomy.
The hospital makes a lot of money from its own dead. Each pathological examination costs money, this money is paid by the insurance company after the fact (CHI). Naturally, the hospital administration is directly interested in autopsying all the corpses. Business…
Whose corpses are usually not autopsied?
1. Natsmenov. A noisy flock comes running, screaming, talking loudly, and in the end they manage to cancel the autopsy.
2. Relatives of doctors and important persons. People quietly piggy and go to meet them, or demand, or pay :).
Legislation.
The main rule on the basis of which the pathoanatomical service now operates is Order of the USSR Ministry of Health dated June 20, 1959 N 316. Since then it has been rewritten several times, but essentially everything remains as it was formulated 50 years ago. The text of that order. And here is the clerk of the Ministry of Health from 1994, number 382.
The topic of refusal to open an autopsy is also discussed in the Basic Law of modern Russia. I quote article 48 in full:
FUNDAMENTALS OF LEGISLATION OF THE RUSSIAN FEDERATION ON THE PROTECTION OF CITIZENS' HEALTH
(as amended by Decree of the President of the Russian Federation dated December 24, 1993 No. 2288; Federal laws dated 03/02/1998 No. 30-FZ, dated 12/20/1999 No. 214-FZ)
Article 48.
Carrying out pathological autopsies.
A pathoanatomical autopsy is performed by doctors to obtain information about the cause of death and diagnosis of the disease.
The procedure for conducting pathological autopsies is determined by the Ministry of Health Russian Federation.
For religious or other reasons, if there is a written statement from family members, close relatives or a legal representative of the deceased or the will of the deceased himself expressed during his lifetime, a pathological autopsy in the absence of suspicion of violent death is not performed, unless otherwise provided by the legislation of the Russian Federation.
A conclusion on the cause of death and diagnosis of the disease is issued to family members, and in their absence - to close relatives or the legal representative of the deceased, as well as to law enforcement agencies at their request.
Family members, close relatives or the legal representative of the deceased are given the right to invite a specialist of the appropriate profile, with his consent, to participate in the pathological autopsy. At the request of family members, close relatives or the legal representative of the deceased, an independent medical examination can be carried out.
Autopsy (synonym: section, autopsy) is an examination of the body of the deceased in order to study the structure of the body, determine changes in organs and tissues, and also to determine the cause of death. It is customary to distinguish between anatomical, pathological and forensic autopsies (see below). Autopsy have great importance in the study of thanatology (the study of death), epidemiology, as well as in the teaching of medical disciplines.
Anatomical dissections are performed in departments of anatomy to study the structure of the human body.
Died in medical institutions usually undergo a pathological autopsy, which is regulated by instructions on the procedure for autopsies of corpses in medical institutions. An autopsy is usually performed no earlier than two hours after death is established. Pathoanatomical autopsies are performed by pathologists in specially equipped rooms (sectional rooms) of the departments pathological anatomy and pathological departments of medical institutions. The purpose of such an autopsy is to establish the underlying disease, complications and concomitant diseases, as well as causes of death. Based on the results of the autopsy, one can judge the correctness of the lifetime diagnosis and the therapeutic measures, which is important for improving diagnostic and treatment work.
The autopsy is preceded by familiarization with all medical documents relating to the deceased. To autopsy corpses, a sectional set of instruments is used. The pathologist and the staff assisting him put on rubber gowns, sleeves and an apron. In cases of death from special dangerous infections or if there are substances (radioactive, chemical agents, etc.) in the corpse that are hazardous to the health of the doctor and those present during the autopsy, special suits are used. After autopsy of the corpses of people who died from especially dangerous infections, all persons who were in the section are subjected to; the room where the autopsy was performed, and the coffin with the body of the deceased - wet. The body is not released to relatives.
The autopsy is preceded by an external examination; note physique, nutrition, body weight and condition skin, pay attention to rigor mortis, cadaveric spots, ulcers, tumors, etc.
Then they begin to autopsy the corpse. For this purpose, various soft tissue incisions are used (straight, Leschke, Fischer and combined). Thoracic cavity opened by dissecting the costal cartilages near their transition into the bone (Fig.). Examining the abdominal pleural cavity and the pericardial cavity, note the presence of fusions of the leaves serous membranes, effusion, the nature of the location of organs, etc. The skull is opened by cutting the soft tissues from ear to ear and detaching them anteriorly, then sawing horizontally and removing the roof of the skull. To extract and open it is necessary to saw through the posterior arches of the vertebrae.
When opening internal organs, they are examined on the spot, then removed from the corpse in a certain sequence: organs of the neck, chest and abdominal cavities, and small pelvis. Organs genitourinary system sometimes isolated separate complex, in some cases, all are extracted as a single complex internal organs.
The extracted organs and organ complexes are carefully examined, their size, weight, color and surface condition are determined, then they are examined after appropriate incisions. Pieces are taken from organs and tissues for histological examination, as well as material for serological and biochemical studies.
After the autopsy is completed, the corpse's organs are placed back into the cavities, the incisions are sutured, washed and dressed. During or after the autopsy, a protocol is drawn up, in the descriptive part of which the changes discovered during the autopsy are objectively recorded. A pathological diagnosis and epicrisis are also prepared. The diagnosis is the essence of the detected changes, described briefly in pathoanatomical terms, in accordance with the course of the main disease process, complications and concomitant diseases. The pathological epicrisis presents the results of a comparison of data and autopsy materials, taking into account all additional research. At the end of the epicrisis, a conclusion is given about the mechanism and causes of death.
A forensic autopsy is performed in all cases of violent death (murder, suicide, accident), if it is suspected; when it did not occur in a medical institution; in cases where the cause of death is not clear, if there are doubts about the correct treatment of the deceased. A forensic autopsy is carried out only subject to a decision by the investigative or inquiry authorities, as well as a court decision. In case of death in medical institutions on the first day after admission with an unknown diagnosis of the disease, a forensic autopsy is also performed.
During a forensic autopsy of a corpse, the cause of death, the time of its occurrence, the presence of alcohol in the corpse are determined, and other issues are resolved depending on the specific circumstances of the case.
During an external examination of the corpse, attention is paid to clothing, cadaveric spots, rigor, temperature, putrefactive phenomena are noted; if there are damages, their exact location, nature is indicated and it is established what they could have been caused by (blunt, piercing or cutting objects, firearms, vehicles and etc.).
All individual characteristics of unidentified corpses are recorded in detail. Parts of organs and body fluids can be taken for histological, forensic chemical and some other laboratory tests.
After the autopsy of the corpse, an act or conclusion is drawn up, in which court medical expert gives answers to the questions contained in the decision on the appointment of an examination (see Medical, forensic documentation).
Typically, an autopsy is performed 12 hours after death, but Soviet legislation allows autopsies to be performed for scientific and practical purposes 2 hours and even half an hour after death.
In these cases, the autopsy must be performed in the presence of three doctors who, before the autopsy, draw up a protocol indicating evidence of actual death and the reasons for the need for an early autopsy (see “Rules for forensic medical examination of corpses,” approved by the People's Commissariat of Health of the RSFSR on December 19, 1928 and the People's Commissariat of Justice of the RSFSR 3 January 1929).
Before each autopsy, the prosector gets acquainted in detail not only with the clinical diagnosis, but also with the medical history of the deceased.
The medical history must be finalized and signed. No fixes in clinical diagnosis after opening are not allowed.
Without a medical history, based only on oral reports, an autopsy is not recommended.
The autopsy should be performed in daylight. With ordinary artificial light, an autopsy is performed only in cases of extreme necessity. But good artificial, electric lighting, bright enough, and even better, shadowless, due to its constancy, has a great advantage over natural lighting, which varies greatly both from the weather (cloudy, overcast, foggy, rainy) and from the hour of the day.
The corpse is placed on the table in a supine position, head to the window, feet to the table drain, not in the middle, but somewhat further from the dissector, leaving more on the table free space to the right of the corpse.
If there are insects on the corpse, they are destroyed with a 10-20% formaldehyde solution.
A headboard is placed under the back of the corpse's head.
The dissection table is installed over the legs of the corpse after a thorough external examination of the latter.
If water is not supplied to the table, it is stored in buckets; in winter I need hot water.
Tools are prepared only the most necessary and placed on a separate board or table
Surgical dressings, drains, catheters, tampons, etc. remain on the corpse until the autopsy and are removed only after a thorough examination of the wound or organ.
The prosector takes place at the section table with right side corpse. Only when the skull is opened does he stand at the head of the corpse. The assistants and those present during the autopsy stand on the left side of the corpse.
Those observing the autopsy should not be allowed to stand next to the prosector, as they will restrict his movements, may accidentally push him and cause unexpected movements with cutting instruments, as a result of which the prosector may injure his hands or irreparably damage the examined tissue of the corpse.
The basic opening procedure is as follows:
1. External examination of the corpse.
2. Opening the skull and removing the brain.
3. Opening of the paranasal cavities.
4. Autopsy spinal canal and extraction of the spinal cord.
5. Opening of the abdominal wall.
6. Opening the chest and neck.
7. Extraction of organs of the neck, chest and abdomen.
8. Study of extracted organs.
9. Opening of limbs.
10. Cleaning the corpse and toileting it.
This is the basic order of autopsy, however, if necessary, dictated by the peculiarities of the case, there may be deviations.
Usually they start with opening the skull, since after removing the organs of the neck and chest, the blood supply to the brain and its membranes may change.
If you suspect air embolism, and also, if necessary, to perform blood cultures from the heart and for other indications, the autopsy should begin from the chest.
Yes, the first impression from the autopsy is very strong. To mentally prepare, you first need to imagine in advance what will be waiting for you there. I am not a pathologist, so I will describe more in simple language your impressions. Enter the morgue and you are enveloped in a veil of heavy, vile smell. There are corpses lying around, preparing for autopsy - of any age and gender. Their scalp is cut off and pulled over their face. The picture looks like this:
Then the opening of the skull begins. The pathologist (or orderly) cuts the bones with a saw (it looks like he is sawing a log, the head swings from side to side), opens the skull, removes the brain (crosses the brain stem with a long knife). The brain is placed on the table and cut into pieces. Looks for tumors, hemorrhages, evaluates general state. Place several pieces in jars with solution. After removing the brain we see this:
Then it opens rib cage. An incision is made with a knife from the neck to the xiphoid process, then the ribs are cut off from the sternum. The pathologist takes out the sternum, spreads the ribs and takes out the lungs, heart and bronchi, trachea, and vessels.
These organs are placed on the table, studied, and cut. The smell from the brain, lungs and heart is the least noticeable.
Next, the stomach is cut open and the stomach, intestines, liver, and spleen are removed. When the abdomen is opened, a layer of yellow subcutaneous fat is clearly visible even in thin corpses. If the corpse is thick, then after cutting, swollen loops of intestine fall out.
This organ complex is placed on the table and each organ is cut. The stomach is opened and its contents are scooped up with a small scoop. The disgusting smell intensifies. It's better to take it with you medical mask- it weakens the smell a little. Undigested food remains visible in gastric juice, slightly crushed. Then it is cut small intestine. Its contents are poured onto the table - a lot yellow diarrhea. The smell is such that your eyes begin to water and the sight makes you sick. But the pathologist is unperturbed - he carefully cuts, studies, tells something, jokes, discusses current affairs. Along the way, the liver is cut and opened gallbladder, spleen. It comes to the large intestine - the diarrhea darkens and thickens. When to cut lower section large intestine, rectum - formed dark brown masses are visible. Fecal notes pervade the smell.
Then the kidneys and bladder are removed.
And now we see a gutted human corpse
Then the remains of the organs are put back into the corpse, the orderly roughly stitches it up, and the deceased is ready for burial. After completing the autopsy, the doctor takes off his dirty clothes, washes his hands, washes himself and goes to drink coffee - at the exit or behind the door there is a dining table with a kettle.
The impressions are very strong. Some days, when you look at people, you imagine their internal organs. You look at your stomach and imagine your insides. Even sexual desire disappears for several days.
Therefore, be prepared for loss of consciousness (especially impressionable girls fainted), nausea or vomiting (it is better to take antiemetic drugs before the autopsy), temporary loss of libido. Each time the autopsies are tolerated easier and easier.
Thank you very much for your detailed answer. But tell me, how can we, in principle, accept the fact that a person is lying dead, gutted? The very essence that a person is dead and has not yet been opened puts me in shock and in real panic. How to accept this morally? I understand that this is a matter of practice (but I’m not even a doctor, but a psychologist who is taken to morgues), but I cannot reassure myself that this is natural.
