How a person is opened. Forensic examination of a corpse (autopsy)
An autopsy is a medical procedure performed in a mortuary to determine the exact cause of a person's death. If there is no suspicion of criminal or medical causes of death, an autopsy waiver by law is POSSIBLE. Therefore, if the deceased was taken to the pathoanatomical morgue (PAO), an autopsy may be refused, since the bodies of those who died from natural causes are placed in the PAO.
Refusal to autopsy the deceased
Often, the question arises before the relatives of the deceased: “Is it possible to refuse the autopsy of the deceased?”, Since for many, the refusal to autopsy is relevant. The reasons for refusing an autopsy may be different: the religious beliefs of the deceased, his will and testament, the desire of his family members. Federal Law No. 323-FZ (Article 67.3) states that it is fundamentally possible to refuse an autopsy. At the same time, the same law clearly stipulates the situations in which an autopsy must be performed without fail.
Presumption of consent to organ harvesting in Russia
In Russia, at the legislative level, there is a presumption of the consent of relatives to the removal of organs of the deceased (transplantation). This means that organ harvesting does not require the permission of relatives. If the family of the deceased has provided a notarized declaration by the deceased to refuse an autopsy, or if they themselves have filed a written refusal of a transplant, the procedure will not be performed (except in situations where an autopsy cannot be refused - see the paragraph below "In what cases is it impossible to refuse an autopsy? ").
How to refuse opening?
How to refuse an autopsy is of interest to many. 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 it is necessary to indicate:
- Full name and passport details of the applicant
- Name, date of birth, date and place of death of the deceased
- reason for not opening
- a notarized copy of the will (if the deceased recorded the refusal to autopsy in his will)
The final decision to conduct or not to perform an autopsy is made by the pathologist based on the available medical indications.
Reasons for not opening
The fundamental possibility of refusing to open an autopsy is fixed by federal and local legislation. The ability 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 the 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 open the remains of the dead.
A mortuary is more likely to accept an autopsy waiver if:
- The deceased was ill and died under the supervision of doctors;
- There is an outpatient card with data on the illness / illnesses of the deceased, including those that led to death;
- Death was due to a long illness
- There are results of histological analysis in case of death from oncology (cancer).
How long does it take to refuse an autopsy?
You have 3 days to refuse opening. There are two main reasons:
- An autopsy in the morgue must be performed within three days after the body is delivered to the morgue
- For burial in accordance with the norms of confessional funeral rites, from 1 to 3 days are allotted
Therefore, if the relatives of the deceased want to refuse to autopsy the deceased, one should not hesitate to submit an application to the morgue.
Who applies for an autopsy waiver?
- relatives (burial organizer by relatives)
- ritual agent
In addition to relatives, an application for an autopsy waiver may be filed by a funeral director who organizes the funeral.
Sample letter of waiver
You can download a sample waiver request form.
In what cases is it impossible to refuse an autopsy?
The law establishes situations in which the mortuary may refuse an application to refuse an autopsy - even if the deceased has recorded the refusal of an autopsy in his will. Federal Law No. 323 contains a list of situations when it is impossible to refuse an autopsy.
- Suspicion of violent death (incl. traffic accident, accident)
- Suspicion of death from drug overdose
- Suspicion of death due to drug intolerance
- Death from infection (or the assumption about it)
- Death from cancer (if there is no histological analysis)
- Death related to blood transfusion
- Death of a pregnant woman, during childbirth, shortly after childbirth
- Death of a child under one month old or stillborn
- Death by environmental disaster
- Unable to determine cause of death without autopsy
- Before death, the deceased was in the 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 the hospital
- Death due to preventive medical procedures
- Death from acute surgical pathology
If the body was admitted to the SME, it is impossible to refuse an autopsy
If the body was admitted to the forensic morgue (FEM), and not to the post-mortem (PAO), it is impossible to refuse an autopsy. In addition to the suspicion of death due to external circumstances, the refusal of an autopsy is not possible 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 an ambulance, then the body will most likely be taken to the forensic morgue. In this case, the refusal of a pathoanatomical autopsy is impossible.
An application for waiver of opening may not be considered in time. What to do?
Due to the high workload of hospitals, an application for refusing an autopsy may not be considered in time and an autopsy will be performed. There is always such a risk.
Entrust the failure to open the site service
It is better to entrust the ritual agent of the official city funeral service with the site to deal with the refusal of an autopsy, since she has established contacts with the 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 grumble
That God took the baby
And it hurts why they
Cursed over him?
Why, like black crows,
Part of the body is white
Tortured? .. Really
Neither God nor the king will intercede?
Vikenty Veresaev, "Doctor's Notes"
When is a pathological anatomical autopsy scheduled?
In any case, death. Violent, from illness or from natural causes. That is, if a person dies in the hospital from a known diagnosis, at home, if he gets into an accident or is killed, an autopsy will most likely be performed.
Why close people do not want an autopsy?
You just don't want to, that's all. This man, this corpse belongs to them and to God, but not to the doctors, dissectors, pathologists who perform the autopsy. "Religious reasons" also exist. Some religions do not provide for an autopsy.
Why do you need to do an autopsy?
In order to try to find out the true cause of death, illness. Evaluate the correctness of treatment, identify and punish those responsible. "Here the dead teach the living" - definitely yes. When the attending physician goes to the pathology department and sees the organs of the person he was trying to treat, punctures, palpates, prescribes pills, a serious experience is formed in the doctor’s head for the future, an opinion appears about the correctness of his actions. He looks at the patient differently. In the case of similar symptoms, it can draw more correct conclusions.
And further. If the patient's relatives decide in a couple of months that the doctors are still murderers, it will be very difficult to prove something without an autopsy. This can be used by the warring clans of heirs when dividing property.
What happens when medical errors are discovered?
Usually nothing. The hand washes the hand. In the history of the disease, the pathoanatomical diagnosis differs from the clinical one, the case is analyzed at the clinical and anatomical conference (if death is in the hospital) and that's it. Divergence of the diagnosis. Healed for someone else. This information does not reach the relatives of the deceased. The death certificate contains a pathological diagnosis. And rightly so. The fact is that usually a more accurate diagnosis does not change anything in the fate of a person. Ah, if only… no. If a person has to die, he will die. Of course there are serious mistakes, but rarely. And, as far as I know, even in the case of obvious mistakes, doctors themselves do not write letters to the prosecutor's office.
What do they say to the relatives of the deceased at the request "not to open". And how to act?
The doctor hesitates, says that this is the way it should be, and an autopsy is mandatory. In this case, the Aesculapius do not own the topic of legislation more deeply and send people to the administration of the medical institution. There, if you really want to prohibit the autopsy, a statement is written:
"I ask you not to perform an autopsy on my **** who died then, in such and such a department, for religious reasons. I understand that in case of refusal to perform an autopsy, the possibility of accurately establishing the cause of death may be lost, I have no complaints against the hospital."
All. If such an application is written and a forensic autopsy is not scheduled, the pathologists will not touch the corpse. And what exactly "Religious reasons" - no one will ask, and if they do, 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.
Held in special morgues. It is prescribed if there is a suspicion of a violent death, whether it be trauma, poisoning, or any other reason. This opening cannot be avoided in any case.
Economics of pathology.
The hospital earns handsomely on their own dead. Each post-mortem examination costs money, this money is paid by the insurance company after the fact (CHI). Naturally, the administration of the hospital is directly interested in opening all the corpses. Business…
Whose corpses are usually not opened?
1. Natsmenov. A noisy flock will come running, screaming, talking loudly, in the end they manage to cancel the autopsy.
2. Relatives of doctors and important people. People quietly piglets and they go to meet 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 of June 20, 1959 N 316. Since then, he has been rewritten several times, but in essence everything remains as it was formulated 50 years ago. The text of that order. And here is the order of the Ministry of Health of 1994, number 382.
The topic of refusing to open an autopsy is also considered in the Basic Law of present-day Russia. I quote article 48 in full:
BASIS OF THE LEGISLATION OF THE RUSSIAN FEDERATION ON PROTECTION OF THE HEALTH OF CITIZENS
(As amended by Decree of the President of the Russian Federation No. 2288 dated December 24, 1993; Federal Laws No. 30-FZ dated March 2, 1998; No. 214-FZ dated December 20, 1999)
Article 48
Carrying out pathological anatomical autopsies.
An autopsy is performed by doctors in order to obtain data on the cause of death and the diagnosis of the disease.
The procedure for conducting pathoanatomical autopsies is determined by the Ministry of Health of the 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 post-mortem autopsy is not performed in the absence of suspicion of violent death, unless otherwise provided by the legislation of the Russian Federation.
The conclusion on the cause of death and the 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 pathoanatomical autopsy. At the request of family members, close relatives or the legal representative of the deceased, an independent medical examination may be carried out.
An autopsy (synonym: section, autopsy) is a study 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, pathoanatomical and forensic autopsies (see below). Autopsies are of great importance in the study of issues of thanatology (the doctrine of death), epidemiology, as well as in the teaching of medical disciplines.
Anatomical autopsies are performed in anatomy departments to study the structure of the human body.
The deceased in medical institutions are usually subjected to a pathoanatomical autopsy, which is regulated by the instructions on the procedure for autopsy of corpses in medical institutions. An autopsy is performed, as a rule, not earlier than two hours after the death is established. Pathological anatomical autopsies are performed by pathologists in specially equipped rooms (sectional rooms) of the departments of pathological anatomy and pathoanatomical departments of medical institutions. The purpose of such an autopsy is to establish the underlying disease, complications and concomitant diseases, as well as the cause of death. According to the results of the autopsy, one can judge the correctness of the intravital diagnosis and the therapeutic measures taken, which is important for improving the diagnostic and treatment work.
An autopsy is preceded by familiarization with all medical documents relating to the deceased. For the autopsy of corpses, a sectional set of tools is used. The pathologist and the staff helping him put on rubber, a gown, oversleeves and an apron. In cases of death from especially dangerous infections or in the presence of substances (radioactive, agents, etc.) hazardous to the health of the doctor and those present at the autopsy, special suits are used. After the autopsy of the corpses of people who died from especially dangerous infections, all persons who were in the sectional room are exposed; the room where the autopsy was performed, and the coffin with the body of the deceased - wet. The body is not released to relatives.
An autopsy is preceded by an external examination; note the physique, nutrition, body weight and condition of the skin, pay attention to rigor mortis, cadaveric spots, ulcers, tumors, etc.
Then proceed to the autopsy of the corpse. To do this, use various incisions of soft tissues (straight, according to Leshka, according to Fischer and combined). The chest cavity is opened by dissecting the costal cartilages near their transition into the bone (Fig.). Examining the abdominal, pleural and pericardial cavities, the presence of adhesions of the sheets of serous membranes, effusion, the nature of the location of the organs, etc. are noted. The skull is opened by an incision of the soft tissues from ear to ear and their detachment anteriorly, then they are sawn horizontally and the roof of the skull is removed. For extraction and opening, it is necessary to saw through the posterior arches of the vertebrae.
When opening the internal organs, they are examined on the spot, then removed from the corpse in a certain sequence: the organs of the neck, chest and abdominal cavities, and the small pelvis. The organs of the genitourinary system are sometimes isolated as a separate complex, in some cases all internal organs are removed as a single complex.
The extracted organs and the complex of organs are carefully examined, their size, weight, color and surface condition are determined, then they are studied after appropriate incisions. Pieces are taken from organs and tissues for histological examination, as well as material for serological, biochemical studies.
After the autopsy is completed, the organs of the corpse are placed back into the cavities, the incisions are sewn up, washed and dressed. During or after the autopsy, a protocol is drawn up, in the descriptive part of which the changes detected during the autopsy are objectively recorded. They also make a pathoanatomical diagnosis and an epicrisis. The diagnosis is the essence of the detected changes, described briefly, in pathoanatomical terms, in accordance with the course of the underlying disease process, complications and concomitant diseases. In the pathoanatomical epicrisis, the results of a comparison of the data and materials of the autopsy are presented, taking into account all additional studies. At the end of the epicrisis, a conclusion is given on 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 not occurring in a medical institution; in cases where the cause of death is not clear, in case of doubts about the correctness of the treatment of the deceased. A forensic autopsy is carried out only subject to a decision by the investigating or inquiry bodies, as well as a court decision. In case of death in medical institutions on the first day after admission with an unidentified diagnosis of the disease, a forensic autopsy is also performed.
During a forensic autopsy, the cause of death, the time of its onset, the presence of alcohol in the corpse, 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 mortis, temperature, putrefactive phenomena are noted, if there are injuries, their exact location, nature are indicated and it is established what they could have been caused by (blunt, piercing or cutting objects, firearms, vehicles and etc.).
In unidentified corpses, all individual signs are recorded in detail. Parts of organs and body fluids can be taken for histological, forensic chemical and some other laboratory studies.
After the autopsy of the corpse, an act is drawn up, or a conclusion in which the forensic expert gives answers to the questions contained in the decision on the appointment of an examination (see Medical, forensic documentation).
Usually, an autopsy is performed 12 hours after death, but Soviet legislation permits autopsies to be performed for scientific and practical purposes after 2 hours and even half an hour after death.
In these cases, an autopsy must be performed in the presence of three doctors, who draw up a protocol before the autopsy indicating the evidence of the actual death and the reasons for the need for an early autopsy (see "Rules for the forensic examination of corpses" approved by the RSFSR People's Commissariat of Health on December 19, 1928 and the RSFSR People's Commissariat of Justice 3 January 1929).
Before each autopsy, the dissector 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 corrections in the clinical diagnosis after autopsy are allowed.
Without a medical history, based only on oral reports, an autopsy is not recommended.
The opening should be done in daylight. Under normal artificial light, an autopsy is performed only in case of emergency. But good artificial, electric lighting, bright enough, and even better shadowless, due to its constancy, has a great advantage over natural, which varies greatly both from the weather (cloudy, cloudy, nebula, rainy), and from the hour of the day.
The corpse is laid on the table in the position on the back, head to the window, feet to the drain of the table not in the middle, but a little further from the dissector, leaving more free space on the table to the right of the corpse.
If there are insects on the corpse, they are destroyed with a 10-20% formalin solution.
A headboard is placed under the back of the head of the corpse.
The dissecting table is set over the shins of the corpse after a thorough external examination of the latter.
If water is not brought to the table, it is prepared in buckets, in winter I need hot water.
Tools are prepared only the most necessary and placed on a separate board or on a table
Surgical dressings, drains, catheters, tampons, etc. remain on the corpse until autopsy and are removed only after a thorough examination of the wound or organ.
The dissector takes a seat at the dissecting table on the right side of the corpse. Only when the skull is opened does it stand at the head of the corpse. On the left side of the corpse are assistants and those present at the autopsy.
Observers should not be allowed to stand near the dissector, as they impede its movements, they can accidentally push it and cause unexpected movements with cutting instruments, as a result of which the dissector can injure the hands or irreparably damage the examined cadaver tissue.
The basic opening procedure is as follows:
1. External examination of the corpse.
2. Opening of the skull and extraction of the brain.
3. Opening of the accessory cavities of the nose.
4. Opening of the spinal canal and extraction of the spinal cord.
5. Opening of the abdominal wall.
6. Opening of the chest and neck.
7. Extraction of the organs of the neck, chest and abdomen.
8. Examination of the extracted organs.
9. Opening of the limbs.
10. Cleaning up the corpse and toileting it.
This is the basic order of opening, however, if necessary, dictated by the characteristics of the case, there may be deviations.
Usually they begin with an opening of the skull, since after the removal of the organs of the neck and chest, the blood supply to the brain and its membranes may change.
If an air embolism is suspected, as well as if blood cultures from the heart are necessary, and for other indications, the autopsy should begin with the chest.
Yes, the first impression of the autopsy is very strong. To mentally prepare, first you need to imagine in advance what you will expect there. I am not a pathologist, so I will describe my impressions in a simpler language. Enter the morgue and you will be enveloped in a veil of heavy, vile smell. There are corpses preparing for autopsy - of any age and gender. Their scalps have been cut off and pulled over their faces. 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 sawing a log, the head dangles from side to side), opens the skull, removes the brain (crosses the brain stem with a long knife). The brain puts on the table and cuts into pieces. Looks for tumors, hemorrhages, evaluates the general condition. Puts a few pieces in jars with a solution. After extracting the brain, we observe this:
Then the chest is opened. 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, pushes the ribs apart and takes out the lungs, heart and bronchi, trachea, and vessels.
These organs are placed on the table, studied, cut. The smell from the brain, lungs and heart is the least noticeable.
Next, the stomach is torn open and the stomach, intestines, liver, spleen are removed. When opening the abdomen, a layer of yellow subcutaneous fat is clearly visible even in thin corpses. If the corpse is thick, then swollen intestinal loops fall out after cutting.
This organ complex is placed on the table and each organ is cut. The stomach is opened, its contents are scooped up with a small scoop. The foul odor intensifies. It is better to take a medical mask with you - it slightly weakens the smell. You can see undigested food residues in the gastric juice, slightly crushed. The small intestine is then cut. Its contents are poured onto the table - a lot of yellow diarrhea. The smell is such that the eyes begin to water, the sight makes you sick. But the pathologist is imperturbable - he carefully cuts, studies, tells something, jokes, discusses current affairs. Along the way, the liver is cut, the gallbladder, spleen are opened. It comes to the large intestine - diarrhea darkens and thickens. When the lower part of the large intestine, the rectum, is cut, formed dark brown masses are visible. Fecal notes penetrate the smell.
Then the kidneys and bladder are removed.
And here we see a gutted human corpse
Then the remains of the organs are again placed in the corpse, the orderly sews up roughly and the deceased is ready for burial. After the autopsy is completed, the doctor takes off his dirty clothes, washes his hands, washes himself and goes to drink coffee - at the exit or outside the door there is just a dining table with a kettle.
Impressions are very strong. For several days, when you look at people, you imagine their internal organs. You look at your stomach and imagine the insides. Even sexual desire disappears for a few days.
Therefore, be prepared for loss of consciousness (particularly impressionable girls fainted), nausea or vomiting (it is better to drink antiemetics before opening), temporary loss of libido. With each time, openings are transferred easier and easier.
Thank you very much for the detailed answer. But tell me, how in general, in principle, to accept the fact that a person lies dead, gutted? The very essence of the fact that a person is dead and has not yet been opened brings me into shock and into real panic. How to accept this morally? I understand that it’s a matter of practice (but I’m not even a doctor, but a psychologist who is taken to morgues), but I can’t console myself with the fact that this is natural.
