Not long ago, a man asked me to explain the laws governing coroners and advise him if, by living will or some other legal means, he could protect himself and his wife from what he perceived as a horrific insult to our lives, deaths and bodies an autopsy.
He and his wife understood the importance of my work, he said, and intended no criticism of me personally, but they opposed autopsies as a matter of spiritual belief and wished to preclude the possibility no matter when and how we die.
Ive had plenty of experience with opposition to autopsies, but such visceral horror expressed so politely took me aback.
I tried to answer each of his points, and though he remained unconvinced, I felt his views deserved a wider audience.
b It seems, he said, that almost everyone who dies outside a hospital is automatically autopsied.
Thats not true. In an average year, I autopsy 50 of the more than 300 people who die in La Plata County.
b Theres no need for an autopsy when someone falls over from an obvious heart attack.
Id agree, if the heart attack were obvious, but the classic scenario of the tennis player, snow shoveler or jogger witnessed to collapse while clutching his chest is rare. Usually, people are found after they collapse in circumstances that suggest sudden death.
Other diseases (stroke, aneurysm, seizure) can cause sudden death, and less innocent explanations include drugs such as cocaine or amphetamine, electrocution or delayed death from injuries.
Fatal internal injuries are not always obvious externally, and Ive seen the bodies of homicide and suicide victims posed to mimic natural death.
b In the case of clear-cut suicide, autopsies arent necessary.
Clear-cut suicide is a contradiction in terms for many families. Suicide can be as traumatic for survivors as a loved ones murder. Many cant accept that determination, and if its made without an autopsy, they are even less likely to agree as they see the investigation as shoddy and incomplete. Its quite common for questions to arise weeks, months or even years later, and theres no going back for information that wasnt gathered at the time.
b If an accident or insurance issues are involved, toxicology should suffice to determine if a person was under the influence.
As external examination is a poor indicator of the nature or extent of internal injuries that can alter the anatomy in unknown ways, blood and fluids obtained by blind puncture cannot be relied upon for toxicological evaluation because they may be contaminated by the contents of ruptured or displaced organs.
b Theres no need for an autopsy if theres no reasonable concern about wrongdoing.
Only on TV and in crime novels is concern about wrongdoing always the primary reason for an autopsy. Knowing the specific cause of a loved ones death can be a great comfort, and sometimes, autopsy findings of unsuspected heritable conditions prolong or save the lives of surviving children or other relatives.
Now thats spiritual.
email@example.com Dr. Carol J. Huser, a forensic pathologist, has served as La Plata County coroner since January 2003.