What Is an Autopsy? A Forensic Pathologist Explains

In his role as a coroner, Dr. Gregory McDonald never speaks to a happy family. "I'm maybe speaking to them on the worst day of their life-giving them some really horrible news," he explained. 

McDonald, the dean of PCOM's School of Health Sciences and director of the MS in Forensic Medicine program, has been the chief deputy coroner at the Montgomery County Coroner's Office since 2008. He has conducted thousands of autopsies, testified in countless court cases, and has, as he described it, provided closure for many people. 

"We are very different from almost every other type of physician," he said. "We have different ways of measuring our successes." Other doctors, he explained, may have to occasionally deliver bad news, but they also have victories where they save lives. "Our victories are measured a bit differently," McDonald added. 

What exactly is an autopsy? 

An autopsy is a detailed examination of a body to determine how an individual died. It may be done as part of a criminal investigation or at the request of family members. According to McDonald, one of the main duties of a forensic pathologist is to testify about autopsy findings in court. "It sounds cliché, but it's really true that we are a voice for these victims," he said. 

McDonald shared the case of a young boy beaten to death. He had to describe in detail what had happened and how the child had died, with the mother sitting in the courtroom, listening to his testimony. The mother later thanked him for being a voice for her child. 

An autopsy can often determine a natural cause of death, but there are cases, such as skeletonized remains, that can be challenging even for experienced forensic pathologists. These autopsies may be performed in a hospital or at a medical examiner facility or coroner's office. According to McDonald, there are no hard and fast requirements regarding when an autopsy must be performed, and different systems are followed in different states and jurisdictions. However, autopsies are generally conducted when there are questions surrounding the cause, timing, location, or reason for a person's death. 

A medical examiner, who specializes in forensic pathology, toxicology, and related areas, performs forensic autopsies. In jurisdictions with a medical examiner's office, both the medical examiner and assistant medical examiners are formally trained as forensic pathologists. Coroners, on the other hand, are elected officials and may not have the same level of training. They often hire forensic pathologists on a contract basis for cases. 

Autopsies can be requested by a medical examiner or coroner when certain criteria, such as trauma, violence, drug-related deaths, or unidentified bodies, are met. Hospital-based autopsies are requested by family members for cases of natural death, where a consent form is signed. 

An autopsy consists of two phases-an external examination and an internal one. The external examination involves noting identifying characteristics, signs of natural disease, and post-mortem changes. The internal examination includes dissecting and examining the organs, collecting fluid samples for analysis, and documenting the findings. The time required for an autopsy varies depending on the complexity of the case. It can range from approximately one hour to up to eight hours. Once the autopsy is completed and cause and manner of death are determined, a report is issued by the forensic pathologist. This report is included in the coroner's report, which also contains input from forensic investigators, law enforcement, and other medical records. 

Despite the challenging nature of his job, McDonald finds immense satisfaction in providing closure for families. He believes that informing families of the autopsy findings allows them to start the grieving process and move forward with their lives. According to McDonald, "When it's something you really enjoy, it's not work."