Do parents have a constitutionally protected property interest in the dead body of their child, including all organs? Not necessarily is the answer given by the U.S. Court of Appeals for the Sixth Circuit in Albrecht v. Treon, at least under Ohio law as interpreted by the Ohio Supreme Court.
The Albrechts brought a Section 1983 suit against the county coroner, among others, alleging that they were deprived of a protected property interest without due process of law when the coroner removed and retained their dead son’s brain without notice. According to the state, the brain was needed for additional study to aid in a criminal investigation. The question was certified to the Ohio Supreme Court, which held that under Ohio law the parents have no constitutionally protected interest in their child’s human remains that are retained for criminal investigation purposes, prompting a judgment for the state in district court. Today, the Sixth Circuit affirmed, distinguishing Circuit precedent that recognized constitutionally protected property interests in a family member’s body parts retained for donation purposes.
1040 says:
these are the first signs of the onslaught on america from zombie law!!!
August 24, 2010, 11:29 amSteve says:
Am I wrong, or does the court not even identify whether this was a minor child?
August 24, 2010, 11:57 amHouston Lawyer says:
You really don’t want to see a relative’s body following an autopsy. I believe the policy followed by the coroner is the most prudent one that would lead to the fewest upset people. I don’t think that most people would read the autopsy report and find out that one or more organs were not returned with the body.
August 24, 2010, 12:01 pmCockleCove says:
According to this ABA Journal article from 3 years ago, Christopher Albrecht was 30 when he died:
August 24, 2010, 12:03 pmhttp://www.abajournal.com/magazine/article/the_body_in_question/
PatHMV says:
It seems odd that you could have a property interest in an object for one purpose but not for another purpose. It would seem to me, off the top of my head, that if the brain (or some other organ) is needed for a criminal investigation, the proper recourse would be to recognize that the body is the property of the next of kin, but have the coroner obtain a warrant for it.
Houston Lawyer, several religions have fairly strict rules regarding disposition of bodies, and all parts thereof. The family probably didn’t want to SEE the brain, but wanted 1) to know what was done with it, and 2) to ensure that it was properly interred or cremated or whatever in accordance with their own believes and desires.
August 24, 2010, 12:46 pmSome dude says:
If I’m reading that correctly, it doesn’t sound right to me. Law enforcement can simply retain any bodily remains they want? That’s grave robbery. I would think they would either need a) permission from next-of-kin, or b) some kind of court order.
August 24, 2010, 12:53 pmKamal says:
This is not good. Within the next hundred years we may be able to scan the brain to recreate the person, so this is not good precedent.
August 24, 2010, 12:55 pmAJK says:
There are many compelling arguments against this holding. This is not one.
August 24, 2010, 1:24 pmjoe x. says:
So if there are property rights, does the body get treated like any other personal property? Direct in your will who gets it, or we follow intestate succession, and have family fights over the body, etc.?
I think some states may have laws addressing disputes over disposal of remains, but those are freestanding laws, not application of “property” law.
August 24, 2010, 1:37 pmDavid Newton says:
So that’s what all those zombiefied computers online are trying to do then…. Who knew that they followed stereotypes to do with brains so rigidly?
August 24, 2010, 1:45 pmDennis N says:
Isn’t there already statute law that allows the State to size a body for investigation in “suspicious” cases? If we grant that right to the State, then the retention of all or part of the body for the duration of the investigation seems to follow.
The right of the Coroner to investigate the bodies of those whose deaths are deemed suspicious goes way back. Is this a Common Law right of the gummint? Overturning that tradition would not be easy.
August 24, 2010, 1:58 pmArkady says:
Well, at least you own your own genes now (for the time being, anyway).
Association for Molecular Pathology, et al. v. USPTO, et al.
August 24, 2010, 2:00 pmOrenWithAnE says:
(1) This is not an appropriate thread in which to use the idiom ‘off the top of my head’. We are talking about the whole head, after all.
(2) I struggle to see where the warrant requirement comes in here. The coroner already has the body, he does not seek to seize it. He is already conducting an autopsy, there’s no need for further permission to search it.
I’m not unsympathetic to the plaintiff’s claims, but it seems to me that the 4A warrant requirement is not a proper vehicle to resolve this matter.
August 24, 2010, 2:01 pmbillo says:
This is a big deal for those of us who investigate these deaths. We have seen the creeping criminalization of our profession, to the point that it interferes with death investigation. For instance, in Florida, the so-called “Dale Earnhardt” law makes it a felony to use images from autopsies for teaching, research, or consultation without a court order. It’s saddening to go to professional conferences and have people from Florida go “I wish I could show you what I’m talking about, but I cannot.”
I can remember back when I was a medical student (too many years ago) when permission from the next of kin was required for a forensic autopsy. Not surprisingly, when the next of kin was the killer, he or she was not enthusiastic about giving permission.
There are many cases in which it is necessary to retain organs. The brain is particularly common because of its consistency. The brain is very soft, with the consistency of gelatin. That makes it very difficult to dissect fresh. In cases where there is the question of significant pathology in the brain that requires careful analysis, it is necessary to fix the it in formalin for a number of weeks prior to dissection.
The brain is not the only organ where retention may be required, however. For instance, it is not uncommon for forensic pathologists to retain a heart and send it to a specialist in heart disease for consultation. In other cases, the very examination of the organ destroys it.
I find it particularly ironic that the legal community pillories the forensic community for not performing adequate research to provide better scientific basis for the conclusions we make, and at the same time wants to criminalize performing that research. In my jurisdiction, the use of material for forensic autopsies for research purposes is illegal unless what I do is directly part of the investigation. Thus, I can do studies about what I’m already doing but cannot do anything innovative. In some jurisdictions, such as New Jersey, *any* activity that goes beyond the determation of cause of death is illegal — including such things as simple retrospective studies on previous autopsies for statistical purposes, or, technically, even completing an autopsy if a cause of death is determined early on.
I am a forensic pathologist, not a lawyer, but I have been told that traditionally the body is considered “quasi-property.”
August 24, 2010, 2:17 pmDuffy Pratt says:
Even if the brain was part of the estate of the deceased, there is nothing to prevent the state from taxing any, or all, of the estate.
For those who think the brain should be the property of the parents — would you also think it OK for the parents then to sell the brain off to the highest bidder? (How much do you think Princess Di’s brain would go for on Ebay?)
August 24, 2010, 2:38 pmdworkenlaw1 says:
I am one of the attorneys in this case, and the comments are very appropriate.
However, a couple of points are critical to clarify the issues.
First, we did NOT make any claim for the brain when the coroner required it to perform the autopsy. The case was only about, and specifically about, whether the government could keep the brain AFTER it was finished with the autopsy and admitted it no longer needed the organ for any investigation or evidence. In this case, the coroner stipulated that he was finished entirely with the brain but was unwilling to return it to the next of kin, on the theory that they had no right to it.
This position by the government was not only inconsistent with our client’s desire, from a personal and religious standpoint, to respectfully dispose of all of her son. Equally important, the coroner’s position clearly suggested that if the government decided, after completion of the autopsy, to keep any number of body parts, or even the complete corpse, they had a right to do so. To burn it as medical waste. To sell it for research. To use it for scientific experimentation.
As legitimate as some of those goals might seem, our society has not allowed the government to ignore the rights of citizens, simply because the outcome of the government’s desire would be beneficial.
Second, we did not assert a typical “property” right in the decedent’s body or his organs. Noone has a right to treat those things like typical property or chattel, which may be sold, traded and disposed of as the owner wishes. The right which exists here is known as the right of “sepulcher”. That is the right given to the next of kin to direct the disposition of the remains of a loved one at the time of death.
There is no question, and we conceded, that the government’s right to take possession of the body and to conduct a full autopsy on it was not challenged. That right in the government supercedes and subordinates the right of sepulcher.
However, when the government right of autopsy (and retention of any parts needed as evidence) is finished, the right of sepulcher remains. The government cannot “keep” the body, the eyes, the brain, etc., whether they subsequently destroy it, sell it, or any other thing. They must return it to the next of kin.
As one of the posters mentioned, in this day and age, there is a very high monetary value for bodies and body parts for sale, research, and other things. Just as the government does not have the right to “keep” a vehicle which was held for evidence after the case is over, even if it is convenient to do so, the government may not keep something as personal and sacred as the body or body parts of a deceased loved one.
When asked about this specific issue, the next of kin said: “I want my son’s brain more than anything else, because that was my son. Not his arms or legs, but his brain and his mind. That was his thought, his personality, his memory, and every thing that made him what I loved.”
The courts have done a TERRIBLE disservice to us as a civilized society with these rulings.
Patrick
August 24, 2010, 2:55 pmbillo says:
“The courts have done a TERRIBLE disservice to us as a civilized society with these rulings.”
Only if you consider preserving forensic investigation and promoting forensic science a TERRIBLE disservice.
August 24, 2010, 3:12 pmJRL says:
Did you not read anything other than his last sentence?
August 24, 2010, 4:51 pmPatHMV says:
billo…. you’re not helping your cause. My deceased relative’s body parts are NOT yours. Keep your filthy freakin’ hands off of them, unless they are needed to investigate the cause of death. THAT is why we as taxpayers employ you, and that is the limited consent we’re generally willing to give you to slice open and dismember the bodies of the deceased.
If you want to conduct research, or show off pictures to your colleagues at conferences (which, I imagine are as full of morbid humor as those of prosecutors and cops), then ask for permission from the next of kin, and do so only when you have that permission in hand. Otherwise, you have no right to play with our late loved ones’ bodies.
A desire to bury our dead, in accordance with our various religious practices, need not conflict with preserving forensic investigation and promoting forensic science. Our medical schools are full of cadavers willingly donated to serve the cause of science and learning. Even the Body Farm manages to find bodies for such purposes, either willingly donated or left unclaimed by anybody at a coroner’s office. Do your research on such willing subjects, not our loved ones.
Oh, and billo, those laws that bother you so much tend to have come about as a result either of excesses by your professional colleagues or (as in the case of Dale Earnhardt) tragically misapplied public records laws. When I was a prosecutor, we would occasionally have a class from one of the local M.E.s. The slide show subjects he chose to illustrate his points tended to be females, and the photos tended to unnecessarily include the breasts and genitals. I wouldn’t want him doing “research” or taking photos of my deceased loved ones for any purpose other than investigating that particular death.
August 24, 2010, 4:52 pmpris says:
I have no understanding what so ever, why the brain was not returned to the parents when the pathologist was finished with it, unless there was some nefarious or research reason. Did the pathologist still have the brain at the time of the request, this must be asked. It does not make sense, legally or ethically. I suppose we must now state unequivocally in our Durable Power of Attorney and Living Will that all parts of our body be returned to the next of kin. Does any of this make sense?
August 24, 2010, 4:55 pmbillo says:
It’s not a matter of just “showing off pictures to our colleagues.” It’s a matter of teaching and learning. Forensic medicine is not a set piece of knowledge that finished in the late 1800s. We need to train students, residents, fellows and each other. We can only do that by showing and discussing cases.
The problem with getting permission in all of these cases is that it will not be given, particularly in the cases that are most important. Do you really think that the husband who murdered his wife and who I have helped put in jail will be in the mood to help me teach a student?
Your imagination that we are ghouls who chitter and chatter and giggle over bodies is mistaken. We take our jobs very seriously, and we do our very best to serve our patients by getting justice for them and answers for the families. We don’t consider this a game, and we don’t trivialize it in the way you imagine. We have families and loved ones, too — who also are sometimes forensic cases. I spend, on average, two to three hours a day helping the families of deceased understand what happened to their loved ones. Your characterization of what I do is thoughtless, misleading, incorrect, and insulting.
Consider the current controversy over so-called “shaken baby syndrome.” Hundreds, if not thousands of parents have been jailed on the basis of this diagnosis, which has, fundamentally, not been proven. There are case reports and different kinds of biomechanical models — some of which support this diagnosis and some which do not.
How many innocent parents need to have their lives destroyed, or conversely, how many child murderers should go free because we are not allowed to do the basic research that will give us the answer? Fundamentally, it is in society’s best interest to permit the kind of research that will answer these questions. That research is not “nefarious” as another poster put it. It is necessary in order to save lives and save families. And it is research that will fundamentally be impossible if it is necessary to get permission from those who are convicted of murder — perhaps wrongly.
As far as I know, there was no forensic pathologist who engaged in “excesses” in the Dale Earnhardt case. Quite the opposite.
And, I gather, you would stop the training of prosecutors? After all, they have no *need* to see *any* autopsy material — since the training of prosecutors is a purpose other than investigating a particular death.
Indeed, there are MEs who are not as sensitive as they should be. Just like there are prosecutors who are venal, incompetent, and dishonest. But it is just as incorrect to characterize all MEs in that way as it is to characterize all prosecutors in that way.
August 24, 2010, 5:25 pmGuy says:
The obvious solution is for doctors and scientists to go back to grave robbing, like Benjamin Franklin did.
August 24, 2010, 5:35 pmSenatorX says:
First, we did NOT make any claim for the brain when the coroner required it to perform the autopsy. The case was only about, and specifically about, whether the government could keep the brain AFTER it was finished with the autopsy and admitted it no longer needed the organ for any investigation or evidence. In this case, the coroner stipulated that he was finished entirely with the brain but was unwilling to return it to the next of kin, on the theory that they had no right to it.
Hmm WTF
August 24, 2010, 5:54 pmPatHMV says:
Billo, I’m sure many of your colleagues are serious, sober folks who do their job with seriousness and dedication. But there are also in your profession the ghouls like the former assistant M.E. I described. I did not characterize all M.E.s as behaving that way. Nor did I accuse M.E.s of excesses in the Dale Earnhardt case. I was careful to note that THAT case was a pernicious application of a general public records law.
But you’re not going to get anywhere demanding some right to do experiments and research on the dead who have come into your clutches because they died under suspicious circumstances. Like it or not, you are an agent of the government; your actions are the actions of the government. There are limits on what you can do with things that belong to other people. Unless we’re going to declare human remains some sort of legal equivalent to wild game, not owned by anybody, and thus free for the taking by anybody, those remains don’t belong to you.
Yes, I sympathize with the difficulties this places on research in this area. You’re probably not going to get permission from the spousal murderer to do additional research for scientific purposes on the dead body. If you want to propose a law which allows a court to appoint some other next of kin for handling bodily remains when the normal next of kin is suspected of the crime, fine, I can support that.
But the idea that you can look the innocent family of a murder victim in the eye and say: “my need for the body of your loved one to conduct scientific research trumps your need for the body for burial”? To that, I say screw you. One of the milestones in the development of the human race, one of the things that distinguishes us from animals, is the existence of burial rituals, the idea that the dead must be laid to rest in accordance with some ritual, and treated with reverence, and not just some other hunk of meat. I don’t think funeral rites should take precedence over actually investigating the murder of the deceased, but over anything else the government desires to do? You bet.
August 24, 2010, 6:06 pmGuest14 says:
Can’t you revere and perform rituals with some hunk of meat that has less research significance? Maybe you could revere a hamburger patty you purchased from a supermarket instead, and perform rituals with a hot dog. That should satisfy everyone, no?
August 24, 2010, 7:26 pmPatHMV says:
Guest14, you’re free to do what you want with your own body and the bodies of anybody for whom you are next-of-kin. All I ask is that you and the government don’t impose your asinine views on me and my loved ones.
August 24, 2010, 7:49 pmGuest14 says:
PatHMV, you’re the one talking about rituals and reverence involving a corpse, but I’m the one with the asinine views? That cracks me up.
August 24, 2010, 7:54 pmPatHMV says:
Yes. You see, any animal is capable of treating a deceased body as equivalent to a hamburger or a hotdog. It took many millions of years for humans to evolve the capability of abstract thought and morality which allow us to see some things as more than the mere sum of their physical parts. Evolution seems to be working backwards in your case.
August 24, 2010, 8:16 pmGuy says:
I don’t mean to denigrate the emotional attachment to the bodies of the deceased that are possessed by survivors, like Guest14 does (it’s very tacky). But I’m skeptical that there’s anything rational about it. Once a person is dead there’s no consciousness left in their body.
August 24, 2010, 8:25 pmbillo says:
My “clutches?” Please. Let’s try to act like adults here, OK? I am proud of what I do. I provide an important service and I help a lot of people — families *and* society as a whole. So let’s try to stay out of the gutter, OK?
Once, again, let’s get real. Nobody is talking about wild game. Actually, the laws about that vary from state to state. In some states, it actually *is* the property of the state until it is released. Not because anybody considers it a “hunk of meat” but because that is necessary in order to do what we need to do.
No you don’t. You don’t sympathize at all. The bottom line is that as far as you are concerned, a million murderers should go free to make sure that every microgram of tissue gets returned to the grave. It *doesn’t matter* how many innocent people die in order to achieve that.
You think for a minute that appointing another next of kin will solve the problem? It won’t. It’s the nature of what we do. We are in the business of investigating suspicious deaths. Our business is discovering things people don’t want to face and telling people truths they don’t want to hear. Not only will we have to maintain a willful ignorance of homicide, but also of suicide and most accidental deaths. After all, we don’t want to do any research in subjects people want to avoid thinking about, right?
Part of my job is taking the brunt of family anger. It is a natural part of the grieving process to engage in denial, become angry, and focus that anger at the person who brings the bad news. I’ve been there myself. I’m the guy who makes the determination that the adolescent daughter of a family committed suicide. And I’m the guy that the father takes out a good deal of his anger, frustration, and denial on. That’s OK. It’s part of my training to absorb the insults, hatred, and barbs because I know that it’s his pain that’s talking, not him. He may *never* believe that the girl killed herself, and I will *always* be the bastard who is keeping the cops from finding her *real* killer. He hates me — and he will hate me until he comes to terms with the death of his loved one. That may be weeks away, months away, years away , or never. You’re the woman the family hires to sue me in order to feed that denial.
And the sad thing is that sometimes he may be right. I’ll never know, because I can’t do the studies that would tell me — and you can be damned sure that he will never give me permission to find out. And that’s OK with you. Willful ignorance should be the hallmark of forensic investigation.
Actually, nobody here has been talking about keeping a body. We have been talking about retention of tissues. Let’s keep the discussion in the realm of what we are really talking about, OK? I’m not going to play your strawman game.
Actually, one of the milestones of the development of the human race was the development of a society where the responsibility and needs of the community as a whole become important. Thus, we have quarantines when people have infectious disease — even if they want to go out in public. We have mandatory vaccinations, even if people want to be free to carry and spread disease. We have laws against the exploitation of the environment, even if people want to dump poison in the water supply.
So, how many innocent people have to die in order for you to have the satisfaction of knowing that every microgram of tissue from a cadaver has been buried?
August 24, 2010, 8:46 pmPatHMV says:
Billo, want a sliver of tissue? Fine. But the entire brain? Please.
I do sympathize. I was a prosecutor. I want to get the scum who murder innocent people. Hell, I want to get the scum who murder guilty people. But I won’t do so at ALL costs. You are the one looking at this matter solely through the spectrum of your work, and that’s what makes you come across, to me at least, as a single-minded ghoul. As I said, you are willing to tell the grieving father of a murdered son that you don’t care what his religious convictions are, YOUR needs (the needs you believe are of utmost importance to society) are more important than his.
Not once have I argued against not performing autopsies…. just research on bodies and body parts AFTER the autopsy has been performed. Are you seriously trying to tell me that our forensic science is so woefully backwards that research on unwilling bodies will actually result in catching a “million” more murderers than we do now?
And I’m not the guy a family hires to sue you. I’m not that kind of a lawyer, and I wouldn’t ever be involved in suing an honest public servant just trying to do his or her job.
August 24, 2010, 9:18 pmbillo says:
Unless, of course, it was a “ghoul” trying to save lives and keep from convicting innocent people.
No, probably only a few hundred thousand. You never answered my question. How many innocent people are you willing to have incarcerated and how many innocent people are you willing to see killed by murderers in order to stop the kind of research we need to do in forensic medicine? I gather that if it were a million, you would be OK with it. What about a hundred thousand?
August 24, 2010, 9:24 pmPatHMV says:
So billo, just what are you advocating? Do you want to keep the whole body for research? Sometimes you say “just some tissue,” but if you’re sincere about doing everything possible to advance forensic science, don’t you want to keep the whole body of the shaken baby, and do every experiment you can on it? Aren’t you letting some murderer go free, or convicting an innocent, if you let any body go?
And after all, you can’t really do research without control subjects. Do you want to raid the hospital morgue for folks who died of natural causes, so you can research what the inside skull of a baby who dies of natural causes looks like, compared to the baby who died of shaken baby syndrome?
August 24, 2010, 10:05 pmPatHMV says:
To elaborate a bit more… I don’t deny the benefits of additional research. That would be foolish. What I don’t accept is the unsupported allegation that the supply of bodies that are either bequeathed willingly or remain unclaimed after a certain period of time is so scarce that the government must confiscate significant portions of the remains of murder victims (and suspected murder victims) against the wishes and religious beliefs of the deceased and/or his or her survivors in order to conduct forensic science research.
August 24, 2010, 10:29 pmReaderY says:
I don’t believe it is correct to characterize the interest involved as purely a property interest.
August 24, 2010, 10:54 pmOrenWithAnE says:
I think we are all willing to say that in case of a conviction for murder, the defendant surrenders all rights relating to decedent. In fact, I figured that was already the case.
Which is a good reason I will shortly include in my will full permission for any coroner or medical examiner to hold to my body for as long as they please. That or ship it out to the medical school for stitching practice.
(1) It’s long held that the solving of an actual crime, and the search for evidence related to that specific crime, trumps any such interest. Justice takes precedence.
(2) I would hope, although perhaps it might be too much to ask, that the victim’s family would honor his/her memory by doing what it takes to prevent future victims. That is, they ought to feel an acute duty to prevent anyone else from being victimized.
In the end, if they want to ignore that and leave the next family to be victimized just as they were, I suppose society has to begrudgingly accept that.
Sure, have a ritual. I don’t see why having the brain in or out the skull impacts the matter. With a good embalmer you wouldn’t even be able to tell the difference without popping the skull open yourself.
Symbolism is the sort of thing not meant to be taken literally.
Screw his needs, how about the needs of the next victim of the perp not to be murdered?
Of course, that person is unknown and consequently out of mind.
August 24, 2010, 11:16 pmbillo says:
“So billo, just what are you advocating? ”
Actually, I’ve been pretty clear about what I’m advocating. You still haven’t answered my question.
“How many innocent people are you willing to have incarcerated and how many innocent people are you willing to see killed by murderers in order to stop the kind of research we need to do in forensic medicine?”
You claim:
The “unclaimed” thing is specious. Tissues are often not useful after a month postmortem. Things happen after death. As to the rest of the stuff you’re writing, now you are just making stuff up. In order to cling to your desire to cast me as a ghoul, you are reduced to blatant falsehood, pushing your prejudices on what you *wish* I was saying in order to create more strawmen.
Unsupported? How about 100 years of fighting this battle in the US? How about the NAS report noting the dismal research in the area? Please. The bottom line is that you either want decent knowledge about these issues or you prefer ignorance. Your choice is the latter. Let a hundred thousand innocent people go to jail and a hundred thousand people die in order to make sure no more than a “sliver” (in your words) is not buried. If more than a sliver is saved, let us instead choose ignorance over knowledge and truth. And anybody who wants to save those lives is a “ghoul.” You don’t “deny” the benefits of forensic knowledge, you just don’t *want* it.
Spare me.
So, once again. How many innocent people are you willing to have incarcerated and how many innocent people are you willing to see killed by murderers in order to stop the kind of research we need to do in forensic medicine?
August 24, 2010, 11:25 pmKen Arromdee says:
But quoted from above, that doesn’t seem to have been happening:
August 25, 2010, 1:03 amKen Arromdee says:
Read the case. The family was upset that they didn’t give the brain back, instead destroying it. Destroying a brain instead
August 25, 2010, 1:07 amof giving it to the family does not save innocent people.
Guy says:
Then how do you get into federal court? It can’t be a liberty interest, can it?
August 25, 2010, 1:18 ambillo says:
Unfortunately, you are creating a distinction without a difference. Let’s assume that folk are not successful in destroying research and teaching in forensic medicine, and that it is still *theoretically* possible, at least to use tissues for these purposes.
Two questions then arise The first is “When do medical samples become medical waste,” and the second is about notification.
In this case, the plaintiffs argued that it was required that the Medical Examiner notify ahead of time that tissues would be retained. This is fundamentally impractical since many decisions about what tests to perform are made at the time of autopsy. If I have, for instance, a sudden death in a known drug addict I will likely assume that it is likely a drug-related death and *not* retain the brain. However, if at autopsy I find bruises on the head, a previously unsuspected skull fracture, and bleeding around the brain, I will likely change my mind and perform more testing on the brain to see if this is a death due to assault. The plaintiffs in this case would have me stop the autopsy and wait until the next of kin are located and the notificiation is made — perhaps days or weeks later. In the meantime, the body deteriorates and data is lost. In almost *every* autopsy, some material is retained — small samples for histology, fluids and tissues for toxicology, etc. Does each sample require separate notification? Should the autopsy be stopped each time a decision to take a sample is made?
Every day, thousands of gallons of blood, pus, bile, drainage, and fragments of tissues are destroyed in hospitals across the country. When you go to the doctor and get a urinalysis, the hospital does not save your pee as invaluable vital essence and return it to you in a decanter. When the test is done, it is discarded as medical waste. We don’t track every drop of urine in order to return it to the person who peed. Sure, if you voluntarily come in for treatment, you have to sign a consent for treatment and testing, but that is generally your choice — either you have the test or you don’t. But when that testing is done in the public interest or as part of an obligation — by court order, in the military, etc. — the test is done and the sample discarded.
And, in general, you don’t have people like PatHMV complaining that laboratory medicine folk are all just “ghouls” waiting to get their “clutches” on that urine.
The same thing is true here. Folk seem to have the idea that this brain is in some sort of pristine shape — that it’s been sitting on a shelf untouched. It’s not. It’s been dissected. That means that it’s been sliced, sometimes into “slivers”, pulled apart, and different pieces sent for different tests. Some pieces have been embedded in paraffin for histologic examination. Some pieces may have been subjected to destructive testing. Some may have been sent off for consultation.
There is no longer a “brain” here. There is a collection of tissue fragments. So, how many tissue fragments constitutes the “brain” and how many are medical waste? Do I have to account for every small fragment down to the microgram level and return it to the body? What if a small fragment falls into the sink and goes down the brain into the collection facility? Do I have to write an incident report and pay restitution to the family for that tiny fragment? Or is that medical waste?
What about the fluid that drains from the body? Is that also collectable vital essence, or is that medical waste? Do I have to set up special containers to catch *every drop* of decompositional fluid that drains from a decomposed body? Or is that fluid medical waste? What about blood? When I send off a sample to toxicology, do they need to track every drop and return the waste to the family five or six years from now?
And what about the specimens that are sent off? To quote from the National Association of Medical Examiner’s amicus brief in this case:
As an aside, the reference to Dr. Mash in this brief refers to one of the few cases of stunning research done on forensic samples in the US. As you may know, many people die in custody each year and their deaths are diagnosed as so-called “excited delirium syndrome” or one of its synonyms. Some people don’t believe that such a syndrome even exists and that it is used as an excuse to cover up murders by police. Happily there are a few jurisdictions in the US where retention of tissues for research has not been criminalized, and brains from victims of excited delirium were sent to her lab for evaluation. She has discovered specific anatomic differences between those who died of excited delirium and those who have not, and has pretty much demonstrated that this is a variant of so-called “serotonin syndrome.” And no, these are not studies that would be possible if consent were required.
Using this knowledge, the American Association of Emergency Room Physicians released a white paper last year recognizing this as a separate clinical entity and suggested therapies to minimize mortality. There are now multiple clinical trials dealing with how to save the lives of these people, and early results of some of them have shown up to a 100% decrease in death according to some briefings I’ve seen. That means hundreds of lives saved every year in the US.
Not bad for a bunch of “ghouls” who just want to get their “clutches” on tissues because they are basically evil cackling body snatchers.
But this is the exception rather than the rule. As the National Academy of Sciences noted in its recent indictment of Forensic Science:
And folk want to restrict it even *more.* Ignorance will out — no matter what the cost.
August 25, 2010, 10:01 amPatHMV says:
Billo, YOU might want to go back and read the case, or even just the comment thread here. You say:
“The plaintiffs in this case would have me stop the autopsy and wait until the next of kin are located and the notificiation is made — perhaps days or weeks later. ”
But the plaintiff’s attorney has assured us, in this thread, that that was not the case:
NO ONE, not one person in this thread has suggested that you must wait to conduct an autopsy until you get permission from the next of kin. But you keep treating research for future cases and the autopsy itself as indistinguishable.
And no, you have NOT been entirely forthcoming about what you desire. You (and the amicus brief you quote from) talk about “what if” the brain has been split up, half sent here, half sent there. But what if it hasn’t? What if it IS the whole brain, sitting there in a jar in the coroner’s office. Do you maintain a right to keep that? Just because my loved one died under circumstances which led him to your table?
The most disturbing, most ghoulish thing about you is that you don’t seem to believe that the other side of the argument has any legitimacy at all. You seem to think, like Ghost14, that cadavers are just meat for experimentation, and that any ritual needs the survivors may have for them is just so much foolish superstition which the power of law must shield you from, so that you may conduct your much nobler scientific research without being bothered by such superstitions.
Perhaps that’s why you have trouble obtaining consent. “Mr. Jones, your daughter is just a sack of meat now, and your religious beliefs are just silly and irrelevant, so we’d like your permission to keep her brain and heart and lungs to do some more research.”
If you ever want to prevail in changing some of these laws that you complain about, you damn well better learn to understand why people feel so strongly about them, understand that you DO seem like a ghoul, and approach the obstacles with a great deal of respect for the 100,000+ years of human cultural evolution which have led us, from our beginnings as a species, to practice funeral rites.
August 25, 2010, 10:23 amOrenWithAnE says:
Ken, that is the claim of the plaintiff’s counsel, one I’m not inclined to assume is true without stipulation from the defense.
Moreover, the plaintiff wanted notice in advance that the brain would be kept. This is different that notifying them afterwards.
August 25, 2010, 10:31 ambillo says:
Ahem. From “the case”:
You continue:
Actually, I’ve never said any of those things. In fact, I’ve stated just the opposite — that I consider working with families and helping them as a fundamental part of my job. You just can’t seem to get over your cartoonish stereotype of me and my profession.
My point is, and remains, that there are instances in which the value to and need of society outweighs individual considerations. As I’ve noted, this is true in cases of vaccination, in quarantine, etc. It is often true in instances of public health and the societal need for justice and reasonably scientifically-based forensic medicine. I understand the concept of sacraments — I am a conservative Christian. I understand religious opposition to vaccination. I understand religious opposition to autopsy.
Tell me, Pat, you say that you have no problem with me performing an autopsy in cases where there is suspected homicide *even when the family objects* based on religious belief. Does that make *you* a “ghoul?” Do you believe that the societal benefit from investigating homicide overrides that consideration — or do you believe that a murderer should get away with denying an autopsy by claiming religious objection?
I simply believe that the benefit of allowing forensic medicine to advance is another area where the benefit to society is important. You clearly don’t believe that it’s important. We disagree, but that doesn’t make me a “ghoul” any more than you are a “ghoul” for believing that homicides should be autopsied even when families object. We are not the cavalier ghouls you keep claiming. We are trying to save lives — in spite of your mischaracterization of us.
And, once again, how many lives are you willing to see lost, how many innocent people jailed, and how many victims of killers let loose are you willing to see killed in order to protect a fragment of tissue?
August 25, 2010, 11:55 amKen Arromdee says:
What? That’s easy to solve. Make the requirement “you should make a good faith effort to return all substantial portions of the body”. The law deals with things that can’t be exactly measured all the time, using concepts like “good faith effort”, “reasonable attempt”, etc.
You seem to think that because it’s not possible to give an exact measurement of how much of the body has to be returned, you shouldn’t have to return it at all. Just because there may be a few drops in the drain or a few pieces on a microscope slide doesn’t justify making it legal for the coroner to keep 98% of the victim’s brain in a jar on his desk.
August 25, 2010, 12:05 pmKen Arromdee says:
That’s like asking “you think it’s okay to search people who are suspects, and lock them up if they can’t pay bail (even if they haven’t been convicted yet), and you think it’s okay to force them to answer questions even if they are just witnesses… so why is it that having the police searching and seizing and questioning random people gets them called
August 25, 2010, 12:20 pmghoulsfascist thugs?” Investigating crimes inherently involves doing things to people, some of whom are innocent, that we wouldn’t accept under virtually any other circumstances.David Newton says:
That is very bluntly stated, but essentially that is what happens to people after they die. Even in most religions it is acknowledged that once a person is dead their body is nothing more than a hunk of flesh and bone. The thing that made the hunk of flesh and bone a person—aka the soul—is gone. I have heard of people who say that they cannot have a funeral without a body etc and that until one is found they will refuse to believe that a person who was vapourised in an explosion is dead. The problem in a lot of those cases is not religion. The problem in a lot of those cases is people who are not prepared to face reality and let go of a person. As the pathologist says there are many people who just will not listen to the truth in those circumstances. That is also why the rate of organ donation is so poor in many countries: people refuse to help others because of their emotional problems letting go of a loved one.
I know that when I attended the funerals of both my grandmothers and also of a close friend who died of leukemia at 27 the important thing was not the coffin sitting at the front of the service with a body in it. The important thing was remembering who the person was and what they had done during their lifetime. From a religious point of view at the two Christian funerals (one grandmother and the close friend) there was the comfort of knowing the person was in heaven. From a religious point of view at the other funeral it was sad to hear the words “… in the sure and certain knowledge of the resurrection …” spoken by the preacher and know that so far as I was aware they were empty words in that case.
It didn’t matter that the bodies of the people concerned were there. It mattered that their friends and family had gathered to remember them.
I would say the more ghoulish thing is to insist on having every piece of a person before they can be buried/cremated than to conduct some needed scientific research using samples taken at autopsy.
August 25, 2010, 12:30 pmDavid M. Nieporent says:
I’m curious by what mechanism you think we’re going to catch “a few hundred thousand” more murderers than we do now with extra forensic research.
Either you think that a lot of deaths are being misclassified as accidental or suicide when they were really murders, or you’re, um, pulling this from your posterior.
August 25, 2010, 1:08 pmDavid M. Nieporent says:
Nothing in that quote — or in the case as a whole — contradicts anything that PatHMV said to you. The Albrechts were not claiming that they had the right to grant or withhold permission for anything. Nor were they claiming that they had a legal entitlement to be notified before the autopsy was done, contrary to your assertions above. Nor, contrary to your ranting in this thread, were they even claiming that the state couldn’t retain the brain for research. They were asking for something very simple, according to both the Sixth Circuit and the Ohio Supreme Court in addressing the certified question (which is what you were actually quoting, and which would not usually be described as ‘the case’): (1) that they be notified when the body was returned to them that the brain was being retained, and (2) that after the brain was no longer needed, that they be notified it was available rather than the corner just tossing it out.
If you didn’t get that, then you should stick to cutting corpses up and stay away from law.
August 25, 2010, 1:24 pmbillo says:
“Nothing in that quote — or in the case as a whole — contradicts anything that PatHMV said to you. ”
That is because Pat misrepresented what I wrote. If you read it, it had to do with notification of intent. I documented what I said, not Pat’s misrepresentation.
August 25, 2010, 1:35 pmbillo says:
Oh please. This case is not about keeping “98% of the victim’s brain in a jar on his desk.” It’s about tissue that, after being dissected and reduced to fragments, was disposed of as medical waste. Let’s please get beyond you and PatHM’s cartoonish fantasies, OK? At least give us the benefit of recognizing what we are actually doing, rather than some made up fiction.
August 25, 2010, 1:47 pmbillo says:
“Either you think that a lot of deaths are being misclassified as accidental or suicide when they were really murders, or you’re, um, pulling this from your posterior.”
No, I’m talking about lives saved and recognizing that forensic medicine is an international discipline, and I’m recognizing that discoveries that save lives keep saving lives for many years afterwards.
Let’s take the results of Dr. Mash’s work on excited delirium. If current research is correct, we can decrease the mortality of this dramatically. While there is not very good data on the number of deaths due to this, but most major jurisdictions have at least a handful every year. So, let’s say it’s about 200 per year in the US — likely a low estimate since many of these are signed out as drug intoxication deaths. Let’s say that we can decrease the mortality by 90%, from 200 to 20. That’s 180 saved lives per year (and, again, that is likely a low estimate). Now add Europe, China, India, etc. For instance, the brains used in Dr. Mash’s study came from the US, Canada, the UK, and Sweden. So, now we are talking about saving at least 2000 – 3000 lives per year worldwide. Now do that for 10 years. That’s 30,000 lives saved, not to mention the fact that these are almost always accompanied by accusations of police brutality and associated charges.
That’s the benefit of *one* advance. And, maybe, if we stop criminalizing this kind of research, there might be more than one.
August 25, 2010, 2:17 pmKen Arromdee says:
An example of a brain that was dissected and reduced to fragments is being used to explain the decision, but the reasoning (and the decision) doesn’t depend on the brain actually being reduced to fragments and would equally well apply if it was in a jar on the coroner’s desk.
In other words, don’t use the most innocuous scenario you can think of to justify all scenarios.
Furthermore, we are not even told that that’s what happened in this case.
August 25, 2010, 3:08 pmjeff says:
Will this research actually prevent murders? I can see aiding future prosecutions or defenses.
August 25, 2010, 4:31 pmPatHMV says:
Billo, so now you’re talking about research to save lives, generally. So do you think that all corpses should be made available for research, regardless of the wishes of the survivors?
As I noted earlier, you can’t really do science without control cases, so in order to get better at diagnosing (to use one of your examples) shaken baby syndrome, you’d have to examine the brains and interior of the skull of babies known to have died of some cause other than shaken baby syndrome. Where do those babies come from? Are you in favor of requiring parents of babies who died in entirely unmysterious, if tragic, circumstances that research needs require you to do an autopsy and perform experiments on the body of their child? Or is it only the bodies of individuals who have the misfortune to die in mysterious circumstances (thus necessitating an autopsy) that you claim you should have the right to seize and use for your own purposes?
August 25, 2010, 5:16 pmbillo says:
I know, I know. I’m just a poor old country doctor and I don’t know all that high falutin’ law stuff. And I’ll be the first to stand in awe of your overwhelming competence compared to my feeble efforts at understanding what is clearly well beyond me.
But you know, I’m a little surprised that a stunning intellect such as yours finds it completely incomprehensible that establishing a new property right might have some effect on our ability to get tissues for the kind of research I’m talking about. I’m just a doddering old man, and what little knowledge I have is lost in the mists of my declining abilities, but somewhere along the way I would almost swear I’ve read somewhere that sometimes court decisions have implications beyond the immediate case involved.
But I’m sure I’m wrong. I’m sure you’re right and that kind of thing *never* happens.
August 25, 2010, 7:10 pmMy2cents says:
billo,
I myself am neutral on the case being discussed here. Having said that, I’ve always had the understanding that an autopsy was performed to determine the cause and classification of death. Could you please tell me when research for the advancement of forensic science became part of an autopsy objective. Another thing I would like to know is if you and all the other forensic scientists and corners that perform the autopsy are seriously trying to tell us that our forensic science is so woefully backwards that research on unwilling bodies is warranted then I would like to know just how many in your profession (including yourself) has donated their remains to forensic science once you’ve/they’ve past on in order to advance your profession if for no other reason for the good of society as a whole.
What I think is warranted here is a complete discloser as to what an autopsy consist of and what might be considered medical waste and have the next of kin sign it as soon a possible. Anything being done besides determining the cause of death should be considered a crime.
August 25, 2010, 7:19 pmbillo says:
Yes. It will both prevent murders and protect the innocent. Let me count the ways:
1) It will prevent murders by aiding in prosecution of killers who kill multiple people. A large number, if not most, of the murders I evaluate are due to the acts of people who kill more than one person. Murder seems to be a bad habit. This is particularly true in child murders. For instance, in 1997 a group in the UK put hidden cameras in the hospital rooms of so-called “near-SIDS” cases in which mothers brought in a child following a near-death experience. Of 39 such cases, they witnessed the mother smothering or otherwise assaulting the child while in the hospital (breaking bones, putting pillow over face, shoving toothbrush down the infant’s throat, etc). Of these 33 mothers, they had managed to kill, as I remember, 12 other children before being observed abusing the children in the study.
This was a landmark study because before it and subsequent similar studies were done, there was a great movement and worry about the epidemic of “near-SIDS” cases. When it turned out that, in fact, almost all cases of real “near-SIDS” have medically discernible causes, and most of these were Muchausen’s by proxy, it dramatically changed how these cases were investigated. Turns out that stopping a mother after the first killing saves the lives of the rest of the children she would have killed.
Not surprisingly, people were outraged at this interference with the privacy of the mother-child relationship, and the physician who performed this research was banned from practice in the UK for many years. He only recently won an appeal after years of support from the medical community. Some things are simply more important that a few dead babies — sanctity of the maternal bond and all that.
Still, the pattern exists. The same thing is true of other kinds of murders from sexual homicide to felony homicide. And, on the other side of the street, the same thing is also true of deaths due to abuse by police and corrections people.
I remember a sexual homicide I worked on some years back. The woman’s nude body was found in a vacant lot, having been raped, throttled, and then run over. Some time later, after unsucessfully attempting to abduct another woman, the killer was captured. At the time he was driving the car of a second victim and they found blood of a third victim in the trunk of the car. He was, at the time, on parole for a conviction of a similar murder. When his apartment was searched, the police found personal effects from something like 20 other women, who he had been stalking in preparation for later killings. Similarly, drug dealers and gang members who kill tend to kill more than one person in their careers.
When you stop one of these people, you tend to save the lives of the people they would subsequently have killed.
2) This kind of research can prevent *homicides,* if not murders — it has been pointed out to me that since I’m just a silly physician I have no place talking about murder per se. But I can talk about homicide. One interesting implication of the excited delirium work in combination with research done on TASER application is that such knowledge can modulate use of force policy in order to minimize deaths in custody. While deaths of prisoners may or may not be “murder” they are certainly homicides and should be minimized. The same thing is true with shaken baby research. If, in fact, shaking a baby can easily be fatal, then that fact can be promulgated to parents and preventative strategies and education put in place — and these homicides can be minimzed. If shaking a baby is not as dangerous as some think, then parents can be reassured and other things can be looked at to explain some of these deaths.
3) Just as it can save lives by showing what is dangerous, it can protect the innocent by showing what is not. As noted above, if shaking is not dangerous, then there are a lot of people in jail who should not be. If a less-lethal technology can be deployed that saves lives when used for subdual by police, then those lives will be saved, and if it can be shown that this technology cannot kill by certain mechanisms, then accusations of homicide based on those mechanisms can be shown false and innocent people can be spared those accusations.
August 25, 2010, 8:18 pmbillo says:
You seem to be under the impression that it is possible to determine the cause and manner of death while maintaining a willful ignorance of what causes death and the implications of those causes towards manner. Your complaint is a little like asking “Isn’t the practice of medicine the treatment of disease and not research into what causes disease and how to treat it?” You forget that forensic medicine *is* medicine, and you cannot separate research and its results from practice. That is why the performance of research is a *requirement* for accreditation of training programs in forensic medicine and why the National Academy of Sciences has come out so strongly in recommending more research in its critique of the Medical Examiner system. And yes, I have willed my body to science.
August 25, 2010, 8:24 pmbillo says:
I’ll answer your questions when you’ve answered mine.
August 25, 2010, 8:41 pmbillo says:
I know. That would be almost as silly as using a nonapplicable, extreme, and prejudical scenario to characterize all scenarios. Good thing we wouldn’t do that, isn’t it?
Well, yes, actually we are.
August 25, 2010, 8:56 pmKen Arromdee says:
No, because when the law allows the government to do something it’s legitimate to claim that it’s bad because it might be abused, while nonsense to claim that it’s good because it might fail to be abused. The worst case scenario has to be considered; the best case scenario is irrelevant.
August 25, 2010, 10:49 pmjeff says:
Billo, I understand your point and I can see some merit to it. I realize many killers kill more than once. The cases you cite don’t justify the retention of the body (or parts) for research. All the Muchausen’s by proxy cases you mention were solved by hidden camera, not forensic research. The sexual homicide case seemed to turn on routine examination of forensic evidence, again not retaining body parts to study.
August 25, 2010, 10:57 pmYou most certainly know more about the subject matter than I do. You may be right, but you arguments are not doing much to convince me. I’m not saying study of “remains” is useless. I just don’t see it saving hundreds of thousands or thousands of lives.
David M. Nieporent says:
Your quote to which I was responding was not about “lives saved.” Your quote was that we would catch “probably only a few hundred thousand” more murderers than we do now.
As far as I can tell, if by “some people” you mean “the vast majority of medical professionals not on Taser’s payroll,” then yes. And as far as I can tell, the primary function of Mash’s work here is to exculpate police officers (and Taser), not to prevent deaths. (Incidentally, the white paper you refer to is from the American College of Emergency Physicians. And “up to 100%”? As opposed to more than 100%?)
(1) Who said consent was required?
August 26, 2010, 12:06 am(2) Why not, exactly?
billo says:
Well, I was trying to give you examples of where this general kind of forensic research did what you were talking about. And, I’ll add, the hidden camera stuff *is* forensic. I’ll also add that your question is a bit of a Catch-22 in the sense that you’re asking “Show me the success of doing what I do not allow you to do.” However, I’ll list some successes and some areas that are of acute interest right now in the profession. Moreover, since I’m listing things, I’ll also point out that forensic medicine is not “just” murder — it’s also public health, counterterrorism, disaster response, etc. For instance, the first instances of the Hantavirus outbreak in the soutwest in the 1990s was first noticed by the New Mexico ME office. When I was in the military at the Office of the Armed Forces Medical Examiner, we were involved in planning for possible biological and chemical events, and was involved in the evaluation of some of the things that happened to hostages and prisoners. So some of the areas of research I’m going to list will address those as well. So, here are a few off the top of my head. Give me a day to review the literature, and I can probably come up with 50 or 60 more, without much effort:
1) TASER-related deaths. A man is TASERED and dies. Is the death due to TASER (a homicide) or excited delirium or drug intoxication (accident). Perhaps it would be useful to do studies to find out how dangerous TASERs are — which requires both antemortem and postmortem data. Studying this requires both antemortem (before death) and postmortem (after death) analysis. Obviously the physiologic responses to TASER use must be done *mostly* before death. Anatomic issues are often best addressed after death. For instance, are there minute or even molecular differences between those who die afte TASER use and those who don’t? How much of that death is due to TASER and how much due to other issues (drugs, excited delirium, etc.). If it’s due to TASER use, then it’s a homicide. If it’s not then it’s not a homicide. If it is due to TASER use, what can one change about the deployment, the device, or the response that might save the life?
2) Excited delirium deaths. I’ve gone on at length about that.
3) SIDS v. child abuse. Are there anatomic differences between children that “really” die of SIDS and those who don’t? There already has been some work in this area, mostly done outside the US. However, as molecular diagnostics and ultrastructural analysis technologies become better, it may be that the differences are not matters of grossly observable anatomic differences, but instead, like the excited delirium cases, at the recptor/molecular level.
4) Shaken baby. I’ve already written about that.
5) More research into the anatomic sequelae of smothering of children. Many people don’t realize that smothering children often leaves no signs of what causes death by traditional autopsy techniques. It’s no accident that the smotherings discovered in England were discovered by video — since they are not discoverable at autopsy. Once again, there needs to be more work on discovering subtle anatomic changes that may be diagnostic of smothering.
6) Virtual autopsy — how can we correlate imaging technologies with “real” autopsies and perhaps avoid doing unnecessary autopsies. What does imaging show us that autopsies do not, and what does the autopsy show us that imaging does not — particularly with soft tissue lesions?
7) How do drugs *really* kill. It turns out that many if not most drug “overdoses” are not drug overdoses at all. Very recently, a study was done in which fentanyl levels were drawn in cadavers over an extended period of time. In some of the cases the amount of fentanyl in the blood rose with the time since death. In one case the fentanyl level was normal at death but by 24 hours out was measured at well over the “lethal” level. This has some important implications when considering “malpractice” in which the physician is accused of causing an overdose. Similarly, some opiates, such as methadone, kill due to direct cardiac effects and not the “regular” method of overdose. The “real” causes of death and how to discover them *after* death need to be nailed down.
8) What are the implications of other postmortem tests? For instance, I was once accused of wrongly ruling a child death a homicide because a blood cell count done at the emergency room many hours after death showed a markedly elevated white cell count that in a living person would be diagnostic of leukemia. Eventually I was able to find research (done outside the US, of course) that showed that the results of such tests were dependent on blood settling in the body and had nothing to do with the antemortem blood conditions.
9) What about studies on time since death? That has huge implications, and the traditional measures are simply horrible. One recently published study (done outside the US, of course) found that there was almost *no* consensus regarding time since death when different experts were asked to look at the same case in the case of extended time since death. There may be molecular studies, however, that are much better.
10) What about sudden cardiac death due to channelopathies such as long Q-T syndome, or minute anatomic variants in the conduction system that result in sudden death? There are hundreds of people who die every year and they have a negative autopsy. Many of these people are almost certainly those who have molecular diseases of the heart that cause arrhythmias. Since these are often genetic and inheritable, learning how to find them in the postmortem interval would save the lives of their children and relatives (since most of the ones we know about are also treatable). Another recent study (not done in the US, of course) looked at the morphology of the sinus node and discovered a novel cell type that may explain some of these deaths.
11) What about patterned injury analysis, where we try to match the marks on bodies with candidate objects used in assault. How do the elastic properties of the skin affect deformation of the marks and how do the microscopic and physiologic responses to injury change them? How do we correlate this with findings at autopsy.
12) What about secondary effects of drug abuse, such as systemic angiocentric granulomatosis, where the filler material in oral prescription drugs that abusers dissolve and inject results in chronic granulomatous reactions that can result in death? How many of these secondary effects are we missing because we don’t know about them since we can’t actually do surveys of tissue to look for them?
13) What about the effects of chronic brain injury. A recent study has shown that chronic brain injury such as that associated with boxing may result in increased rates of suicide. Perhaps it would be useful to look at the anatomic changes associated with chronic brain injury deaths that are associated with suicides.
14) What about aging wounds? A number of forensic cases hang on *when* a wound occurred. Many traditional ways of aging such things as bruising are very bad — one study of visual estimation of bruise age found an accuracy of less than 50%, and other studies have been similar. However, there is evidence that there are molecular markers of repair that might answer these questions better. How do these relate to forensically important injury, and how does it change in the postmortem period?
15) What about markers of hemorrhage and wounds on dry bone in skeletonized remains? The evaluation of badly decomposed remains involves both forensic pathology and forensic anthropology working together. In a recent study (not done in the US, of course) evaluation of bones was performed to look for markers and antemortem injury with some success.
16) What about anatomic changes in the brain associated with poisoning? A recent study (not done in the US, of course) looked at the brains of people who had died of methanol poisoning and found some specific changes. It is not possible in every case to get a good drug level postmortem, and sometimes you have to make the diagnosis of a drug effect from anatomic changes (or you may not know to look for a specific drug when you do your routine testing). The next challenge will be to separate these from the effects of chronic alcholism, since many people who drink methanol are alcholics.
17) What about something as simple as the use of helmets in motorcyclists. There is actually no good systematic study of the anatomic differences between accidents involving motorcyclists who wear helmets and those who do not beyond the use of ISS scores. It may be that looking carefully at the injuries associated with these deaths — beyond the “multiple head trauma” level of the traditional autopsy could save many lives.
18) How does the handling and the holding of bodies affect postmortem bleeding? There are issues with “bruises” that occur in the postmortem interval that are incorrectly labeled as antemortem — and thus implicated in assault. A recent study (not done in the US, of course) looked at these changes and how they can be distinguished from “real” injury.
19) What about subtle changes in hanging and near-hanging deaths? It turns out that recent information has taught us that most of what we thought we knew about e xtrajudicial hanging is wrong.
20) What about changes in the brain associated with electrocution? Turns out that there may be some subtle anatomic changes here as well, and electrocution is another one of those causes of death that may not give anatomic evidence.
21) What about molecular and physiologic responses to fire and explosion? How does that affect analysis of what happened in the death and the reconstruction thereof?
22) Estimation of age of the deceased by evaluation of telomere shortening. A study (not done in the US, of course) has looked at molecular methods of determining the age of decedents for identification purposes with good results.
23) Sudden death in epilepsy. This is another diagnosis that has no anatomic signs. Perhaps if folk were allowed to look for them they might be found.
24) Deaths in sickle cell trait. You have some people who say that this never occurs, and there has been at least one forensic pathologist who has been fired for diagnosing it, while you also have studies that show a 40x increased mortality among people with sickle cell trait under certain circumstances — to the point that the national association of sports physicians has put out specific warnings. But there has never been a good study of the anatomic changes in these deaths.
25) Deaths due to “less-lethal” devices other than TASERs. There are more and more of these being deployed. Recently, a jurisdiction deployed a focused heat ray device. You think there might be some use in looking at deaths associated with these new technologies?
26) Fatal low force injuries in the elderly. Older people are much more likely to die due to trivial trauma. What anatomic features are associated with this, and what can we do to minimize it?
27) Signs of throttling and hanging when the skin changes are not obvious. A recent study (not done in the US, of course) collected tissues from hanging victims and found an elevated level of thyroid hormones — most likely due to trauma to the thyroid gland.
28) Emerging and re-emerging diseases. Where I work, we are having a resurgence of active tuberculosis, both with new and traditional manifestations both as the primary cause of death and as incidental findings from homicides, etc. It would be useful to be able to look at pieces of these tissues and characterize this outbreak in terms of changes in the organism and details of its manifestation. This is particularly important in the case of emerging diseases such as new viruses, and in the re-emergence of diseases once thought near-controlled such as malaria and dengue fever.
29) Cardiac injuries in blunt trauma. There are studies (done outside the US, of course) that suggest that there are deaths due to cardiac injury in blunt trauma that are not caught during the traditional autopsy.
August 26, 2010, 12:06 pmbillo says:
“And “up to 100%”? As opposed to more than 100%?)”
In general usage, when you say “up to” something, you are discussing an upper limit. Thus, for instance, if I measure the heights of a group of children and say “the children measured up to five feet tall,’ that is usually read to mean that the tallest child or children were five feet tall, and the rest were shorter. Thus, when I wrote “up to 100%” I was noting that it may well be that it may be possible to prevent these deaths altogether.
And, of course, you are mistaken both about the purpose of Dr. Mash’s work and the position of most physicians — particularly those who are involved with and know about the subject.
Thank you for correcting my error. That’s what I get from writing from memory.
As far as consent, it is required by law an many jurisdictions, and in many others it is simply illegal. The reason that consent is difficult is that in many of these cases the interests of the family and those of society are different. The autopsy is often done against the wishes of the family, and the research may likely not support their hopes in pending litigation — either as plaintiffs or defendants. I will point to your attitude about Dr. Mash’s work. Clearly you wish that we had remained ignorant of her findings.
I will also note that many of these issues are not common. This is often not like lung cancer where there are lots of opportunities to get cases.
August 26, 2010, 1:14 pmbillo says:
ell, I was trying to give you examples of where this general kind of forensic research did what you were talking about. And, I’ll add, the hidden camera stuff *is* forensic. I’ll also add that your question is a bit of a Catch-22 in the sense that you’re asking “Show me the success of doing what I do not allow you to do.” However, I’ll list some successes and some areas that are of acute interest right now in the profession. Moreover, since I’m listing things, I’ll also point out that forensic medicine is not “just” murder — it’s also public health, counterterrorism, disaster response, etc. For instance, the first instances of the Hantavirus outbreak in the soutwest in the 1990s was first noticed by the New Mexico ME office. When I was in the military at the Office of the Armed Forces Medical Examiner, we were involved in planning for possible biological and chemical events, and was involved in the evaluation of some of the things that happened to hostages and prisoners. So some of the areas of research I’m going to list will address those as well. So, here are a few off the top of my head. Give me a day and I can probably come up with another 50 or so.
1) TASER-related deaths. A man is TASERED and dies. Is the death due to TASER (a homicide) or excited delirium or drug intoxication (accident). Perhaps it would be useful to do studies to find out how dangerous TASERs are — which requires both antemortem and postmortem data. Studying this requires both antemortem (before death) and postmortem (after death) analysis. Obviously the physiologic responses to TASER use must be done *mostly* before death. Anatomic issues are often best addressed after death. For instance, are there minute or even molecular differences between those who die afte TASER use and those who don’t? How much of that death is due to TASER and how much due to other issues (drugs, excited delirium, etc.). If it’s due to TASER use, then it’s a homicide. If it’s not then it’s not a homicide. If it is due to TASER use, what can one change about the deployment, the device, or the response that might save the life?
2) Excited delirium deaths. I’ve gone on at length about that.
3) SIDS v. child abuse. Are there anatomic differences between children that “really” die of SIDS and those who don’t? There already has been some work in this area, mostly done outside the US. However, as molecular diagnostics and ultrastructural analysis technologies become better, it may be that the differences are not matters of grossly observable anatomic differences, but instead, like the excited delirium cases, at the recptor/molecular level.
4) Shaken baby. I’ve already written about that.
5) More research into the anatomic sequelae of smothering of children. Many people don’t realize that smothering children often leaves no signs of what causes death by traditional autopsy techniques. It’s no accident that the smotherings discovered in England were discovered by video — since they are not discoverable at autopsy. Once again, there needs to be more work on discovering subtle anatomic changes that may be diagnostic of smothering.
6) Virtual autopsy — how can we correlate imaging technologies with “real” autopsies and perhaps avoid doing unnecessary autopsies. What does imaging show us that autopsies do not, and what does the autopsy show us that imaging does not — particularly with soft tissue lesions?
7) How do drugs *really* kill. It turns out that many if not most drug “overdoses” are not drug overdoses at all. Very recently, a study was done in which fentanyl levels were drawn in cadavers over an extended period of time. In some of the cases the amount of fentanyl in the blood rose with the time since death. In one case the fentanyl level was normal at death but by 24 hours out was measured at well over the “lethal” level. This has some important implications when considering “malpractice” in which the physician is accused of causing an overdose. Similarly, some opiates, such as methadone, kill due to direct cardiac effects and not the “regular” method of overdose. The “real” causes of death and how to discover them *after* death need to be nailed down.
8) What are the implications of other postmortem tests? For instance, I was once accused of wrongly ruling a child death a homicide because a blood cell count done at the emergency room many hours after death showed a markedly elevated white cell count that in a living person would be diagnostic of leukemia. Eventually I was able to find research (done outside the US, of course) that showed that the results of such tests were dependent on blood settling in the body and had nothing to do with the antemortem blood conditions.
9) What about studies on time since death? That has huge implications, and the traditional measures are simply horrible. One recently published study (done outside the US, of course) found that there was almost *no* consensus regarding time since death when different experts were asked to look at the same case in the case of extended time since death. There may be molecular studies, however, that are much better.
10) What about sudden cardiac death due to channelopathies such as long Q-T syndome, or minute anatomic variants in the conduction system that result in sudden death? There are hundreds of people who die every year and they have a negative autopsy. Many of these people are almost certainly those who have molecular diseases of the heart that cause arrhythmias. Since these are often genetic and inheritable, learning how to find them in the postmortem interval would save the lives of their children and relatives (since most of the ones we know about are also treatable). Another recent study (not done in the US, of course) looked at the morphology of the sinus node and discovered a novel cell type that may explain some of these deaths.
11) What about patterned injury analysis, where we try to match the marks on bodies with candidate objects used in assault. How do the elastic properties of the skin affect deformation of the marks and how do the microscopic and physiologic responses to injury change them? How do we correlate this with findings at autopsy.
12) What about secondary effects of drug abuse, such as systemic angiocentric granulomatosis, where the filler material in oral prescription drugs that abusers dissolve and inject results in chronic granulomatous reactions that can result in death? How many of these secondary effects are we missing because we don’t know about them since we can’t actually do surveys of tissue to look for them?
13) What about the effects of chronic brain injury. A recent study has shown that chronic brain injury such as that associated with boxing may result in increased rates of suicide. Perhaps it would be useful to look at the anatomic changes associated with chronic brain injury deaths that are associated with suicides.
14) What about aging wounds? A number of forensic cases hang on *when* a wound occurred. Many traditional ways of aging such things as bruising are very bad — one study of visual estimation of bruise age found an accuracy of less than 50%, and other studies have been similar. However, there is evidence that there are molecular markers of repair that might answer these questions better. How do these relate to forensically important injury, and how does it change in the postmortem period?
15) What about markers of hemorrhage and wounds on dry bone in skeletonized remains? The evaluation of badly decomposed remains involves both forensic pathology and forensic anthropology working together. In a recent study (not done in the US, of course) evaluation of bones was performed to look for markers and antemortem injury with some success.
16) What about anatomic changes in the brain associated with poisoning? A recent study (not done in the US, of course) looked at the brains of people who had died of methanol poisoning and found some specific changes. It is not possible in every case to get a good drug level postmortem, and sometimes you have to make the diagnosis of a drug effect from anatomic changes (or you may not know to look for a specific drug when you do your routine testing). The next challenge will be to separate these from the effects of chronic alcholism, since many people who drink methanol are alcholics.
17) What about something as simple as the use of helmets in motorcyclists. There is actually no good systematic study of the anatomic differences between accidents involving motorcyclists who wear helmets and those who do not beyond the use of ISS scores. It may be that looking carefully at the injuries associated with these deaths — beyond the “multiple head trauma” level of the traditional autopsy could save many lives.
18) How does the handling and the holding of bodies affect postmortem bleeding? There are issues with “bruises” that occur in the postmortem interval that are incorrectly labeled as antemortem — and thus implicated in assault. A recent study (not done in the US, of course) looked at these changes and how they can be distinguished from “real” injury.
19) What about subtle changes in hanging and near-hanging deaths? It turns out that recent information has taught us that most of what we thought we knew about e xtrajudicial hanging is wrong.
20) What about changes in the brain associated with electrocution? Turns out that there may be some subtle anatomic changes here as well, and electrocution is another one of those causes of death that may not give anatomic evidence.
21) What about molecular and physiologic responses to fire and explosion? How does that affect analysis of what happened in the death and the reconstruction thereof?
22) Estimation of age of the deceased by evaluation of telomere shortening. A study (not done in the US, of course) has looked at molecular methods of determining the age of decedents for identification purposes with good results.
23) Sudden death in epilepsy. This is another diagnosis that has no anatomic signs. Perhaps if folk were allowed to look for them they might be found.
24) Deaths in sickle cell trait. You have some people who say that this never occurs, and there has been at least one forensic pathologist who has been fired for diagnosing it, while you also have studies that show a 40x increased mortality among people with sickle cell trait under certain circumstances — to the point that the national association of sports physicians has put out specific warnings. But there has never been a good study of the anatomic changes in these deaths.
25) Deaths due to “less-lethal” devices other than TASERs. There are more and more of these being deployed. Recently, a jurisdiction deployed a focused heat ray device. You think there might be some use in looking at deaths associated with these new technologies?
26) Fatal low force injuries in the elderly. Older people are much more likely to die due to trivial trauma. What anatomic features are associated with this, and what can we do to minimize it?
27) Signs of throttling and hanging when the skin changes are not obvious. A recent study (not done in the US, of course) collected tissues from hanging victims and found an elevated level of thyroid hormones — most likely due to trauma to the thyroid gland.
28) Emerging and re-emerging diseases. Where I work, we are having a resurgence of active tuberculosis, both with new and traditional manifestations both as the primary cause of death and as incidental findings from homicides, etc. It would be useful to be able to look at pieces of these tissues and characterize this outbreak in terms of changes in the organism and details of its manifestation. This is particularly important in the case of emerging diseases such as new viruses, and in the re-emergence of diseases once thought near-controlled such as malaria and dengue fever.
29) Cardiac injuries in blunt trauma. There are studies (done outside the US of course) that suggest that there are deaths due to cardiac injury in blunt trauma that are not caught during the traditional autopsy.
August 26, 2010, 1:17 pm