Post Mortem
Post Mortem
Post Mortem is also called autopsy (which means to see for oneself). Mortem is a latin term which means death, Post Mortem simply means after death. It is a medical examination which is carried out on the body of the deceased. The aim of the Post Mortem examination is to determine the cause of the death. Post mortem is usually carried out in government hospitals in India. It is conducted on the order of an investigating officer or magistrate in cases of sudden, suspicious unnatural deaths, which are labelled as MLC cases.
Official Definition of Post Mortem
While the term is not defined in legislation, reference is made to the medico-legal examination of dead bodies under Sections 194 and 196 of BNSS 2023.
Post Mortem Procedure under Bharatiya Nagarik Suraksha Sanhita, 2023
BNSS under sections 194 and 196 talks about the post mortem procedure, providing instructions for police officers, under S 194, and for the magistrate enquiring into cause of death, under S 196.
Section 194 says when the officer in charge of a police station or some other police officer specially empowered by the State Government in that behalf receives information that a person has committed suicide, or has been killed by another or by an animal or by machinery or by an accident, or has died under circumstances raising a reasonable suspicion that some other person has committed an offence, he shall immediately give intimation thereof to the nearest Executive Magistrate empowered to hold inquests, and, unless otherwise directed by any rule made by the State Government, or by any general or special order of the District or Sub-divisional Magistrate, shall proceed to the place where the body of such deceased person is, and there, in the presence of two or more respectable inhabitants of the neighbourhood, shall make an investigation, and draw up a report of the apparent cause of death, describing such wounds, fractures, bruises, and other marks of injury as may be found on the body, and stating in what manner, or by what weapon or instrument (if any), such marks appear to have been inflicted. Additionally, the report shall be signed by such police officer and other persons, or by so many of them as concur therein, and shall be forwarded to the District Magistrate or the Sub-divisional Magistrate within twenty-four hours.
Section 196 says the Magistrate so empowered may hold an inquiry into the cause of death either instead of, or in addition to, the investigation held by the police officer; and if he does so, he shall have all the powers in conducting it which he would have in holding an inquiry into an offence. Where an inquiry is to be held under this section, the Magistrate shall, wherever practicable, inform the relatives of the deceased whose names and addresses are known, and shall allow them to remain present at the inquiry. The Magistrate or the Executive Magistrate or the police officer holding an inquiry or investigation shall, within twenty-four hours of the death of a person, forward the body with a view to its being examined to the nearest Civil Surgeon or other qualified medical person appointed in this behalf by the State Government, unless it is not possible to do so for reasons to be recorded in writing. In this section, the expression "relative" means parents, children, brothers, sisters and spouse.
Standard Operating Procedure for Conducting Post-Mortem
Post-mortems in India are typically conducted in government hospitals, especially medical colleges that have forensic departments. A forensic pathologist or a trained medical officer performs the autopsy. The body is thoroughly examined externally for signs of injury, marks, or other abnormalities. The body is then dissected to examine internal organs such as the heart, lungs, liver, and brain. The forensic expert looks for signs of trauma, poisoning, disease, or any other factor contributing to death. In cases of suspected poisoning or drug overdose, samples of blood, urine, or tissues are collected for toxicology analysis. Based on the findings, the forensic expert prepares a detailed post-mortem report, which is submitted to the investigating authorities and can be used as evidence in legal proceedings.
What happens in a post mortem examination?
The full post mortem examination can be described in the following stages:
1. Receiving a request letter for conduction of post-mortem examination along with complete inquest papers including brief history, statements, hospital documents, investigating officer’s report etc.
2. Identification
3. The external examination
4. Internal examination
5. The internal examination consists of inspecting the internal organs of the body. This part of the examination is like a major operation and usually takes two to three hours to complete.
6. Special examinations/tests and reports: This includes retention of tissue samples for further laboratory investigations. An account of the findings is then written up by the doctor and later the results of any special examinations or tests and of the microscopic examination may be added. The timeframe for the availability of the final post mortem report varies but an effort is made to.
Types of Post Mortem
- Forensic Post Mortem
Forensic post mortem, also known as medicolegal post mortem, is an examination of the body of the deceased for medical or legal reasons, in cases where there is suspicion of an unnatural death, which may include homicide, suicide, or accident. Forensic post mortem is an important part of the forensic evidence-gathering process of a legal investigation. It attempts to define factors such as cause of death, manner of death, extent of injury, identification of the victim, post mortem interval (time period between examination and death), signs of struggle (before death) etc.
- Clinical Post Mortem
Clinical post mortem, also known as pathological post mortem, is conducted to diagnose a particular disease to determine the pathological processes that lead to the death of the person. Other purposes for conducting a clinical post mortem are research, ensuring the standard of care in hospitals, preventing death of patients etc.
- Academic Post Mortem
Academic post mortem is conducted by students and researchers for research purposes, overlapping with the fields of anatomy and pathology.
Post Mortem Regulations in India
Consent : In routine cases, a post-mortem requires no consent from the deceased’s family if the death is unnatural or suspicious. However, in cases where the family believes the death to be natural, they can request the police or court to avoid the procedure.
Timings : The recent guidelines issued by the Ministry of Health and Family Welfare, which allowed post mortem to be carried out during night, with permission from the valid authority, except for cases where the death is caused by homicide, suicide, rape, unless there is a law and order situation.
NHRC Guidelines
The National Human Rights Commission issued an advisory to the Centre and States on upholding the dignity and protecting the rights of the dead in view of the large number of deaths during this second wave of the COVID-19 pandemic and the challenges in the management of bodies.
The Report cites Paramananda Katara v Union of India, which highlighted the importance of conferring dignity to dead persons. The report confers this duty on citizens, medical practitioners, forensic department, mortuary services,police, media and the government. Provisions under Bharatiya Nyaya Sanhita conferring rights to deceased persons include Section 301 which penalizes trespassing on burial grounds, and Section 356 penalizing defamation which also includes defaming a dead person.
International Experience
USA
In the United States of America, the coroner system and medical examiner system of medicolegal death investigation are prevalent.
India
Either the magistrate or the police conduct the medicolegal death investigation.
Scotland
The procurator fiscal investigates deaths requiring further explanation.
England, Wales, and Northern Ireland of the United Kingdom
The coroner investigates deaths demanding further explanation.
Post Mortem Examination Challenges
Performing post-mortem examinations can be emotionally draining for both the pathologist and the family of the deceased. Striking a balance between the scientific investigation and showing respect for the deceased and their loved ones necessitates sensitivity and ethical considerations.
Legal and consent issues pose a significant challenge in obtaining appropriate permission for post-mortem examinations, particularly in cases where the cause of death is uncertain. The intricacies of legal frameworks and cultural sensitivities must be navigated carefully.
Technical challenges also arise in post-mortem examinations, as they require meticulous attention to detail and specialized techniques. Factors such as advanced decomposition, trauma, or pre-existing medical conditions can complicate the process and interpretation of findings.
Time constraints add to the complexity of post-mortem examinations, as timely completion is crucial for legal proceedings, public health investigations, and providing closure for the family. However, logistical issues, limited resources, and caseloads can present obstacles in meeting deadlines.
Landmark "case laws" that deal with/concern post mortem
· Parmanand Katara vs Union of India, 1989: right to life, fair treatment and dignity, extend not only to a living person but also to his dead body. These rights have been derived from Article 21 of the Constitution of India.
· Ashray Adhikar Abhiyan v. Union of India, 2002 (W. P. (C) 143 of 2001), that dignity of the dead must be maintained and respected.
· In P. Rathinam v. Union of India, 1994 (SCC (3) 394), the ambit of article 21 was widened to include the dignity of a person. It emphasized that the right to life means a meaningful life and not merely animal existence. Further, this right to dignity was also expanded to a dead person.
· In the case of S. Sethu Raja v. Chief Secretary, 2007 (W.P. (MD) No. 3888 of 2007), the Madras High Court directed the Government authorities to bring the dead body from Malaysia, so that burial can take place at home according to traditions and customs.
· Ramji Singh and Mujeeb Bhai Vs. State of U.P. & Ors, 2010 (PIL) No.- 38985 of 2004) – In this case the Allahabad High Court contended that a person’s right to life includes the right of the dead body to be treated with the same respect that he would have deserved if he were alive. It is imperative for the State to treat the corpse with dignity, and must only resort to postmortem if it is a necessity
2. Guidelines/regulations for conducting post mortem
· Chapter XV of Hospital Management by the Ministry of Health and family Welfare, 2002: https://mohfw.gov.in/sites/default/files/15%20CH.%20XV%20Autopsy.pdf
· Regulation on the conduct of post mortem after sunset: https://mohua.gov.in/upload/whatsnew/619f7df242767post-mortem_0001.pdf
· Guidelines for video-filming and photography of post-mortem examination in case of death in police action (NHRC): https://nhrc.nic.in/sites/default/files/Guidelines_for_video_photography_of_PME_death_in_police_action.pdf
· Post mortem in death row cases, MHA- 2014 : https://www.mha.gov.in/sites/default/files/2022-09/AdvisorySafeGuarding_040214_0%5B3%5D.pdf.
· Advisory for Upholding the Dignity and Protecting the Rights of the Dead, NHRC, 2021: https://nhrc.nic.in/sites/default/files/NHRC%20Advisory%20for%20Upholding%20Dignity%20%26%20Protecting%20the%20Rights%20of%20Dead.pdf
· Covid, AIIMS: https://www.aiims.edu/images/pdf/notice/COVID-19_Forensic_stamdard%20guidline_6-5_20.pdf
4. State- level variations
Government of Karnataka. Government Order [G.O. No. AaKuKa/711 part 03]. 2003 Sep 17 [Cited 2022 Jan 3]. Available from: https://indiankanoon.org/doc/153129288/?type=print
V Eswaran vs Government of Tamil Nadu on 16 April 2019. [Cited 2022 Jan 3]. Available at: https://indiankanoon.org/doc/65220320
Government of Kerala. Conducting 24 hours autopsy in five Government Medical Colleges. Government Order, G.O (MS) No.239/H/FWD dated 26/10/2015. [Cited 2022 Jan 3]. Available from: https://keralapolice.gov.in/storage/orders/iaps/d1Syca1hyDCe6F8OeyPy4KXPrgCM1e9xDFTBnBKr5n8hq73EJa.pdf
Government of Maharashtra. Hospital Administration Manual Vol. I (Revised). Chapter XII. Government Central Press (Bombay). June 1976: p121-140.
3. Format for post mortem
https://nhrc.nic.in/sites/default/files/Revised%20format%20of%20post-mortem%20examination_0.pdf
5. Any learnings or Best Practices
NHRC: Basic Principles for Upholding the Dignity and Protecting the Rights of the Dead- https://nhrc.nic.in/sites/default/files/NHRC%20Advisory%20for%20Upholding%20Dignity%20%26%20Protecting%20the%20Rights%20of%20Dead.pdf
· CEHAT guidelines 2020: https://www.cehat.org/uploads/files/Guidelines%20for%20autopsy%20in%20sustodial%20deaths%201.pdf
5. Appearance of 'term' in Database
MP website: https://medleapr.mp.gov.in/
6. Research that engages with 'term'
· Project Report on Standardization of Equipment & other facility for Post Mortem at District Hqrs, National Police Mission- 2016-17: https://bprd.nic.in/uploads/pdf/final%20Standardization%20of%20Equipment%20&%20other%20facility%20for%20Post%20Mortem%20at%20District%20Hqrs%20(13.12.2024).pdf
· https://pmc.ncbi.nlm.nih.gov/articles/PMC9254770/
· https://ncdc.mohfw.gov.in/wp-content/uploads/2024/03/Autopsy-Findings-in-Heat-Related-Deaths_March24_NPCCHH.pdf
· https://www.researchgate.net/publication/273724823_Socio-demographic_Profiles_of_Post_Mortem_Cases_in_a_Sub-district_West_Bengal_India
· Amar Jesani: https://www.cehat.org/uploads/files/E01102.pdf
· https://www.cehat.org/uploads/files/A%20306%20Medico-Legal%20Cases%20Across%20Various%20Hospitals%20-A%20review.pdf
· https://pmc.ncbi.nlm.nih.gov/articles/PMC10664656/
