Autopsy or post mortem is a word which family members of a deceased person never want to hear about, though it would confirm the cause of the death or whether any medical diagnosis and treatment before death was appropriate. But experts say the living can actually learn a lot from the dead, to better their health from such an examination, reports Sade Oguntola.

Melonie Ware was convicted in 2004 and sentenced to a life term in a prison in Georgia, United States of America (USA), for murdering a 9-month-old boy she was babysitting, based in large part on the testimony of a local forensic pathologist, Dr. Gerald Gowitt.

Gowitt said someone shook the child violently, damaging his brain, and slammed his head, causing three near-identical bruises beneath the scalp.

After an extensive legal battle, a judge granted Ware a new trial in 2009 after her attorneys produced evidence from the baby’s medical records overlooked in her first trial which explained what killed the child as well as two prominent physicians testifying that the child had died from a complication of sickle cell anemia.

No doubt, forensic examination of corpses is not new in Nigeria; remember the case of Chief Moshood Abiola, who was rumored to have been poisoned.

Conversely, cases of families found dead in their homes at Ogbomosho and Ibadan after meals of amala are still vivid in the minds of many people as well as the usual response by the police that post mortem examination would be done to ascertain the cause of their death.

An autopsy (also known as a post-mortem examination) consists of a thorough examination of the body of a dead person to determine the cause of death, the state of health of the person before he or she died, and whether any medical diagnosis and treatment before death was appropriate. It is usually performed by a specialised medical doctor called a pathologist.

The extent of an autopsy can vary from the examination of a single organ such as the heart or brain, to a very extensive examination that involves the examination of the chest, abdomen, and brain.

Autopsies are performed for either legal or medical purposes. For example, a forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes.

According to forensic pathologists like Dr ,,,,,Eze at the University College Hospital (UCH), Ibadan, Oyo State, autopsies play a critical role at the intersection of medicine and law enforcement. Employed by medical examiners and coroners’ offices, they are called in to figure out how people have died. They scrutinize corpses, searching for clues, and their findings carry enormous weight within the criminal justice system.

Though depicted as glamorous and high-tech when forensic pathologists testify in the law court, the field of death investigation is plagued by chronic underfunding, a shortage of specialists, and a lack of national standards in many countries of the world, including Nigeria.

What is more, the number of autopsies performed in hospitals has been decreasing for decades, even though the reduction in autopsies is negatively affecting the care delivered in hospitals.

For instance, Dr Eze pointed out, “when mistakes result in death, they are often not investigated and lessons therefore remain unlearned because families refuse autopsy examination or there are no facilities for it to be done.

“We need to know the cause of deaths in the community through autopsy examinations. Without this, there is no way we can prevent death or treat those things that cause death.”

Autopsy examination is one of the most potent public health tools worldwide. It has been recognised as a preventive health measure in the sense that when autopsy examinations are done and disease processes are well outlined, then finding appropriate treatment or preventive measures to curtail such diseases are possible in people that are still living, Dr Eze declared.

But autopsy examination is not restricted to natural diseases or diseases arising from germs or cancers alone. “Even when there are suspected murder or suicide cases or deaths from road traffic accidents or other forms of accidents, there would still be the need to ascertain the exact cause of the death, even where the cause might seems obvious,” he stated.

“I hear people ask why an autopsy examination should be carried out on a person who was knocked down by a motor vehicle. But could you believe that in some situations, you will actually discover that a disease process that was going on in the driver’s body led to the accident?

For instance, “a driver that died from a road traffic accident might already have hypertensive heart disease and on autopsy examination, be found to have evidences suggestive of stroke or fatal heart attack. This actually was what made him lose control of the wheels and created the fatal road accident.”

Such a finding is important in formulating policies on issuance of driver’s license, especially as it relates to the mental and health of a would-be driver.

Paradoxically, autopsy examinations, even in hospital settings, can help to establish cases of medical negligence, or otherwise. For instance, some health workers, due to negligence, end up killing patients. But where there is no post mortem examination on the corpse, there will be no way to make it clear to the public that the death did not arise from medical negligence, inappropriate care or poor care, Dr Eze said.

What is more, mysteries on death of people in the community could be easily solved to ensure that such things as conspiracy to kill by family members or business partners are prevented because coroner laws are operational.
Dr Eze stated: “The coroner’s law, which exists in virtually all states of the federation, will want to ascertain that the person has not died in any questionable circumstances, which may warrant those that are responsible for the death being recommended for persecution.”

In countries where coroner’s law are effective, the government pays for coronal autopsies, just as the clinical or academic autopsies are paid for by the hospital to know how a particular disease affects body organs and systems in order to improve on treatment of people who have similar diseases. Of course, a clinical or academic
autopsy cannot be done without the consent of the relations. 

Unfortunately, Dr Eze stated many states of the federation have no budget for coroner autopsies, adding, “I know that the Lagos State government budgets for coroner autopsy and in fact has a centre where such autopsies are done. But it is part of the state’s responsibility to determine the common causes of death and prevent preventable deaths based on the findings of such examinations.”

What is more, Dr Hannah Dada-Adegbola, a consultant medical microbiologist at the UCH, Ibadan, stated that where autopsies are allowed, they also can uncover genetic or environmental (for example, a bacterium or fungus) causes of diseases that could affect other family members.

For example, a case where genetic diseases such as cancers are discovered, the family members would know they are also at the risk of having such as a disease and so be proactive in adopting protective measures.

In addition, Dr Adegbola-Dada stated that it could demonstrate to the family that the care provided was appropriate, thereby alleviating guilt among family members and offering reassurance regarding the quality of medical care.

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