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There is no legal definition of what constitutes a PM. It can include any of the following: external examination of the body; toxicology tests; tests on organ and tissue samples from the body; CT or MRI scanning; and/or full internal invasive examination of the body.

PMs are not a requirement of all death investigations by the Coroner. However, sometimes, the only way that a Coroner can establish the medical cause of death or assist in answering the statutory question of how the deceased came by his death is through a PM.

The general trend over the last twenty years has been a decrease in first PMs arranged by Coroners. The Chief Coroner welcomes this reduction and recognises that PMs cause distress to bereaved families and may also delay the release of bodies.

The Coroner has legal control over the body so the next of kin’s consent is not required for a PM. However, the family must usually be informed by the Coroner of the date, time and place of the PM. The family are also entitled to be represented by a medical practitioner at the PM.

The Chief Coroner’s Guidance No 32 states “It is usual practice that a PM examination will be carried out, subject to the availability of pathologists, within a few days of the death, and ideally within 24 hours”. However, there is a national shortage of pathologists which means that the timescales can be longer.

The Coroner must release the body as soon as is reasonably practicable. This will generally be immediately the PM has been completed. If a body cannot be released within 28 days of the death being notified to the Coroner, there is a duty to notify the next of kin of the reasons.

Full PM

Pathologists perform post-mortem examinations to standards set by the Royal College of Pathologists. These standards include carrying out the post mortem in a respectful manner and with regard for the feelings of the bereaved relatives.

Most post mortems are carried out by pathologists who specialise in histopathology, which is the laboratory study of disease and of diseased tissue. Pathologists are helped by anatomic pathology technologists, who have had specialist training to assist pathologists. Post mortems are usually carried out in the hospital mortuary in a special post-mortem examination room, which is a similar to an operating theatre.

Limited Post-Mortem

long incision is made down the front of the body to enable the internal organs to be removed and examined. A single incision across the back of the head allows the top of the skull to be removed so that the brain can be examined. Organs are examined carefully with the naked eye and dissected to look for any abnormalities such as blood clots or tumours. If further information is required, postage-stamp-sized pieces of tissue may be retained for examination under the microscope or samples of body fluids taken for analysis in the laboratory. After being examined, the organs are returned to the body.

Forensic or Home Office Post Mortem

If the death is thought to have occurred as a result of criminal activity, then the post mortem will be undertaken by a forensic pathologist. Forensic pathologists investigate deaths where there are medico-legal implications, for example, suspected murder, death in custody and other complex medico-legal cases.

In such circumstances, a legal defence team (e.g. the barrister or solicitor of the accused person) can request a second post mortem by an independent forensic pathologist. This is allowed, because otherwise, the accused person could allege that the post-mortem was not carried out properly, resulting in the court case being dismissed without a clear outcome.

Limited Post-Mortem

In some circumstances, usually following a CT Scan which has not ascertained the cause of death the coroner may following discussion with the pathologist, request a limited PM to certain part of the body. For example, limited to the chest are if the scan has revealed no abnormalities in the brain and abdomen.

Non-Invasive CT Scan

A full internal invasive PM is incredibly disruptive to the body. The family can request a CT/MRI Scan instead. The Chief Coroner Guidance No 32 “encourages coroners to consider the use of less invasive forms of examination in appropriate cases, especially where the bereaved family has a strong objection to invasive examination”.

Imaging based examinations have the further benefit that through detailed images the state of the body, both externally and internally, is permanently recorded for anyone to review in future.

A full PM can include the removal and retention of small tissue samples for examination under a microscope. In most cases the process is very much like having a biopsy in life – the samples are approximately the size and thickness of a little fingernail. Sometimes whole organs may be retained for closer examination.

Small quantities of blood, urine or other body fluids may also be taken if the Pathologist needs to check for the presence of alcohol, over the counter medications, prescribed medications or drugs of abuse.

The Coroner/pathologist may not need the family’s consent to remove tissue/organs.

However, the Coroner must notify the family that samples are being preserved or retained, the period for which they are required to be preserved or retained and the options for dealing with them once that period has expired. Those options are as follows:

• The hospital should lawfully and sensitively dispose of any samples (which may include cremation).
• The hospital should retain any samples either as part of the deceased’s clinical record only or for use in education and training.
• The samples should be reunited with the body prior to the body being released for a funeral (which may delay funeral arrangements).
• The samples should be returned to the family for a separate funeral at their own expense.