FM2.{16,25},FM14.6 | Conducting & Reporting the Medico-legal Autopsy — Summary & Reflection

KEY TAKEAWAYS

The medico-legal autopsy is a structured procedure beginning with verification of legal authority and ending with a signed, court-ready PM report. Professionalism (FM2.25) demands independent objective findings, separation of observation from opinion, and appropriate communication with law enforcement and the judiciary. The examination follows four phases: clothing examination → external examination → internal examination (thorax, abdomen, cranium) → viscera preservation. Viscera for chemical analysis must be preserved without formalin (formalin destroys toxic substances); blood requires sodium fluoride. Post-mortem artefacts — resuscitation marks (CPR rib fractures, intubation injuries), insect activity pseudo-wounds, handling lividity, decomposition changes — must be explicitly recognised and distinguished from ante-mortem injuries in both the observations and opinion sections. The PM report opinion must reference specific numbered findings, use 'consistent with' rather than certainty language, and be marked 'provisional' when FSL results are awaited. FM14.6 requires practising this procedure across at least 15 cases of varied aetiology.

REFLECT

During your supervised autopsy rotation, you are asked to write the opinion section for a drowning case where resuscitation was attempted by bystanders for 30 minutes. You find rib fractures and laryngeal bruising. The attending officer insists these are 'strangulation marks.' How do you approach writing an opinion that is evidence-based, differentiates artefacts from injuries, and withstands the officer's pressure? What professional resources (guidelines, second opinion, documentation practices) would you use to protect both the deceased and yourself?