Death Investigation Bioethics

The ethical challenges associated with the performance of the autopsy are among the most complex in the practice of pathology. The ethical dilemmas that are frequently encountered in medicolegal death investigation systems include family opposition to autopsy, presenting pathological evidence in court, duties of the forensic pathologist, organ retention and post-mortem organ donation. Yet there is a lack of systematic ethical analysis in the literature examining these challenging medicolegal ethical dilemmas in the post-mortem context. Ethical scholarship in medicine has largely focused on the antemortem context, specifically examining the doctor–patient relationship, the healthcare needs of the individual patient and understanding the physician’s duty to their patient. Death investigation systems reverse the priorities of the individual by rebalancing individual interests in favour of collective welfare, which is counter to the current state of ethics. In this context, there is no agreed-upon framework, body of work or meta-analysis for ethical dilemmas that arise in medicolegal death investigation. This distinguishing feature, in comparison with other areas of medicine, arises from the notion that pathologists perform an autopsy on the decedent for the benefit of society, rather than for the individual who has died. Furthermore, the authority to perform an autopsy comes from legislative powers rather than the previously expressed consent of the decedent. A paucity of ethical reasoning, recognition of ethical issues and a shared sense of how to engage in ethical dilemmas that are particular to medicolegal death investigation puts forensic pathologists, and those who operate in medicolegal death investigation systems, at risk to know which ethic to apply. The solution is the creation of a nascent field of ethical scholarship, referred to as death investigation bioethics, which focuses on the post-mortem context of healthcare to assist in the ever-present ethical dilemmas that arise in the medicolegal investigation of death. This chapter seeks to develop this area of scholarship by providing awareness of ethical issues that arise in medicolegal death investigation systems and summarize ethical theories that may be used as tools to deal with ethical issues. Analysis of these issues is in its infancy and requires more scholars, ethicists, forensic pathologists, medical examiners, coroners and others to consider these difficult ethical dilemmas.