The term autopsy or necropsy is used to refer to dissection and examination of a dead body
to determine the cause(s) of death. It may be carried out for legal or for educational purposes.
2.0 HISTORICAL BACKGROUND
Autopsies were carried out by 2 Greek physicians, Herophilus and Eraststratus, in Alexandria
around 300 BC. The famous Roman physician Galen carried out autopsies in the 2nd century AD to correlate symptoms
and pathology. However autopsy did not become popular until the European Renaissance when taboos against dissecting the human
body were breached. Autopsy enabled more detailed understanding of anatomy and disease that opened new horizons for medicine.
By the 18th and 19th centuries AD autopsies were carried out in Europe
and new techniques of examination were introduced.
3.0 PURPOSES OF AUTOPSY
examination serves several purposes. It can be done for scientific research to understand the natural history, complications,
and treatment of a disease condition. It can be done for further education of physicians and medical students especially when
they compare their clinical diagnosis with the evidence from autopsy a process usually referred to as clinico-pathological
correlation. The lessons learned will improve their diagnostic and treatment skills in the future and decrease the incidence
of clinical mistakes. Post mortems are also undertaken for forensic purposes to provide evidence on the timing, manner, and
cause of death. Legally the courts may require scientific proof of the cause of death
in order to make decisions regarding various forms of legal liability.
4.0 THE PROCEDURE OF THE AUTOPSY
The first step in an autopsy is examination of the exterior of the body. Then the body
cavity is opened to examine the internal organs. Organs may be removed for examination or may be examined in situ. After the
examination removed organs are returned and the external incision is sewed up restoring the body to almost its original appearance
with the sole exception of having an incision. During the examination tissues and fluids are removed for further examination
that may include histological, microbiological, or serological procedures.
5.0 ETHICO-LEGAL ISSUES CADAVER DISSECTION FOR MEDICAL EDUCATION
5.1 Permissibility under the principle of necessity, dharuurat: Dissection of cadavers has been very important for medical education over the past decades when there was really no
alternatives to dissection. Cadaver dissection was therefore permissible under the legal principle of necessity, dharuurat.
The reasoning is that cadaver dissection enables future doctors to be trained well to treat patients which fulfils the second
purpose of the Law, preservation of life. The situation of necessity explained above takes precedence over considerations
of violating human dignity by dissecting the body under the general principle of the Law that necessities legalize what would
otherwise be prohibited. However human dignity cannot be violated more than necessary. The body should still be handled with
respect and consideration. All tissues cut away should be buried properly and the remaining skeleton should also be buried
in a respectful way. There are issues of consent, sale of bodies, wills etc that we need not discuss here because there are
legal doubts about the necessity of cadaver dissection in the traditional way.
5.2 Alternative ways of achieving the educational objectives:
The following arguments cast doubt on the degree of necessity for cadaver dissection in medical education. The cadaver is
treated before dissection and does not truly represent the structure or appearance of tissues in a living person. Secondly
with availability of computer graphics and anatomical models, medical students can learn human anatomy very conveniently and
6.0 ETHICO-LEGAL ISSUES IN AUTOPSY FOR EDUCATIONAL PURPOSES
6.1 Permissibility under the principle of necessity, dharuurat: Autopsy
for educational purposes can be permitted under the principle of necessity, dharuurat, as argued above for cadaver
dissection. However this can only be carried out if there is informed consent from the family members who have the authority
to consent as prescribed by the Law. As far as possible this consent should take into consideration the will of the deceased
on this matter if it was known before death.
6.2 Alternatives to autopsy: The necessity of educational autopsies can be
reduced by modern endoscopic and imaging technology that can enable inspecting internal structures without the making an incision
to inspect internal tissues. If the educational objective can be achieved fully using such technology then the rational for
the necessity will disappear and educational autopsies will be considered repugnant to the Law.
7.0 ETHICO-LEGAL ISSUES IN AUTOPSY FOR LEGAL OR FORENSIC PURPOSES
necessity of a forensic post-mortem is based on the paramount paradigm of Islamic Law to ensure justice. If the only way evidence
about a crime on a deceased is by an autopsy then it becomes a necessity to carry put the autopsy. A forensic or medico-legal
autopsy is more detailed in that it tries to look for clues to the motivation and method of death. It is equally important
to record some findings as it is to record negative findings. The deceased should be identified accurately. Documentation
is very thorough. The time of death must be estimated. The postmortem record is a legal document that can be produced in a
court of law.