The “Value-Added” Forensic Autopsy: Public Health, Other Uses, and Relevance to Forensic Pathology's Future

Abstract

This article centers on the “value-added” forensic autopsy, one in which the autopsy goes beyond the basic tasks of determining cause, manner, and basic circumstances of death. It is important to recall that the word “forensic” is derived from the Latin “forensis” which means “forum,” or “public,” not “crime” or “science.” Thus, the value-added forensic autopsy can be seen as one that is done with the public in mind, as opposed to being focused only on needs of the criminal justice system. The value-added autopsy might be one in which a decision is made to perform an autopsy in case that might otherwise not have been autopsied, or to do a more extensive or “complete” autopsy than might otherwise have been performed, or, perhaps, do additional ancillary laboratory testing. The “value-added” concept is not offered in the financial context, but rather, the societal context. This article discusses perceived reasons why value-added autopsies might not be performed and reasons and examples of how they can be beneficial. More study is needed, however, to determine their place in the medicolegal death investigation setting. The forensic pathology profession might be wise to consider whether it wants to remain considered as mainly a criminal justice player or in addition, take further advantage of its potential in public health, public safety, research, civil law proceedings, and other activities and disciplines that can benefit from forensic pathology information. Such contemplation and action could seal, or even secure the fate and future of forensic pathology practice.

Implications of Death Certification on Sudden Unexpected Death in Epilepsy (SUDEP) Research

“…Based on the autopsy findings, circumstances surrounding death, and ancillary studies like toxicological findings, MEs subsequently certify these deaths, specifically indicating the cause and manner of death, along with factors that may have contributed to death (6). Death certificates are important sources of information for epidemiologists and public health agencies that use data from death certificates to determine the incidence of diseases like SUDEP in a population, and also to identify cases for research (7,8). Forensic pathologists use a wide variety of terminologies when certifying SUDEP and SUDEP-related deaths.…”

The Toolbox Approach to Forensic Pathology

“…It depends on how the office interprets its mandate and how it wants to utilize its resources. A detailed discussion of this point is beyond the scope of this manuscript but the concept of the "value-added" autopsy is described in detail elsewhere (56).…”

The Evolution of the Autopsy

“…Performing autopsies has always been a public health measure, but in these days of preventative and personalized medicine, we may find that we cannot content ourselves with cause of death pathology. Perhaps the only "complete" or "proper" autopsy will be the "value added" autopsy (48). This is becoming true for channelopathies as well as neoplasia.…”