Distribution of autopsies

An autopsy is a type of medical procedure in which a dead body is divided into parts. The goal of an autopsy is to determine the cause of death of a given person and to understand the shape and function of individual organs and systems. The room in which an autopsy is performed is generally called an autopsy room, in the case of pathological-anatomical, medical, and forensic autopsies, the name autopsy room is also sometimes used. Depending on the type of autopsy, the autopsy may be performed by a pathologist, medical examiner, anatomist, and the like.

Types of autopsies
In general medicine, we distinguish 4 types of autopsies:


 * Anatomical dissection
 * Pathological-anatomical dissection
 * Medical autopsy
 * Forensic autopsy

Anatomical dissection
Anatomical dissection is performed in an anatomical institute. The autopsy is performed by students under the supervision of the teacher. The purpose of the autopsy is to obtain study knowledge or research knowledge.

Pathological-anatomical dissection
An autopsy is usually performed to confirm a diagnosis or establish the disease that led to death in a medical facility.

The pathological-anatomical autopsy is determined by the Act on Health Services §372/2011 - specifically §88 and its amendment Act No. 147/2016 Coll.


 * The pathological-anatomical autopsy is determined by the attending physician in the medical facility where the patient died according to the indications for this autopsy.
 * The autopsy is performed by a pathologist, and the autopsy report is the result of the autopsy.


 * Indication


 * For women who died in connection with pregnancy, childbirth, abortion, artificial termination of pregnancy or in childbirth;
 * for fetuses from artificially terminated pregnancies performed for reasons of genetic indication or indication of a congenital developmental defect of the fetus;
 * in stillborn children and in children who died before the age of 18;
 * in patients who died during surgery, during a non-surgical interventional procedure, in connection with a complication following an operation or a non-surgical interventional procedure or during induction of anesthesia;
 * if an organ was removed from the body of the deceased for the purposes of transplantation, tissues or cells for human use or if a part of the body was removed for research or teaching purposes; in cases where the Transplantation Act stipulates the performance of autopsies differently, the procedure is carried out in accordance with the Transplantation Act,
 * in the event that the death occurred in connection with a serious adverse event during the clinical evaluation of a human medicinal product or with an adverse event during clinical trials of a medical device or in connection with the verification of new knowledge using methods that have not yet been introduced in clinical practice on a living person, or in case of suspicion of these facts;
 * if the death is suspected to have occurred in connection with the removal of an organ for transplantation or tissue or cells for human use;
 * in the case when the cause of death, underlying disease, other diseases or their complications or clinical diagnosis is not sufficiently clarified.

Medical autopsy
A medical autopsy is performed to determine the cause of death and to clarify other medically serious circumstances and the mechanism of death in persons who died outside or in a medical facility by sudden, unexpected or violent death, including suicide.

((Violent death here means, for example, death in a traffic accident, when the PČR does not require a forensic autopsy))

Medical autopsy is determined by the Health Services Act §372/2011 - specifically §88 and its amendment Act No. 147/2016 Coll.


 * A medical autopsy is ordered by an emergency service doctor, an EMS doctor, and a coroner for persons who died outside a medical facility.
 * The autopsy is performed by a medical examiner and results in an autopsy report .


 * Indication


 * In case of sudden and unexpected deaths, if the cause of death was not determined during the examination of the deceased's body or the cause of death was not sufficiently clarified;
 * in all violent deaths including suicide ;
 * in case of suspicion that the death may be causally related to an incorrect procedure in the provision of health services, expressed by a health worker involved in the provision of health services, a doctor who examined the body of the deceased, or a person close to the deceased;
 * when it is suspected that the death may have been caused in connection with the abuse of addictive substances ;
 * for persons who died while in custody, imprisonment or security detention.

Forensic autopsy
A forensic autopsy is always carried out if it is ordered by the PČR, and in the case of deceased persons, where there was clear or unclear culpability of another person and where violence was committed. Furthermore, a forensic autopsy is ordered by a police authority in case the identity of the deceased is unknown, or if there is doubt about his identity (for example, an advanced stage of decomposition or a charred body). During the forensic autopsy, the police authority performs actions aimed at establishing or confirming the identity of the deceased. Biological samples are then taken by a doctor (DNA analysis and other actions aimed at identifying the deceased) and these are further processed by police experts (genetics, anthropology, etc.). The autopsy is ordered by the law enforcement authorities, most often the police authority, or public prosecutor. A judicial autopsy is ordered by resolution according to § 115 of the Criminal Code in the event that there is a suspicion that a person's death was caused by a criminal act. A forensic autopsy also includes a complementary laboratory examination as well as a medical expert opinion.

The judicial autopsy is determined by the Act on Health Services §372/2011 - specifically §88 and its amendment Act No. 147/2016 Coll.


 * Pursuant to §88, paragraph 5, the transportation of the body of the deceased to the forensic autopsy and back is ensured and paid for by the law enforcement agency that ordered it. It also covers all other costs associated with the autopsy.
 * The judicial autopsy is ordered by the criminal authority (State Prosecutor's Office, PČR) .
 * It is carried out by 2 forensic doctors - experts.
 * The result of the forensic autopsy is an expert opinion.

Interruption of autopsy

 * According to paragraph (7) §88 ZOS 372/2011 newly 147/2016

If, as part of the autopsy, there is a suspicion that the death was caused by a criminal offense, or that the circumstances of the death are unclear , the autopsy is interrupted. The provider will immediately notify the Police of the Czech Republic of this fact. If the law enforcement authority does not order an autopsy according to another legal regulation within 2 hours of this notification, the provider may complete the interrupted autopsy.

Amendment to ZZS 147/2016 Coll., at ZZS 372/2011
The provider performing the autopsy may choose to:


 * does not perform a pathological-anatomical autopsy in cases according to § 88 paragraph 2 letter a), b) or c) or medical autopsy in cases according to § 88 paragraph 3 letter b) or d), if it is a death, the cause of which is obvious, and the deceased patient expressed demonstrable disagreement with the execution during his lifetime, or the legal representative or guardian of the deceased patient or a person close to the patient requested not to perform an autopsy
 * does not perform a pathological-anatomical autopsy in cases according to § 88 paragraph 2 letter a), b), c) or h) or medical autopsy in cases according to § 88 paragraph 3 letter a), b) or d), if the cause of death is obvious during an additional expert assessment ;
 * performs a pathological-anatomical or medical autopsy in cases according to Section 88, paragraph 2 or 3, even if it was not determined by the doctor performing the examination of the deceased's body.

For the method of voicing demonstrable disagreement by the patient with the performance of the autopsy according to paragraph 1 or paragraph 2 letter a) shall be applied analogously to § 81 paragraph 5. Demonstrable disagreement of the patient with the performance of the autopsy, written request of the legal representative or guardian of the deceased patient or a person close to the patient not to perform the autopsy according to paragraph 1 or paragraph 2 letter a) or a record of it is part of the medical documentation kept about the deceased; in the case of a stillborn child, it is part of the medical documentation maintained about the mother.

On the decision not to perform a medical autopsy according to paragraph 2 letter a) or b) the provider in the field of forensic medicine is obliged to inform the Police of the Czech Republic.

related articles

 * Identification of unknown corpses
 * Identification by dentition
 * Sudden death
 * Violent death
 * Postmortem changes
 * Death

Source

 * FISHER, Vojtěch. Pathologist vs. Medical examiner and distribution of autopsies  [online]. ©2017. [feeling. 2017-02-16]. < https://www.facebook.com/unsupportedbrowser >.


 * Czech Republic. Health Services Act. 2016. Also available from URL < http://www.mzcr.cz/Legislativa/dokumenty/zakon-c147/2016-sb-kterym-se-meni-zakon-c372/2011-sb-o-zdravotnich-sluzb_11977_11.html >.


 * Czech Republic. Health Services Act. 2011. Also available from the URL < https://www.zakonyprolidi.cz/cs/2011-372 >.