Increasing the Information available to Coroners : the effect on autopsy decision making

This paper details research completed in 2007 which investigated autopsy decision making in a death investigation. The data was gathered during the first year of operation of a new Coroners Act in Queensland, Australia, which changed the process of death investigation in three ways which are important to this paper. First, it required a greater amount of information to be gathered at the scene by police, and this included a thorough investigation of the circumstances of the death, including statements from witnesses, friends and family, as well as evidence gathering at the scene. Second, it required Coroners, for the first time, to determine the level of invasiveness of the autopsy required to complete the death investigation. Third, it enabled the communication of a genuine family concern, to be communicated to the Coroner. The outcome of such information was threefold. First, a greater amount of information offered to the Coroner led to a decrease in the number of full internal autopsies ordered, but an increase in the number of partial internal autopsies ordered. Second, this shift in autopsy decision making by Coroners saw certain factors given greater importance than others in decisions to order full internal or external only autopsies. Third, a raised family concern had a significant impact on autopsy decision making and tended to decrease the invasiveness of the autopsy ordered by Coroners.

Communicating with the coroner : how religion, culture, and family concerns may influence autopsy decision making

Based on coronial data gathered in the state of Queensland in 2004, this article reviews how a change in legislation may have impacted autopsy decision making by coroners. More specifically, the authors evaluated whether the requirement that coronial autopsy orders specify the level of invasiveness of an autopsy to be performed by a pathologist was affected by the further requirement that coroners take into consideration a known religion, culture, and/or raised family concern before making such an order. Preliminary data reveal that the cultural status of the deceased did not affect coronial autopsy decision making. However, a known religion with a proscription against autopsy and a raised family concern appeared to be taken into account by coroners when making autopsy decisions and tended to decrease the invasiveness of the autopsy ordered from a full internal examination to either a partial internal examination or an external-only examination of the body. The impact of these findings is briefly discussed.

Challenging the authority of the autopsy in coronial investigations

The central purpose of this chapter is to address the tension between legal and medical discourses within the coronial/medico-legal system. In the context of a death investigation, medical expertise, manifest through the knowledge gained in an internal autopsy, is positioned as contributing the more valuable facts of the case, especially when contrasted with the evidence gathered at the scene of the death. We challenge this taken for granted understanding of medical knowledge in three ways: first, we examine the aspects of the history, philosophy and consequences of the processes by which the medical model gained its current dominance; second, we challenge the assumption that internal autopsy adds value to the death investigation, by utilising data from our own research in Australia; and finally, we engage with the debate about the purpose of a coronial/medico-legal investigation and role of an internal autopsy within that system.

Arguing the Autopsy : mutual suspicion, jurisdictional confusion and the socially marginal

Vulnerable and marginalised populations are not only over-represented in the criminal justice system, but also in civil jurisdictions like the coronial system. Moreover, many of the personnel who deal with criminal matters, especially in rural and regional areas, are also those who manage the coronial death investigation. This movement back and forth between civil and criminal jurisdictions is difficult for the both professional personnel and the families, but especially for those families who may also have had dealings with these personnel in the criminal justice system, or who present as suspicious due to larger historical and global issues. While coronial legislation now allows families to raise cultural and religious concerns about the process, particularly to do with the autopsy of their loved one, this also requires them to identify themselves to police at the initial stage of the death investigation. This paper, part of a larger body of work on autopsy decision making, discusses the ways in which this information is gathered by police, how it is communicated through the system, the ways in which families are supported through the process, and the difficulties that ensue.

The body in grief : death investigations, objections to autopsy, and the religious and cultural 'other'

Sudden, violent and otherwise unexplained deaths are investigated in most western jurisdictions through a Coronial or medico-legal process. A crucial element of such an investigation is the legislative requirement to remove the body for autopsy and other medical interventions, processes which can disrupt traditional religious and cultural grieving practices. While recent legislative changes in an increasing number of jurisdictions allow families to raise objections based on religious and cultural grounds, such concerns can be over-ruled, often exacerbating the trauma and grief of families. Based on funded research which interviews a range of Coronial staff in one Australian jurisdiction, this paper explores the disjuncture between medico-legal discourses, which position the body as corpse, and the rise of more ‘therapeutic’ discourses which recognise the family’s wishes to reposition the body as beloved and lamented.

Attributes of clinical role models as described by senior veterinary students in Australia

Role models incite admiration and provide inspiration, contributing to learning as students aspire to emulate their example. The attributes of physician role models for medical trainees are well documented, but they remain largely unexplored in the context of veterinary medical training. The aim of the current study was to describe the attributes that final-year veterinary students (N=213) at the University of Queensland identified when reflecting on their clinical role models. Clinical role model descriptions provided by students were analyzed using concept-mapping software (Leximancer v. 2.25). The most frequent and highly connected concepts used by students when describing their role model(s) included clients, vet, and animal. Role models were described as good communicators who were skilled at managing relationships with clients, patients, and staff. They had exemplary knowledge, skills, and abilities, and they were methodical and conducted well-structured consultations. They were well respected and, in turn, demonstrated respect for clients, colleagues, staff, and students alike. They were also good teachers and able to tailor explanations to suit both clients and students. Findings from this study may serve to assist with faculty development and as a basis for further research in this area.

Sewage disposal and wildlife health in Antarctica

Sewage and its microbiology, treatment and disposal are important to the topic of Antarctic wildlife health because disposal of untreated sewage effluent into the Antarctic marine environment is both allowed and commonplace. Human sewage contains enteric bacteria as normal flora, and has the potential to contain parasites, bacteria and viruses which may prove pathogenic to Antarctic wildlife. Treatment can reduce levels of micro-organisms in sewage effluent, but is not a requirement of the Environmental Protocol to the Antarctic Treaty (the Madrid Protocol). In contrast, the deliberate release of non-native organisms for any other reason is prohibited. Hence, disposal of sewage effluent to the marine environment is the only activity routinely undertaken in Antarctica knowing that it will likely result in the release of large numbers of potentially non-native species. When the Madrid Protocol was negotiated, the decision to allow release of untreated sewage effluent was considered the only pragmatic option, as a prohibition would have been costly, and may not have been achievable by many Antarctic operators. In addition, at that time the potential for transmission of pathogens to wildlife from sewage was not emphasised as a significant potential risk. Since then, the transmission of disease-causing agents between species is more widely recognised and it is now timely to consider the risks of continued discharge of sewage effluent in Antarctica and whether there are practical alternatives.

CT imaging of an Egyptian mummy

Over the last few years various research groups around the world have employed X-ray Computed Tomography (CT) imaging in the study of mummies – Toronto-Boston (1,2), Manchester(3). Prior to the development of CT scanners, plane X-rays were used in the investigation of mummies. Xeroradiography has also been employed(4). In a xeroradiograph, objects of similar X-ray density (very difficult to see on a conventional X-ray) appear edge-enhanced and so are seen much more clearly. CT scanners became available in the early 1970s. A CT scanner produces cross-sectional X-rays of objects. On a conventional X-radiograph individual structures are often very difficult to see because all the structures lying in the path of the X-ray beam are superimposed, a problem that does not occur with CT. Another advantage of CT is that the information in a series of consecutive images may be combined to produce a three-dimensional reconstruction of an object. Slices of different thickness and magnification may be chosen. Why CT a mummy? Prior to the availability of CT scanners, the only way of finding out about the inside of a mummy in any detail was to unwrap and dissect it. This has been done by various research groups – most notably the Manchester, UK and Pennsylvania University, USA mummy projects(5,6). Unwrapping a mummy and carrying out an autopsy is obviously very destructive. CT studies hold the possibility of producing a lot more information than is possible from plain X-rays and are able to show the undisturbed arrangement of the wrapped body. CT is also able to provide information about the internal structure of bones, organ packs, etc that wouldn’t be possible without sawing through the bones etc. The mummy we have scanned is encased in a coffin which would have to have been broken open in order to remove the body.

Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background: While the relationship between socioeconomic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. We examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship. Methods: Adults (n=38 355) aged 40-69 years living in Melbourne, Australia were recruited in 1990-1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports. Results: CVD mortality was higher for those with primary education only compared to those who had completed tertiary education, with a hazard ratio (HR) of 1.66 (95% confidence interval [CI] 1.11-2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared to the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78-1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups. Conclusions: Most of the excess CVD mortality in lower socioeconomic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socioeconomic groups.

Rural Poultry in the Developing world

In 2007 I travelled to Mozambique and Tanzania to photographically document the work undertaken by a group of Australians who are working to bring a self sufficient lifestyle back to the HIV Aids stricken communities of Africa. University of Queensland veterinary researchers have developed a vaccination that can eradicate disease from local rural poultry. The Kyeema Foundation is working in country to supply this vaccine to families battling HIV AIDS and to teach local residents how to successfully implement it. QUT, AusAID and the Kyeema Foundation funded the trip.