Post-mortem Computed Tomography and Bereaved People’s Experiences of the Coronial Investigation
Post-mortem computed tomography (PMCT) has changed the experiences of bereaved people in coronial investigations. PMCT was developed by the Virtopsy® team initially at the University of Bern, but later at the University of Zurich, in the 1990s. It has been implemented in parts of Australia, Canada, Europe, Japan, UK, and USA since the early 2000s. When the technology is used as a triage tool to decide whether a medical cause of death can be found through CT scanning and an external examination of the body, it can decrease the rate of invasive autopsies in the coronial jurisdiction. For example, when the Victorian Institute of Forensic Medicine, located in Melbourne, Australia, introduced PMCT in 2005, the autopsy rate decreased by approximately 50%, and the rate of objections to autopsies by the next of kin also diminished.
I am conducting a three-year research project titled 'Socio-Legal Implications of Virtual Autopsies in Coronial Investigations', which is funded by an Australian Research Council Discovery Early Career Researcher Award (DE220100064). The project explores how PMCT impacts coronial investigations in Australia. During this project, I have interviewed medico-legal personnel, which includes coroners and forensic pathologists, about the social and legal implications of forensic imaging technology in Australia. A common theme in these interviews is that the technology has improved the experiences of bereaved people by reducing the number of unnecessary autopsies in an investigation. This not only creates better outcomes for bereaved people who oppose autopsies due to religious or cultural beliefs, or who do not like the idea of their loved one’s body being dissected, but it also expediates the return of the deceased body to the family for burial or cremation.
Bereaved people may feel more involved in the coronial investigation due to PMCT, as highlighted by a medico-legal personnel I interviewed in Australia, who told me that the technology has resulted in more consultations with families: “without the CT, I don’t think we would have ever come to this point where we have the pathologist, coroners and the families’ wishes being discussed in such depth and the decision being made, no autopsy to be performed, so often”. It is unequivocal then that for PMCT to have a significant impact on families’ experiences of the coronial investigation, it must be implemented as a triage rather than a supplementary tool. In other words, PMCT must be used to differentiate between reportable deaths that require invasive autopsies to discern a medical cause of death, and reportable deaths that can be determined based on CT scanning, external examination, and where relevant, toxicological investigations.
The aim of PMCT is to determine a medical cause of death through the process of exclusion, which has been shown to radically reduce the number of natural causes deaths that require invasive autopsies. This of course requires significant investments by governmental authorities, whether federal, state or local, to install and support PMCT on an on-going basis in coronial jurisdictions. But this investment not only has efficiency dividends; it can place bereaved people and their wishes and experiences at the centre of the coronial investigation.