FSC271 Lecture 8 - Ethics in Death Investigations PDF

Lecture 8- Ethics in Death Investigations History of Autopsies The study of death bodies has been important in the study of anatomy In the past, the desire to acquire, dissect, and preserve the dead have brought anatom...

Lecture 8- Ethics in Death Investigations History of Autopsies The study of death bodies has been important in the study of anatomy In the past, the desire to acquire, dissect, and preserve the dead have brought anatomists into conflict with religious customs In Europe during the medieval period, there was a limited number of dead bodies that were made available to surgeons for dissection In 1540, Henry VIII allowed barbers and surgeons to have the bodies of 4 hanged criminals per year (these were the only legal bodies available for dissection and was part of the criminal’s punishment) Until the 1800, dissection was a teaching event made available to the public, and was held in the winter as bodies would preserve better In 1831, only 11 bodies were legally available for dissection in a city with over 900 anatomy students This led to unethical relationships with grave-robbers and body-snatchers, causing surgeons to be looked down upon (as they were still trying to establish themselves as respectable professionals) Body Snatchers: Burke and Hare Murdered over 15 people and sold bodies to an anatomy school run by a doctor called Dr. Knox Burke was eventually hung for murder and his body was dissected by Dr. Knox’s rival Coroner’s Investigations - Ontario Licensed physicians, covered under the coroner’s act Coroner’s act: Lecture 8- Ethics in Death Investigations 1  A legislative framework to investigate deaths, order autopsies, conduct inquests, authorize cremations, and to ship bodies outside of Ontario A coroner’s warrant is more important than the police The coroner’s act was revised in 2009 with Bill 115 following the public inquiry into Pediatric Forensic Pathology in Ontario (Dr. Charles Smith) Changes included: Establishment of an oversight council Registry of pathologists for coroner’s autopsies Improved death investigation services to First Nation communities Roles and responsibilities Coroner Death investigations Exercise authority with warrants Seizing anything important to an investigation Engaging with pathologists when an autopsy or a pathology-related opinion is required Inquests Identification Cremation certificates Forensic pathologists Medicolegal autopsies Registry of pathologists Expert witness testimony Note: In Canada, pathologists can be coroners, but coroners are not normally pathologists unless they have received proper medical training Autopsy: Modern Day Lecture 8- Ethics in Death Investigations 2  Hospital autopsy General pathology Intended to investigate the extent of disease(s) and to confirm (or revise) the cause of death that is already known Consent is required Coroner’s autopsy Requires additional training beyond general pathology Part of a corner’s death investigation Intended for unexpected or unexplained deaths (e.g., suspected drug overdose, young person deaths not due to accident) No consent required Every effort is made to take family concerns and beliefs into account In the end, the decision regarding autopsies and organ retentions is up to the pathologist and the coroner Ethical issues The conflicts of religious beliefs and autopsy Some people that the deceased should be subjected to assault of any kind Many believe that the body is God’s property For others, the interference of the deceased’s body will prejudice the future of the deceased in their next life Advantages and legal requirements of autopsies are recognized by Christians, Jewish, Hindu, and Muslim faiths etc. Objections are long standing and deeply held Religious liaisons will sometimes explain to a family why an autopsy needs to be done Benefits of Autopsy Provides knowledge about a rare or contagious disease Lecture 8- Ethics in Death Investigations 3  Provides information on how to prevent future deaths of a similar nature Provides important medical information to a family (e.g., genetically related disease) May provide peace of mind to the family Effect of Grief In the context of a death investigation, families are often asked to make important decisions when they are in shock and in disbelief of the death of the loved one There may be a lack of cognitive processing and decision making as a result of grief; hence, it is difficult for people to know what they are agreeing to Sometimes, people may not remember consenting to or agreeing to an autopsy Death investigators should be aware of the ethical implications of decision making in this context Some police and coroners will try to retain a distance from the families in order to maintain professional objectivity Grief counsellors can act as a liaison between families and investigators Issues for Indigenous Canadians There is a large variety of beliefs regarding funeral and burial practices among First Nation Canadians For instance, investigating potential burial sites from Canadian residential schools Mandate: Independent Special Interlocutor for Missing Children and Unmarked Graves and Burial Sites associated with Indian Residential Schools The Special Interlocutor will identify needed measures and make recommendations for a new federal legal framework to ensure the respectful and culturally appropriate treatment of unmarked graves and Lecture 8- Ethics in Death Investigations 4  burial sites of children at former Indian Residential Schools and associated institutions. This will be done in close collaboration with First Nations, Inuit, and Métis governments, representative organizations, communities, survivors and families, the federal, provincial, and territorial governments, and other relevant institutions such as church entities and record holders. The Special Interlocutor will function independently and impartially, in a non-partisan and transparent manner to achieve the objectives of her mandate. Case 1: Pine Creek Excavation Pine Creek Nation - Minegoziibe, Anishinabe 4 week excavation surrounding an old residential school — Pine Creek Indian Residential School Survivors of the residential school believed that their ancestors were buried underneath the residential school 14 anomalies were found with the GDR (which utilizes electromagnetic waves to find disturbances in the ground) within the church and 57 anomalies were detected on the outside of the church None of them led to the identification of human bones with an excavation Main lesson: Do not trust GDR (ground penetrating radar) and its reflections as your only source of evidence; actually conduct a potential excavation and see what is uncovered Importance of conducting a thorough excavation in relation to death investigation and human remains It is more important for the Indigenous to heal from this rather than relying on ground penetrating radar as conclusive evidence Case 2: Pikangikum Fire Investigation In the early morning of March 30, 2016, there was a fatal house fire in the Pikangikum Reserve Lecture 8- Ethics in Death Investigations 5  There were 9 victims ranging from 5 months to 51 years old in age; all died of smoke inhalation OFPS multiple fatality implementation plan began planning their response, which included an anthropologist, OCC, OFPS, OFM There were difficulties as the location was remote and there was a lack of cell phone access The main purpose was to complete a thorough investigation and to also return the bodies back to the community and complete proper burials Investigators attended the scene. Work was completed and bodies were transported to Toronto by April 2. Postmortem identifications were completed and the bodies were flown back to the community by April 4 This case helped to improved mandates for death investigations in Ontario Changes in Autopsy Practices More open approach to autopsies Determination of the extent of the autopsy (external, limited internal, full examination) Ensuring new autopsy techniques undergo proper validation Validating older methods that have not been previously validated Compassion for the families Thorough explanation regarding the autopsy process and its need Clear guidelines regarding the need for tissue/organ retention Process to assist those with strong religious beliefs New methods that allow organ retention periods to be very brief (1 day vs 1 week) New imaging techniques Non-invasive autopsy Virtual autopsy (Vitrospy) Lecture 8- Ethics in Death Investigations 6  Done through Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) No opening of the body is required Some studies have indicated that 80% of causes of death can be diagnosed using these techniques However, despite the differences of these diagnostic tools, some researchers still advocate for using both virtual and traditional techniques (e.g., information about smell and/or texture can be lost) E.g., cyanide, alcohol Organ Retention History The practice of organ retention was known to relatively few, such as pathologists, hospital staff, and mortuaries Autopsy reports often did not reference organs that were retained, though organ and tissue retention was seen as an important and routine practice Keeping organs was not a controversial practice because pathologists believed they had the right to use and keep organs for their own purpose Important for research, teaching, public interest, and for better care in future generations In the 1980-1990s, societal views on organ retention began to change Families began refusing hospital postmortems (cannot refuse coroner postmortems, however) Case Examples 1. Samantha Rickard In 1992, 11-month old Samantha Rickard died while undergoing open-heart surgery at Bristol Royal Infirmary In 1996, Helen Rickard (mother) learned of the allegations of excessive mortality rates for children’s heart surgery at the BRI. Lecture 8- Ethics in Death Investigations 7  She demanded a copy of her daughter’s medical records from the hospital She also discovered a letter from the pathologist who performed the post-mortem to her surgeon, stating that he had retained Samantha’s heart In 1997, following a formal complaint, the hospital returned the heart During an investigation into BRI heart surgery, a surgeon mentioned that there was a store of infant hearts that were kept at Adler Hey hospital in Liverpool Led to the Royal Liverpool Children’s Inquiry 2. Jesse Shipley 17 year old Jesse Shipley died in a car accident in January 2005. His family agreed to an autopsy The cause of death was clear: “blunt force trauma resulting from a car accident” His body was returned to the family for burial On a school field trip to the Medical Examiner’s office, Jesse’s school friends noticed a jar containing a brain labelled “Jesse Shipley” Arguments for retaining brain Dr. Weedn - Forensic pathologist There could be activities that occurred in the brain resulting in Jesse’s death (e.g., epilepsy resulting in epileptic fit) Brain and other tissues need two weeks to be fixed in formalin before it can be processed This process is necessary in order to rule out criminal activity Arguments for retaining brain Dr. Caplan - Medical ethicist There is a duty in ruling out crime but it does not justify the act of keeping organs Lecture 8- Ethics in Death Investigations 8  Additional view points: Asking family about retaining organs can cause more upset in an already traumatic experience Perhaps it is okay for the medical examiner to take the brain but wrong to display it The Shipley family sued and was awarded a 1,000,000 settlement (later reduced 600,000) Court of appeal in a 5-2 ruling dismissed the ruling and overturned the settlement The ruling was based on the common-law “right of sepulcher” Right of sepulcher: Legal right to control the final disposition of a deceased person, including burial, cremation, and or other arrangements This right does not include the deprivation of organs or tissues samples within the body, hence the law was not violated in this case 3. Ontario coroners Headline: “Province apologizes for keeping body parts after autopsies without telling families” Ministry of community safety and correctional offices - Organ retention posed a question that asked the following: “Did you lose a family member before June 14, 2010 that resulted in a coroner’s investigation and autopsy?” It was possible that an organ was retained after autopsy and kept for further testing Some people did contact the ministry Practice of Organ Retention: To Inform Key practices of organ retention: To give some semblance of peace and control Lecture 8- Ethics in Death Investigations 9  To delay the funeral so that organs and tissues can be returned to the body before burial or cremation To return the retained organ or tissue to the deceased when the Coroner’s investigations are complete Decision to keep an organ must be justifiable and must be authorized by the Chief Forensic Pathologist or Chief Coroner Legitimate reasons: A specific organ must be retained for examination which cannot take place at the time of autopsy (i.e., required specific expertise or the application of a specific technique) Cannot be retained for research if this is a coroner’s investigation The time periods for organ and tissue retention must be provided Family must be informed that the organ is retained and the reasons for doing so as soon as possible The family may determine the ultimate organ disposition Mass Disasters: Identification of the deceased Misidentification of the deceased The risk of misidentification increases in high trauma situations with multiple victims where the bodies of both the dead and living have been disfigured Grieving families may also be incapable of providing a reliable identification of their loved ones Case examples 1. Humboldt Tragedy A bus crash that resulted in the deaths of 16 people and the injuries of 13 others Photos and information from the team (player’s heights and weight) were initially used by the coroner’s office and funeral home to match the bodies with names Lecture 8- Ethics in Death Investigations 10  Xavier LaBelle was declared dead but had actually survived, but Parker Tobin was thought to be alive but had actually died 2. Indiana Tragedy Whitney Cerak had been misidentified as another girl, Lauren VanRyn. Laura had actually been one of the five people killed in the Indiana crash The VanRyn family had sat with Whitney for weeks, thinking she was their daughter 3. The Marchioness SS Disaster 51 people were killed in the 1989 Marchioness boat disaster on the River Thames Many bodies were trapped in the water and investigators had difficulties retrieving the bodies quickly Identification of the deceased To help with the identification process, the coroner used dental records, and personal items and clothing descriptions provided by the families Instruction for fingerprints For bodies which were not recovered from the wreckage immediately, but would likely float due to putrefaction and bloating, the following would apply: Visual identification would be unreliable, perhaps even impossible, and cause distress for relatives so that it should not be used In circumstances where it was impossible to take adequate fingerprints from the bodies without removing the bodies to the Fingerprint Laboratory, the hands should be removed Case example: Cindy Gladue Case background Deceased: Cindy Gladue Lecture 8- Ethics in Death Investigations 11  Accused: Barton, on account of first degree murder Barton was accused of hiring Gladue for two nights of sex in June 2011 He testified that she consented to rough sex and ended up bleeding. When Cindy went to the bathroom, he fell asleep The next morning, Barton found Cindy’s body in the tub and called 911 Barton told the jury that the sex was consensual The trial The Crown called a medical examiner to the trial who testified that an 11 cm cut to Ms. Gladue’s vaginal wall had been caused by a sharp object The victim’s vagina had been preserved and the judge allowed the prosecutor to display it as an exhibit It was an unprecedented decision by prosecutors to submit a victim’s preserved tissue as evidence Criticism was received for both ethical and legal reasons Ms. Gladue was referred to as a “native woman” and was not addressed respectfully Furthermore, it should be questioned as to why her vagina was allowed to be displayed Lecture 8- Ethics in Death Investigations 12