|Year : 2013 | Volume
| Issue : 3 | Page : 173-176
Perceptions of relatives toward medico-legal investigation and forensic autopsy: A cross-sectional survey from rural Haryana
Rajesh Duraisamy Rathinam1, Mukul Chopra2, Abhishek Singh3, Anu Bhardwaj4, Prasanna Mithra5, Adiba Siddique6
1 Department of Forensic Medicine, AVMCH, Puducherry, India
2 Department of Forensic Medicine, CMC, Ludhiana, India
3 Department of Community Medicine, SHKM Govt. Medical College, Mewat, India
4 Department of Community Medicine, MMIMSR, Mullana, India
5 Department of Community Medicine, Kasturba Medical College, Mangalore, India
6 Department of Obstetrics and Gynaecology, MM Institute of Nursing, Mullana, Ambala, Haryana, India
|Date of Web Publication||19-Feb-2014|
Assistant Prof., Department of Community Medicine, SHKM Govt. Medical College, Mewat - 122 107, Haryana
Source of Support: None, Conflict of Interest: None
Background: Currently, a greater emphasis is being placed on the active participation of patients and their families; it is time that the attitude and feelings of the families with regard to autopsies are investigated. Objectives: Therefore, the present study was planned with an objective to analyze and ascertain deceased family member's attitudes toward medico-legal investigation and forensic autopsy. An additional objective was to determine factors influencing autopsy refusal by relatives of the deceased. Materials and Methods: Two hundred family members or relatives were selected randomly from the list of address and contact number prepared from all the cases on whom autopsy was performed from 2010 to 2012 at the MM Institute of Medical Sciences. Results: Data of 165 deceased personnel were processed and analyszd. 30.9% of the respondents had a primary level of education while 35.2% of them were illiterates. A high proportion of study subjects considered that autopsy would result in visible disfigurement of the body. Involvement of police/court (92.1%), no use in knowing the cause of death/nature of death (88.6%) and autopsy delays funeral (83.4%) were the three top most causes responsible for autopsy refusal by family members or relatives of the deceased. Conclusion: The experience and opinions of relatives and family members can be utilized in more effective management of medico-legal cases.
Keywords: Autopsy, Family members, Perceptions
|How to cite this article:|
Rathinam RD, Chopra M, Singh A, Bhardwaj A, Mithra P, Siddique A. Perceptions of relatives toward medico-legal investigation and forensic autopsy: A cross-sectional survey from rural Haryana. J Med Soc 2013;27:173-6
|How to cite this URL:|
Rathinam RD, Chopra M, Singh A, Bhardwaj A, Mithra P, Siddique A. Perceptions of relatives toward medico-legal investigation and forensic autopsy: A cross-sectional survey from rural Haryana. J Med Soc [serial online] 2013 [cited 2020 Oct 20];27:173-6. Available from: https://www.jmedsoc.org/text.asp?2013/27/3/173/127386
| Introduction|| |
Autopsy is an indispensable research tool that has been used for centuries. It is of two types: forensic or medico-legal and clinical or academic autopsies. Forensic autopsy is medico-legal investigation of cases of unnatural and unexplained deaths. This procedure is still under the umbrella of misconceptions, myths and emotions by the lay people as well as by the physicians. 
In India, by law, forensic or medico-legal autopsy is carried out without the consent of the relatives. In such a scenario, the response of relatives can vary greatly, ranging from objection to approval. Investigation into the experiences of the next of kin will help both family and forensic experts to deal with the borderline situations that are so often encountered. , A recently expressed opinion states that autopsy is not something that should be performed as a favor to the family, but is something to which the family has a right, of which they should be informed. 
Currently, a greater emphasis is being placed on the active participation of patients and their families; it is time that the attitudes and feelings of the families with regard to autopsies are investigated.  The experiences of deceased family members will teach the forensic fraternity on how to handle an autopsy. Therefore, the present study was planned with an objective to analyze and ascertain deceased family member's attitudes toward medico-legal investigation and forensic autopsy. An additional objective was to determine factors influencing autopsy refusal by relatives of the deceased.
| Materials and Methods|| |
The present cross-sectional survey was conducted at the Department of Forensic Medicine, MM Institute of Medical Sciences, during May 2011 to April 2012. The study population consisted of relatives or family members of the deceased. The inclusion criteria were that an autopsy had to have been performed at the MM Institute of Medical Sciences and that the relatives or family members of the deceased were available. A list of the address and contact number was prepared for all the cases on whom autopsy was performed from 2010 to 2012. A sample of 200 study subjects was randomly chosen from the list with the help of a random number generator.
All the 200 randomly selected family members or relatives were approached by the author (a postgraduate student from the Department of Forensic Medicine). From 3 to 4 months after the autopsy, a postgraduate who had experience with the grieving process and with grief counselling visited the household of the deceased to conduct a verbal interview. If a telephone number was available, an advance appointment was made with an appropriate respondent. Eighteen families could not be traced and contacted and hence were excluded from the study. Of the 182 families with whom the author could make contact, 17 did not consent for participation in the study and were again excluded from study. Finally, 165 study subjects participated in the study. One hundred and fifteen family members or relatives accepted that they were not willing for autopsy (Group A) and that it was forcibly conducted against their wish, and the remaining 50 family members or relatives were in the view that autopsy was conducted with their wish (Group B).
Written informed consent was obtained in the local language from every study subject before conducting each interview. They were explained about the nature and purpose of the study and were requested to participate in the study. To obtain consent, the author read the contents of the consent information sheet out loud to each respondent, who was given the opportunity to ask the questions. It took an average of 20 min to complete each interview.
| Results|| |
Of the 200 study subjects approached, data of 165 subjects were processed and analyzed. Majority (79.4%) of the respondents were in the age group of 30-50 years. 88.4% of the study subjects were male. Most (80.6%) of them were Hindus. 30.9% of the respondents had a primary level of education, while 35.2% of them were illiterate.
Of a total of 165 autopsied cases, 27 were homicidal, eight were natural death cases (sudden death or illness), 98 were accidental cases and the remaining 32 were suicidal cases [Figure 1].
Almost 63 and 86% of the respondents from Group A and Group B, respectively, correctly said that autopsy will tell us the exact cause of death, and the difference was found to be statistically highly significant (P < 0.001). A high proportion of study subjects appeared to have a fair understanding of the technical aspects of autopsy, but many considered that autopsy would result in visible disfigurement of the body. Very few, i.e. 7%, from Group A and 22% from Group B correctly said that autopsy does not involve court in all the cases. The difference was found to be statistically significant (P < 0.05) [Table 1].
|Table 1: Knowledge and perceptions of family members or relatives of the deceased about autopsy|
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Involvement of police/court (92.1%), no use in knowing the cause of death/nature of death (88.6%) and autopsy delays funeral (83.4%) were the three top most causes responsible for autopsy refusal by family members or relatives of the deceased. Eighty percent of the relatives denied out of fear of disfigurement of the body. Refusal on religious ground was the least common reason cited by the participants [Table 2].
|Table 2: Factors influencing autopsy refusal by family members or relatives of the deceased|
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| Discussion|| |
A good number of relatives were interested in knowing the exact cause of death. They were in the view that knowing the exact cause of death would help them in coping with the catastrophic, unfortunate bereavement of their beloved. The majority of these relatives were literate and, in their view, incomplete information about the circumstances of death of their loved one caused them greater apprehension and agony.
Regarding the purpose of autopsy, almost 30% were not able to state any reason for it. Another study from Delhi reported that a slightly lesser proportion of people, i.e. 21%, was not able to tell the purpose of autopsy.  It is very evident that the awareness level among the general public in this geographical area is not as good as in the national capital of Delhi. This finding can be directly related to the literacy rate. Lower literacy rate and awareness among the general public might be responsible for the above finding. The most suitable way to change the public perception of autopsy is through education. Media can be used as an effective tool for such educational programmes. Another study by Brown  is also in concordance with our observations.
More than 90 of the relatives of the deceased patients refused to provide consent for autopsy because of the fear of involvement of the police and court. Majority of the relatives complained of the casual and indifferent attitude of police personnel. In general, somehow, they were not comfortable with the police personnel. Herein lies the importance of the way of interaction with the members of such families. Training police personnel on the significance of dissemination of adequate information to the affected family members will definitely help in betterment of the existing situation.
It was observed in our study that concern about mutilation of the body was the reason cited by 80% of the relatives of the deceased patients for refusal to consent to autopsy. The proportion of relatives in this study who refused to give consent because of concern about mutilation is similar to that found in a study from Zambia.  Studies of relatives of the deceased from China  and Sweden  were also in the same view. A similar finding was recorded by McPhee et al. in his study on clinical autopsy.  The above finding shows that such concerns about autopsy cut across cultures and races. Furthermore, it is often a layman's perception of the autopsy. The autopsy, however, is a scientific procedure during which utmost consideration is given to prevent the disfigurement of the body. This observation also buttresses the need to step up the public education about the autopsy.
This study has several strengths. First, we have compared the knowledge and awareness among the family members or relatives who were not willing for autopsy and among those who were willing. According to our knowledge, comparison of this aspect has not been closely investigated by the experts in the field. No similar experience is available in the literature. Second, families were chosen randomly, which provides protection against selection bias. Third, all the interviews were conducted by a single person, which creates a sense of uniformity.
The study has some limitations as well. First, some may argue that the results obtained may not be applicable to the general population. I agree because baseline data like income, literacy, gender distribution and other socio-demographic - cultural factors tend to vary in different geographical areas. Second, such a community-based study is always susceptible to recall bias.
| Conclusion|| |
The findings of the study highlight the importance of delivery of sufficient relevant explanations and information to the family members and relatives in improving the acceptance and giving consent for autopsy. Before conducting an autopsy, the doctor should spend some time and properly explain the purpose and merits of autopsy, which would bring about the desired change. The experience and opinions of relatives and family members can be utilized in more effective management of medico-legal cases.
| Acknowledgments|| |
The authors would like to thank Prof. O. P. Aggarwal, Head, Department of Forensic Medicine, MMIMSR, for his keen interest and constant support throughout the study. His timely help and suggestions have been of great assistance during the entire project. The authors also thank all team members who worked with them in this investigation.
| References|| |
|1.||Brown HG. Perceptions of the autopsy: Views from lay public and program proposal. Hum Pathol 1990;21:154-8. |
|2.||Schaaf G, Meyboom-de Jong B. Hoe wordt euthanasie door naasten ervaren? [How is euthanasia experienced by family members?] Groningen: Department of General Practice, University of Groningen; 1991. |
|3.||McPhee SJ, Bottles K, Lo B, Saika G, Crommie D. To redeem them from death. Reactions of family members to autopsy. Am J Med 1986;80:665-71. |
|4.||Van den Weel JG. Obducties als kwaliteitsinstrument serieus nemen. [Autopsies have to be taken seriously as an instrument for quality assurance] (with English summary). Ned Tijdschr Geneeskd 1999;143:2351-4. |
|5.||Turner J, Raphael B. Requesting necropsies. Greater humanity and awareness of suffering will help doctors and patients alike. Br Med J 1997;314:1499-500. |
|6.||Behera C, Rautji R, Dogra TT. Relatives' attitudes towards medico-legal investigation and forensic autopsy: A study from South Delhi. Med Sci Law 2008;48:159-62. |
|7.||Lishimpi K, Chintu C, Lucas S, Mudenda V, Kaluwaji J, Story A, et al. Necropsies in African children: Consent dilemmas for parents and guardians. Arch Dis Child 2001;84:463-7. |
|8.||Bierig JR. Informed consent in the practice of pathology. Arch Pathol Lab Med 2001;125:1425-9. |
|9.||Sanner MA. In perspective of the declining autopsy rate: Attitudes of the public. Arch Pathol Lab Med 1994;118:878-83. |
[Table 1], [Table 2]
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