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Forensic pathology

Forensic pathology

Overview
Forensic pathology is a branch of pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 concerned with determining the cause of death
Cause of Death
Cause of Death is a 1990 album by American death metal band Obituary. Cause of Death is considered a classic album in the history of death metal. The artwork was done by artist Michael Whelan...

 by examination of a corpse. The autopsy
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...

 is performed by the pathologist at the request of a coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...

 or medical examiner
Medical examiner
A medical examiner is a medically qualified government officer whose duty is to investigate deaths and injuries that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests....

 usually during the investigation of criminal law
Criminal law
Criminal law, is the body of law that relates to crime. It might be defined as the body of rules that defines conduct that is not allowed because it is held to threaten, harm or endanger the safety and welfare of people, and that sets out the punishment to be imposed on people who do not obey...

 cases and civil law
Civil law (common law)
Civil law, as opposed to criminal law, is the branch of law dealing with disputes between individuals or organizations, in which compensation may be awarded to the victim...

 cases in some jurisdictions. Forensic pathologists are also frequently asked to confirm the identity of a corpse. Also see forensic medicine.

The word forensics is derived from the Latin forēnsis meaning forum.

Forensic pathology is an application of medical jurisprudence
Medical jurisprudence
Medical jurisprudence, or forensic medicine in the broad sense , now embraces all matters which may bring the physician into contact with the law...

.
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Encyclopedia
Forensic pathology is a branch of pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 concerned with determining the cause of death
Cause of Death
Cause of Death is a 1990 album by American death metal band Obituary. Cause of Death is considered a classic album in the history of death metal. The artwork was done by artist Michael Whelan...

 by examination of a corpse. The autopsy
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...

 is performed by the pathologist at the request of a coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...

 or medical examiner
Medical examiner
A medical examiner is a medically qualified government officer whose duty is to investigate deaths and injuries that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests....

 usually during the investigation of criminal law
Criminal law
Criminal law, is the body of law that relates to crime. It might be defined as the body of rules that defines conduct that is not allowed because it is held to threaten, harm or endanger the safety and welfare of people, and that sets out the punishment to be imposed on people who do not obey...

 cases and civil law
Civil law (common law)
Civil law, as opposed to criminal law, is the branch of law dealing with disputes between individuals or organizations, in which compensation may be awarded to the victim...

 cases in some jurisdictions. Forensic pathologists are also frequently asked to confirm the identity of a corpse. Also see forensic medicine.

The word forensics is derived from the Latin forēnsis meaning forum.

Scope of forensic pathology


Forensic pathology is an application of medical jurisprudence
Medical jurisprudence
Medical jurisprudence, or forensic medicine in the broad sense , now embraces all matters which may bring the physician into contact with the law...

. The forensic pathologist:
  • Is a medical doctor who has completed training in anatomical pathology
    Anatomical pathology
    Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...

     and who has subsequently sub-specialized in forensic pathology. The requirements for becoming a "fully qualified" forensic pathologist varies from country to country. Some of the different requirements are discussed below.
  • Performs autopsies/postmortem examinations to determine the cause of death. The autopsy report contains an opinion about :
    • The pathologic process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called mechanism of death), such as a bullet
      Bullet
      A bullet is a projectile propelled by a firearm, sling, or air gun. Bullets do not normally contain explosives, but damage the intended target by impact and penetration...

       wound to the head, exsanguination
      Exsanguination
      Exsanguination is the fatal process of hypovolemia , to a degree sufficient enough to cause death. One does not have to lose literally all of one's blood to cause death...

       caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.), and
    • The "manner of death", the circumstances surrounding the cause of death, which in most jurisdictions include:
      • Homicide
        Homicide
        Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...

      • Accidental
      • Natural
      • Suicide
        Suicide
        Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

      • Undetermined

  • The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased.
  • Examines and documents wound
    Wound
    A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...

    s and injuries, both at autopsy and occasionally in a clinical setting.
  • Collects and examines tissue specimens under the microscope (histology
    Histology
    Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

    ) in order to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
  • Collects and interprets toxicological analyses on body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
  • Forensic pathologists also work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths i.e. the coroner (England
    England
    England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

     and Wales
    Wales
    Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...

    ), procurator fiscal
    Procurator Fiscal
    A procurator fiscal is a public prosecutor in Scotland. They investigate all sudden and suspicious deaths in Scotland , conduct Fatal Accident Inquiries and handle criminal complaints against the police A procurator fiscal (pl. procurators fiscal) is a public prosecutor in Scotland. They...

     (Scotland) or coroner or medical examiner (United States
    United States
    The United States of America is a federal constitutional republic comprising fifty states and a federal district...

    ).
  • Serves as an expert witness in courts of law testifying in civil or criminal law
    Law
    Law is a system of rules and guidelines which are enforced through social institutions to govern behavior, wherever possible. It shapes politics, economics and society in numerous ways and serves as a social mediator of relations between people. Contract law regulates everything from buying a bus...

     cases.


In an autopsy, he/she is often assisted by an autopsy/mortuary technician (sometimes called a diener
Diener
The word Diener is German for servant. In English, it is generally used to describe the person, in the morgue, responsible for handling, moving, and cleaning the corpse...

 in the USA).

Forensic physicians, sometimes referred to as 'forensic medical examiners' or 'police surgeons' (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault (including sexual assault) and those individuals who find themselves in police custody. Many forensic physicians in the UK practise clinical forensic medicine part-time, whilst they also practise family medicine, or another medical specialty.

In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, Membership of the Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...

 is not a prerequisite of appointment as a Coroner's Medical Expert, i.e. doctors in the UK that are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, simply because of the vague wording of 'The Coroners Act', which merely stipulates a 'suitably qualified medical practitioner', i.e. anyone on the GMC Register.

Investigation of death



Deaths where the known cause and those considered unnatural
Unnatural death
Unnatural death is a category used by coroners and vital statistics specialists for classifying all human deaths not properly describable as death by natural causes...

 are investigated. In most jurisdiction
Jurisdiction
Jurisdiction is the practical authority granted to a formally constituted legal body or to a political leader to deal with and make pronouncements on legal matters and, by implication, to administer justice within a defined area of responsibility...

s this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.

Terminology is not consistent across jurisdictions


In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.

Similarly, the title "Coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions the title of "Coroner" is exclusively used by physicians.

Canadian coroners


In Canada, there is a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas in British Columbia, there is predominantly a non-physican coroner system. Alberta and Nova Scotia are examples of ME systems

Coroners and medical examiner in the US


In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...

 degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).

In contrast, a medical examiner is typically a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 who holds the degree of Doctor of Medicine. Ideally, a medical examiner has completed both a pathology residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.

History


Forensic pathology was first recognized in the USA by the American Board of Pathology in 1959.

In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, it was formally recognized in 2003, and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada
Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada ' , French: Collège royal des médecins et chirurgiens du Canada, is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada...

.

Becoming a forensic pathologist


Forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country.

Australia


There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).

Canada


In Canada, anatomical pathology is a five year residency; Then residents who wish to become forensic pathologists must complete a one year fellowship in forensic pathology. Traditionally this fellowship is completed at a centre in the United States, but with the recognition of forensic pathology as a subspecialty by the Royal College of Physicians and Surgeons, this training can now be done in Canada. Currently, the only training program in Canada is in Toronto, with British Columbia, Manitoba, and Alberta possibly offering fellowships in the near future.

Indonesia


In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 8 years.

Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.

United Kingdom


In the UK, anatomical pathology is a five year residency. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...

 (GMC) having obtained Membership of the Royal College of Pathologists (United Kingdom).

A specialist training (ST) post is applied for post foundation year to enter a training program in Histopathology. Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises, however the Royal College have not issued their response to this matter as of yet. It is then necessary to obtain the MRCPath Part I examination in Histopathology, after which it is then possible to apply to one of few training posts in Forensic Pathology in the UK. Current approved centres include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow and Dundee. Not all the posts are currently actively training. Following 3 years training in Forensic Pathology and completion of the FRCPath Part II slanted to Forensic Pathology you may then obtain CCT (certificate of completion of training) and work as a Consultant Forensic Pathologist. Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Patholoists in Forensic Pathology (DipRCPath (forensic)), or the Diploma in Medical Jurisprudence (DMJ). In England & Wales you will also need to be Home Office Accredited, which will require checks of your training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.

Foreign graduates and specialists will need to apply to the GMC and the RCPath directly to practise Forensic Pathology in the United Kingdom.

United States of America


In the United States of America, forensic pathologists typically complete at least one year of additional training (a fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...

) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a three to five year residency in anatomic pathology, which is something one does on completing medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.

In the U.S., all told, the education after high school
High school
High school is a term used in parts of the English speaking world to describe institutions which provide all or part of secondary education. The term is often incorporated into the name of such institutions....

 is typically 13 years in duration (4 years undergraduate
Undergraduate degree
An undergraduate degree is a colloquial term for an academic degree taken by a person who has completed undergraduate courses. It is usually offered at an institution of higher education, such as a university...

 training + 4 years medical school + 4 years residency (in anatomic and clinical pathology + 1 year forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several ""diploma mills" that give on line certificates in the field.

India


In India, the speciality is commonly referred to as Forensic Medicine or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to award of degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by National Board of Examinations, leading to awarding of Diplomate of National Board (DNB).

The majority of the specialists are attached to the Department of Forensic Medicine in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader) and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5000 autopsies a year depending upon the jurisdiction. Apart from this the clinical forensic examinations constitute a major part of the work and number of cases can run up to 10000 a year in an average institution.

The largest association of the speciality is the Indian Academy of Forensic Medicine (IAFM), which also publishes its quarterly journal JIAFM regularly. This association has a specialist member strength of more than 800. The most active regional association is the Punjab Academy of Forensic Medicine & Toxicology (PAFMAT), which also publishes its journal JPAFMAT biannually regularly since 2001. JPAFMAT is also indexed in many listings and also available through HINARI and SafetyLit. PAFMAT has links with many international bodies including WHO.

External links


Becoming a pathologist