Forensic Pathology

• Author: Forensic Pathologists of the Provincial Forensic Pathology Unit in Toronto
• Pages: 626-668

626

A. OVERVIEW

1) Qualif‌ications of the Forensic Pathologist

Forensic pathology is the specialty of medicine that underlies the medico-

legal investigation of death. The forensic pathologist, then, is a specialist in

death investigation, a physician who uses the tools of science and medicine to

discover the truth behind a person’s death. Forensic pathologists undertake

f‌ive years of postgraduate training in anatomical (i.e., hospital) pathology,

followed by an additional year of training in forensic pathology. Their train-

ing in both pathology and forensic pathology is recognized through certif‌i-

cation from the Royal College of Physicians and Surgeons of Canada (Royal

College) after meeting the college’s requirements and passing examinations.

Forensic pathology has been a subspecialty of the Royal College for only

a few years. Prior to this, many forensic pathologists in Canada obtained

their training and certif‌ication in other jurisdictions. Some forensic pathol-

ogists currently working in Ontario (and elsewhere in Canada) have been

“grandparented” into the speciality based on long experience and recog-

CHAPTER 18

Forensic Pathology

Forensic Pathologists of the Provincial Forensic

Pathology Unit in Toronto*

LEgAL ConTExT: CAiTLin PAkosH

* In alphabetical order: Maggie Bellis, MB, BCh, BAO, FRCP; Kristopher Cunningham,

MD, PhD, FRCPC; Anita Lal, MD, D-ABP, FCAP; Jayantha Herath, MD, DLM, MD

(Forensic), FCAP,FRCPC (AP & FP); Michael Pickup, MSc, MD, FRCPC; Michael S.

Pollanen, MD, PhD, FRCP, DMJ (Path) FRCPC Founder; Ashwyn Rajagopalan, MD,

FRCPC; Toby H. Rose, MD, FRCPC. For further biographical information, please

refer to the Contributors section of this book.

Forensic Pathology 6 627

nized expertise in the criminal justice system. In Ontario, any pathologist

or forensic pathologist who wishes to perform medicolegal autopsies must

be on the register of pathologists of the Ontario Forensic Pathology Service.

Provincial and territorial medicolegal death investigation systems may

be headed by a medical examiner or by a coroner. Medical examiners are

always forensic pathologists. Depending on the province, coroners may

be medical or nonmedical. At the time of this writing, no chief coroner in

Canada is a forensic pathologist.

2) Practice of Forensic Pathology

Sudden and unexpected deaths are investigated to determine the cause

and manner of death. The manner of death is sometimes described as “by

what means” the death occurred. In Ontario, the possible manners of death

are: natural, accidental, suicide, homicide, and undetermined. In medical

examiner systems, the medical examiner certif‌ies the cause and manner

of death (i.e., f‌ills out the medical certif‌icate of death) and submits it to

the registrar general or other of‌f‌icial. In coroner systems, the coroner is

responsible for certif‌ication. In both types of death investigation systems,

forensic pathologists are the medical specialists who perform autopsies

and testify about them in court.

Less than twenty percent of the typical forensic pathologists’ work

involves the criminal justice system. The remainder is spent dealing with

other types of sudden death, including those resulting from accident, sui-

cide, and natural causes.

B. THE SCIENCE OF FORENSIC PATHOLOGY

1) The Medicolegal Autopsy (Post-mortem Examination)

An autopsy, or post-mortem examination, is the examination of a body

after death. An important function of any autopsy is the conclusive identi-

f‌ication of the body. During the autopsy, the forensic pathologist observes,

documents, and interprets any f‌indings. Objective f‌indings establish the

facts underlying the death and lead to an expert opinion on the meaning

of those f‌indings (expert opinions usually relate to the cause of death).

However, deciding the cause of death may be only the beginning in most

cases, since the medicolegal issues may be subtler than just the cause of

death. The process of the medicolegal autopsy is divided into f‌ive steps:

628 6 Forensic Pathologists of the Provincial Forensic Pathology Unit in Toronto

1) Consideration of the scene and circumstances around the death. This step

includes the transmission of historical information from police, cor-

oners, or other investigators or medical experts and the review of the

scene by inspecting digital images. Forensic pathologists may visit the

scene to make f‌irst-hand observations that may be relevant in the ul-

timate interpretation of the autopsy.

2) External examination of the body in the autopsy room. In this step, the

body is examined both clothed and unclothed from head to toe and

photographs, samples, physical exhibits, and observations are made

and recorded. A detailed examination is made of injuries and changes

due to natural disease. This will often include the creation of diagrams

or written descriptions with both qualitative and quantitative data.

Evidence of post-mortem changes and injuries (i.e., post-mortem arti-

facts) are recorded, along with evidence of attempted resuscitation or

surgical/medical treatment. In some cases, such as stabbings or shoot-

ings, X-ray images are obtained to check for projectiles or other metal

foreign bodies, such as knife tips, in the body.

3) Internal examination of the body. Routine dissections include the head,

neck, chest, abdomen, and pelvis, with a detailed examination of injur-

ies and changes due to natural disease, as above.

Additional dissections are performed as required, including dissec-

tion of the tissue layers of the face and anterior neck, the back, and the

extremities. In some cases, such as potential sexual assault, the external

genitalia and pelvic organs may be further dissected. Photographs are

made, and tissue samples are obtained for microscopic examination.

This step may require consultation with other experts to examine

specif‌ic tissues or organs. A neuropathologist can give an expert opinion

on the brain in cases of head injury and a forensic anthropologist may be

consulted to give an expert opinion on injuries to bones and assistance

with identif‌ication of the body, particularly where the remains are skele-

tonized, burned, decomposed, mutilated, or otherwise unrecognizable.

4) Special laboratory tests (ancillary tests). Some tests are performed by a

pathologist and some by other experts. The most frequent tests are

toxicology (i.e., examination of body f‌luids for drugs and poisons) and

histology (i.e., microscopic examination of tissues for abnormalities

and injuries). Other ancillary tests may be performed according to the

specif‌ic requirements of the case.

5) Creation of an expert opinion. The f‌inal product is a written report of

post-mortem examination, including the pathologist’s determination