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[There are a few peculiar incidental advantages to being in the world of forensic pathology. 1) In many jurisdictions, the forensic pathologist, as a criminal investigator, may acquire a permit to carry a handgun. This is perfect for those just macho enough to wish to go armed, but not so macho as to want to go to jail for it. 2) Since forensic pathologists typically work in nonmedical institutions, such as city morgues and county medical examiner's offices, they may be exempt from licensing/certifying agencies and may thumb their noses at even the most basic laboratory safety practices. It is something of a tradition for a lot of eating and smoking to be going on while actually performing autopsies. On the other hand, forensic pathologists are not known for their longevity] 


Forensic pathology, which for practical purposes deals with the postmortem investigation of sudden and unexpected death, is about as far from the mainstream of medicine as one can get. The training of a forensic pathologist generally entails a complete five-year residency in anatomic and clinical pathology, followed by one or more years of fellowship training in a medical examiner's office in a large city "fortunate" enough to have hundreds of homicides per year. A completely credentialed forensic pathologist is certified by the American Board of Pathology as both a general pathologist and as a subspecialist, following successful completion of the Board examinations in anatomic, clinical, and forensic pathology.

The good forensic pathologist is an amalgamation of pathologist, detective, politician, and public relations person. Not only must one know the technical aspect of the discipline, but he/she needs to have the communication skills to acquire supportive information from law enforcement officers and explain the results of medical examinations to juries (which are specifically selected for technical ignorance) and other laypeople. Also, mediocre media operatives, desperate for exposees when news is slow, find medical examiners to be quick and easy targets. Forensic pathology, because it involves no mean amount of educated guessing, lends itself well to glib Monday morning quarterbacking by amateurs. 


Role of the Forensic Pathologist
Forensic determinations go beyond those of patient-oriented medicine, as they involve legal as well as medical considerations: 

A. Cause of death
This is a specific medical diagnosis denoting a disease or injury (e.g., myocardial infarction, strangulation, gunshot wound). In particular, 

1. Proximate cause of death. The initial injury that led to a sequence of events which caused the death of the victim. 

2. Immediate cause of death. The injury or disease that finally killed the individual.  Example: A man burned extensively as a result of a house fire dies two weeks later due to sepsis. The proximate cause of death is his burns, leading to sepsis, which is the immediate cause of death. 
B. Mechanism of death
This term describes the altered physiology by which a disease or injury produces death (e.g., arrhythmia, hypoventilatory hypoxia, exsanguination). 

C. Manner of death
This determination deals with the legal implications superimposed on biological cause and mechanism of death: 
1. Homicide. Someone else caused the victim's death, whether by intention (robber shoots convenience store clerk) or by criminal negligence (drunk driver, going 55 mph on Fondren, runs red light at Bellaire and strikes pedestrians in crosswalk). After the forensic determination is made, it may of course be altered as a result of a grand jury or other legal inquiry. For instance, when one child shoots another, the forensic examination may conclude from the body that homicide was the manner of death, but after considering all evidence, a grand jury may conclude that the gun discharged accidentally. 
2. Suicide. The victim caused his/her own death on purpose. This may not always be straightforward. For instance, a victim may strangle himself accidentally during autoerotic behavior (apparently some people find a certain amount of hypoxia very stimulating). If the examiner were not to consider all of the evidence (such as erotic literature found near the body), an incorrect determination of "suicide by hanging" might be made. This error may be financially disastrous for the victim's survivors, since many life insurance policies do not award benefits when the insured is a suicide. Also, in some cultures suicide is a social stigma or a sin against its deity. 

3. Accidental. In this manner of death, the individual falls victim to a hostile environment. Some degree of human negligence may be involved in accidental deaths, but the magnitude of the negligence falls short of that reasonably expected in negligent homicide. Whereas the negligence of the speeding drunk, above, would be considered gross by a reasonable observer, a pedestrian killed at the same intersection by a sober driver, not speeding or running a red light, would be reasonably considered a victim of accidental death. 

4. Natural causes. Here, the victim dies in the absence of an environment reasonably considered hostile to human life. Most bodies referred for forensic examination represent this manner of death. 

Copyright (c) 1995, Edward O. Uthman.

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