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The central purpose of this paper is to address the tension between legal and medical discourses within the coronial system. Medical expertise, based largely upon internal autopsy, becomes positioned as providing the more important information, rather than the legal model which focuses on evidence gathering at the scene. This paper will examine the aspects of the history, philosophy and consequences of the processes by which the medical model gained its current dominance and will conclude that, while autopsies are necessary, they are also over-used in the coronial system.

This paper details research completed in 2007 which investigated autopsy decision-making in a death investigation. The data was gathered during the first year of operation in Queensland, Australia, of a new Coroners Act which changed the process of death investigation in three ways which are important to this paper. First, it required a greater amount of information to be gathered at the scene by police: this included a thorough investigation of the circumstances of the death, including statements from witnesses, friends and family, as well as evidence gathering at the scene. Second, it required coroners, for the first time, to determine the level of invasiveness required in the autopsy to complete the death investigation. Third, it enabled any genuine family concerns to be communicated to the coroner. The outcome of such information was threefold: (i) a greater amount of information offered to the coroner led to a decrease in the number of full internal autopsies ordered, but an increase in the number of partial internal autopsies ordered; (ii) this shift in autopsy decision-making by coroners saw certain factors given greater importance than others in decisions to order full internal, or external only, autopsies; (iii) a raised family concern had a significant impact on autopsy decision-making and tended to decrease the invasiveness of the autopsy ordered by the coroner.

Medico-legal autopsies can be directed by coroners. However, in a number of jurisdictions family members can lodge objections with coroners against such procedures taking place. The authors analyse the objections, successful and unsuccessful, taken in Australia. Reviewing recent Victorian developments, they emphasise the public interest in autopsies which reveal medical causes of death. They identify the ongoing importance of coroners being able to exercise their statutory function to undertake death investigations effectively and to make informed recommendations to reduce the incidence of avoidable deaths.

The Human Tissue Acts of the various States and Territories that were enacted following the 1977 Report of the Australian Law Reform Commission on Human Tissue Transplants are in need of an overhaul as a result of rapid advances in medical science and biotechnology, as well as growing public expectations regarding the ethical use of tissues and organs obtained from autopsies and other sources. The author argues that the time is ripe for a comprehensive review and revision of the Acts throughout the country in order to maintain a consistent approach.

Previous studies have consistently shown that autopsy examination after surgery can identify a significant rate of discrepant and/or erroneous diagnoses. Findings gleaned from autopsies can be invaluable for the medical community and science as a whole, ultimately leading to improvements in quality surgical care. Despite the proven benefits of this underused tool, the number of autopsies carried out in Australian hospitals is declining dramatically, with autopsy rates plummeting from 21% in 1992-1993 to 12% in 2002-2003. This notable decline ought to be a genuine source of concern and deserves further examination. This review seeks to address the reasons for decline, while reasserting the value and relevance of autopsies within modern surgical practice Down Under.

Recent controversies both in Australia and overseas have focused public attention on autopsy practice. It has become apparent that there is an increasing expectation amongst the public for more detailed information concerning autopsy procedures and, in particular, tissue retention. This article attempts to review the legal and ethical issues with respect to postmortem examination in Australia and to contemplate potential offences and penalties should such obligations be breached.

Information concerning autopsy laws, regulations, rates, and practice was collected from 29 industrialized countries. In many countries, laws have been revised in recent years, introducing more restrictive rules, with consent required from the next-of-kin. With one exception (Finland), introduction of a requirement for consent was followed by a decline in the autopsy rate. Experiences in various countries are discussed. It is apparent that the problem of decreasing autopsy rates is an international one. Efforts to inform and educate the public about the benefits of autopsy are necessary, if the decision whether to perform autopsy is to remain their responsibility.