MEDICOLEGAL DEATH INVESTIGATION SYSTEM
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Department of Justice. The views presented in this report are those of the WORKSHOP PARTICIPANTS and are not necessarily those of the funding agency
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COMMITTEE FOR THE WORKSHOP ON THE MEDICOLEGAL DEATH INVESTIGATION SYSTEM
RICHARD BONNIE (Chair), John S. Battle Professor of Law and Director Institute of Law, Psyschiatry, and Public Policy,
University of Virginia, Charlottesville, VA
DAVID KAYE, Regent's Professor,
College of Law, Arizona State University, Tempe, AZ
THOMAS PEARSON, Albert D. Kaiser Professor and Chair and Professor of Medicine,
Department of Community and Preventive Medicine, University of Rochester, Rochester, NY
KATHLEEN TOOMEY, Director,
Division of Public Health, Georgia Department of Human Resources, Atlanta, GA
ROBERT WALLACE, Irene Ensminger Steecher Professor of Epidemiology and Internal Medicine,
Colleges of Public Health and Medicine, University of Iowa, Iowa City, IA
CAROLYN E. FULCO, Senior Program Officer
GINA BATA, Research Assistant (until December 2002)
HOPE R. HARE, Research Assistant
A. WEZI MUNTHALI, Research Assistant
DEEPALI PATEL, Sr. Project Assistant
ROSE MARIE MARTINEZ, Director,
Board on Health Promotion and Disease Prevention
NORMA GROSSBLATT, Senior Editor
MIRIAM DAVIS, Independent Medical Writer,
Silver Spring, Maryland
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
MARGARET BERGER, Professor, Brooklyn Law School, Brooklyn, NY
RANDY HANZLICK, Associate Professor of Forensic Pathology, Emory University School of Medicine, Chief Medical Examiner, Atlanta, GA
CHARLES HIRSCH, Chief Medical Examiner, Office of the Chief Medical Examiner, New York, NY
KURT NOLTE, Assistant Chief Medical Investigator, New Mexico Office of the Medical Investigator, Professor of Pathology, University of New Mexico School of Medicine, Albuquerque, NM
VICTOR WEEDN, Principal Research Scientist, Director of Biotechnology and Health Initiatives, Mellon Institute, Pittsburgh, PA
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by LAWRENCE GOSTIN, J.D., Professor of Law, Georgetown University, Professor of Public Health, Johns Hopkins University, Center for Law and the Public’s Health, CDC Collaborating Center Promoting Health Through Law, Washington, DC, who was appointed by the Institute of Medicine. Mr. Gostin was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the institution.
On first glance, official identification of human remains and certification of the cause of death appear to be mundane endeavors that serve mainly private needs of families, insurers, and litigants. In truth, however, valid and reliable data on the circumstances and causes of deaths serve a variety of important public needs, including fair and accurate adjudication in criminal and civil cases, maintenance of accurate vital statistics, effective public health surveillance and response, advances in health and safety research, and improvement in quality of heath care. The combined task of collecting and interpreting information about circumstances and causes of death has traditionally been called medicolegal death investigation, terminology that reflects the interface of medical science with law and public policy. This "forensic" function has been performed for centuries in all societies, although not always by medical professionals.
Concerns about the adequacy of medicolegal death investigation in the United States have been raised for many decades. The concerns have been voiced by all the constituencies that have a stake in the accuracy of data related to circumstances of death and in the official determinations based on them. For the criminal justice system, concerns about the adequacy of data about deaths merge with general concerns about all aspects of forensic science. Those concerns led the National Institute of Justice to ask the Institute of Medicine to conduct a workshop on the medicolegal death investigation system in the United States. IOM appointed a committee to plan the workshop with the advice and assistance of NIJ, staff of the Centers for Disease Control and Prevention, and other interested constituencies. The workshop was held on March 24-25, 2003, and this report summarizes the ideas and observations expressed at the workshop.
Presentations and opinions expressed at the workshop demonstrated clearly that the current practices of medicolegal death investigation in
this country are in substantial need of improvement. The workshop discussions also showed that accurate data on the circumstances and causes of death (and the identification of human remains) are, in the language of economists, a valuable public good and that much of their value accrues to the benefit of the nation as a whole. To rectify the many deficiencies of the system, it will be necessary to solve many problems, including fundamental issues of financing. The workshop was a starting point for further study and, I hope, for eventual reform.
Richard J. Bonnie
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