Relatives' attitudes towards medico-legal investigation and forensic autopsy: a study from South Delhi

External challenges for specialists dealing with forensic autopsies

BACKGROUND

In addition to poor infrastructure, and human resource constraints, forensic medicine specialists in developing countries face many external challenges.

OBJECTIVES

We aimed to investigate the prevalence, type, and source of external challenges confronting them including sex, age, religion, deceased's place of residence and the number of accompanying relatives.

MATERIALS AND METHODS

This cross-sectional, observational study was conducted between August 2020 and July 2022 at the Mortuary of AIIMS, Bhubaneswar with the approval of the ethical committee.

RESULTS

Of note, forensic medicine specialists faced external challenges in about one in five cases (20.5%). Most demands were to either minimise the autopsy procedure (n = 65) or to conduct the autopsy at inappropriate times (n = 58). The demands to minimise the autopsy procedure were significantly associated with the deceased's age (p = 0.046), religion (p = 0.010), socioeconomic class (p = 0.020) and manner of death (p = 0.019).

CONCLUSIONS

Our study found that forensic medicine specialists in India face significant external challenges. Avoiding unnecessary complete autopsies, implementing night autopsies, and embracing minimally invasive autopsies are recommended to mitigate these challenges.

Perceptions of family, community and religious leaders and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study

Background

Minimal invasive tissue sampling (MITS) has emerged as a suitable alternative to complete diagnostic autopsy (CDA) for determination of the cause of death (CoD), due to feasibility and acceptability issues. A formative research was conducted to document the perceptions of parents, community and religious leaders on acceptability of MITS.

Methods

This qualitative study was conducted at and around the Safdarjung Hospital, Delhi, India. Participants for in-depth interview included the parents who had either child or neonatal death or stillbirth and the key community and religious representatives. The focus group discussions (FGDs) involved community members. Process of obtaining consent for MITS was observed. Data were analyzed inductively manually for emerging themes and codes.

Results

A total of 104 interviews (parents of deceased children, neonates or stillbirths, n = 93; community members, n = 8 and religious leaders, n = 7), 8 FGDs (n = 72) were conducted and process of obtaining consent for MITS (n = 27) was observed. The participants were positive and expressed willingness to accept MITS. The key determinants for acceptance of MITS were: (1) understanding and willingness to know the cause of death or stillbirth, (2) experience of the healthcare received and trust, (3) the religious and sociocultural norms. Parents and community favored for MITS over CDA when needed, especially where in cases with past stillbirths and child deaths. The experience of treatment, attitude and communication from healthcare providers emerged as important for consent. The decision making process was collective involving the elders and family. No religious leader was against the procedure, as both, the respect for the deceased and need for medical care were satisfied.

Conclusions

Largely, MITS appeared to be acceptable for identifying the causes of child deaths and stillbirths, if the parents and family are counseled appropriately considering the sociocultural and religious aspects. They perceived the quality of care, attitude and communication by the healthcare providers as critical factors for acceptance of MITS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01218-4.

India tops the chart of childhood deaths and stillbirths globally. The causes of many childhood deaths and stillbirths remain unknown or ill-defined in India. For planning the health policies, program and clinical practices, the cause of death (CoD) and stillbirth are primarily determined by verbal autopsy (VA) method, which has several inherent limitations. The acceptance and implementation of complete diagnostic autopsy (CDA) or full autopsy for CoD determination is limited. Minimally invasive tissue sampling (MITS) is a suitable alternative to full autopsy for CoD determination. MITS has been found to be acceptable and being implemented in some low and middle income countries. Considering the multi-religion and sociocultural contexts of India, an understanding about the perceptions, practices, acceptance and barriers among the parents, community members and religious leaders regarding MITS was necessary for designing appropriate communication strategies and materials for consent. A qualitative study was undertaken in New Delhi, India using in-depth interviews with the parents of deceased children and stillbirths, community leaders, community health workers and religious leaders and focus group discussions with the community members and observation of obtaining consent for MITS. The parents and community members were positive about MITS and expressed willingness to accept it over full autopsy to know the CoD and stillbirths. The factors like past stillbirths and child deaths, experience of the healthcare received and trust, the religious and sociocultural norms emerged as important determinants for acceptance of MITS. The religious leaders were also positive about MITS if needed for treatment and benefit of the family.

Myths and misconceptions about medico-legal autopsies among the people of Tamilnadu, India

BACKGROUND

Medico-legal autopsies are conducted as a part of necessary investigation in all unnatural deaths. In India, the awareness about medico-legal autopsies among the population is still at incipient stage. The procedure is largely stigmatised due to various myths and misconceptions. Apprehension about the procedure brings about various emotional reactions of relatives. Hence the study was carried out to know those myths and misconceptions.

OBJECTIVES

To find out the various myths and misconceptions about the medico-legal autopsies among the people. To make a lay person aware of the importance of medico-legal autopsies.

METHODS

This is a descriptive cross sectional study conducted in central part of Tamilnadu, India. About 600 participants of age 18 to 80 years were included. Their responses were obtained by semistructured questionnaires.

RESULT

There is a significant difference noted on various views among this population.

INTERPRETATION

Administration should strive to rescind these misapprehensions and myths. The medical staff, mass and electronic media should also come forward to educate them.

CONCLUSION

Stipulation of health education about the medico-legal autopsies is must for a lay person.

Autopsy translates in Arabic to al-tashreeh. Could this term influence its acceptability?

It is not unusual for laypersons to object on the conduct of an autopsy of a loved one for fear of disfigurement or burial delays. In this paper, we discuss a new possible reason for objection among Arabic speaking communities related to the language. The Arabic word for autopsy is "al-tashreeh" which, when examining its other linguistic uses, might result in wrong inferences among laypersons.