Why no autopsy?

Factual Questions
1

I apologize for the length of this post, but I wanted to include as much information as possible so there would be more answers than questions.

Almost two years ago, my uncle died and no autopsy was performed. He was cremated and most, if not all, of his ashes have been spread. Since then, there has been this nagging feeling in the back of my mind that an autopsy should have been performed and I’m really curious as to why one wasn’t.

Let me give as much background information as possible.

*He was 49 years old and in pretty good shape.

*He lived alone and had no known significant other or children

*Health wise, he had complained about mild chest pains 8 months earlier when he was mowing my grandparents lawn in the hot summer sun, and had mentioned similar pains closer to when he died, but hadn’t seen a doctor. He had a cardiologist appointment scheduled for later that month.

*We know that he went to work on Friday and all of his coworkers said that he was acting normal and in good spirits.

*He was found in his condo on Saturday night only after the police were called by my dad to break the door down. The doorknob and the deadbolt were both locked, I don’t think the door was chained.

*He was found on the couch with a light blanket covering him, wearing shorts and a t-shirt, like he was watching something on TV before going to bed. My dad said that he looked like he was sleeping. We assume that he fell asleep on the couch but never woke up.

*The police said that with the previous complaints about chest pains and the doctor’s appointment reminder sitting out on his desk by the door, it was pretty obvious to them that he had a heart attack so no autopsy would be performed. This was in Cook County, Illinois and my dad was told that the coroner was always very busy and this case was pretty open and shut. This entire conversation took place in my uncle’s condo less than an hour after he was found, so my dad’s state of mind wasn’t very logical and he agreed.

The lack of autopsy seemed weird to me, but I understood the argument for not doing one. However, I subconsciously started paying attention to news stories where people died and autopsies were performed and I noticed that they happen all the time, and in cases of even more obvious death than my uncle’s.

For example, there was a woman who died in a car accident in which she was the passenger. The driver hit a patch of black ice, the car spun out and flipped over and she was ejected from the vehicle and died. Pretty clear that massive trauma was the cause of death, but an autopsy was still performed.

Another example - My grandfather (from the other side) was in the hospital for 6 months before he died. At no point did the doctors not know what he was in there for or what he was dying of, but an autopsy was still performed.

There are also a variety of stories about gun shot victims (person shot in the head, autopsy to be performed) where it seems pretty obvious what happened.

So, it looks like there are autopsies performed even when it seems obvious what the cause of death is. Here’s my concern - I can come up with several plausible causes of death that would present themselves the same way.

If he was killed by someone, committed suicide or died of a physical ailment, I would still like to know the true cause of death. If the cause of death is a physical ailment, myself and others in my family could be at risk. Presumably the same is true if he was murdered (although the murderer hasn’t tried to kill anyone else in 2 years).

Anyway, after this long post, my question is why wasn’t an autopsy performed on my uncle after he was found dead in his condo?

2

I don’t know how it is in Illinois, but when my uncle died in New York with an “obvious” cause of death (he was a heavy smoker) the family was given the option of declining an autopsy. Since his family did, no autopsy was performed.

Perhaps Illinois is similar.

3

Autopsies are expensive and time-consuming. Dozens to hundreds of people die each day in large cities. Doing autopsies for every person who died would be prohibitively expensive, require dozens of medical examiners to be hired and huge surgical and storage facilities built, hold up the determine of death in cases where it is vital, be against the religion of many peoples, such as Jews and Muslims who also require burial within a day of death, and not generally tell anyone much of what they already didn’t know.

It’s logistically and politically infeasible.

4

IANAD, but I think you answered your own question.

5

The car accident victim is a form of homicide. The grandfather in the hospital was probably intellectual curiosity on the part of the hospital. Your uncle’s death had a probable cause, and no one to prosecute.

6

When a person with a poorly documented (or undocumented) medical history dies at home without explanation, whether or not an autopsy is performed will depend on 1) circumstances surrounding the death, and 2) the jurisdiction involved. In many states, the coroner (not necessarily a forensic pathologist, and possibly not even a physician) will look at the investigator(s)’ report and determine whether an autopsy is justified.

I did forensic pathology rotations (as a pathology resident physician) in a small city where we saw a number of similar cases - no suspicious circumstances, person found dead at home, lack of good medical history - which generated autopsies. In my current location (a medium-large city) it appears to be a relative rarity for those folks to get autopsied (unless relatives want to pay for a non-medical examiner pathologist to do one).

I’m not surprised that Cook County would forego a medical examiner autopsy in such circumstances. They are probably overwhelmed with accidents and homicides and have insufficient staff and funds to handle medical cases.

7

Granted that your father was in a difficult situation, and people don’t always make the best decisions under such conditions. But also consider that these were professionals, giving you their opinions based on a lot more experience than you or I have. I hope I don’t sound cold and cruel, but honestly ask yourself whether you have real suspicions of some kind, or if you’re just curious.

Yes, but those are the only cases which are considered newsworthy. They are a much smaller number than of all the people who died of whatever cause. You’re getting a skewed picture.

8

Another anecdote: My dad died in his early 50s, in his sleep, in a decent-sized (but not large) city in Wisconsin. After the police checked out the scene and ruled out foul play, my mother was given the option of asking for an autopsy or not. She decided for one as she didn’t know why he died; he had a minor heart condition, a “leaky valve” that he was being treated for. IIRC he had a freak arrhythmia that for some reason his heart did not recover from.

9

Not only that, but in a case like this, they want to make sure the passenger was still alive when the car rolled over. They need to make sure that the person wasn’t murdered (via any method from blunt trauma to poison) and the car accident was being used to cover it up.

10

Anecdote: About five years ago a co-worker was killed in a car accident on the expressway. He hit a stopped and disabled vehicle on the shoulder. It was sunny and the road conditions were perfect. He had been driving for many years.

His family wanted to know whether he passed out, had a stroke, heart attack, etc., but the coroner said that since the cause of death was obvious (i.e. car accident) then they would have to pay if they wanted an autopsy…

11

Seems to be the cause of death isn’t obvious at all. It seems very likely he could have been dead before he veered off the road. In a case like this you’d think there’d be some insurance companies that would want to know what happened.