How can we reduce the number of coroner autopsies? Lessons from Scotland and the Dundee initiative

Currently the medicolegal dissection rate for England and Wales is 22% (110,000 coronial autopsies for 500,000 deaths per annum), yet there is a general lack of evidence about the utility of and justification for such a high level of activity, which is between double and triple the rate in other jurisdictions. The government is currently consulting on how to reduce the numbers, and the Coroners and Justice Act 2009 is permissive of external examinations as an alternative to dissections. We describe the philosophy and practice of the Scottish system of postmortem external examinations, and the 20-year experience of a local initiative to maximize use of such external examinations. Currently our regional medicolegal dissection rate is 6%, which if applied to England and Wales would reduce the number of dissections from 110,000 to 30,000 per annum, with all of the social, resource and management implications. While the autopsy is an important tool in modern death investigation, an almost automatic recourse to it is inappropriate. In our view external examinations are not only cost-effective but also a necessary element in any death investigative system which wishes to strike an appropriate balance between intrusion by the state and the rights of the bereaved.