At the end of June, SCoJeC organised an unprecedented meeting to discuss alternatives to invasive surgical post-mortem. Among the participants were a forensic pathologist, a consultant radiologist, a senior representative of the Crown Office and Procurator Fiscal Service, and a member of the Scottish Parliament Justice Committee, as well as religious and communal leaders and medical experts from both the Jewish and Muslim communities.
Ephraim Borowski, Director of the Scottish Council of Jewish Communities, opened the meeting by explaining that many faith communities are concerned about the desecration of the body, and Jews and Muslims in particular share a desire to avoid anything that delays burial. However, the decision whether or not to require a post-mortem is one for the Procurator Fiscal, and practice seems to vary across the country. In England and Wales, the Coroners and Justice Act, recently passed at Westminster, explicitly recognises new technology, such as MRI scans and other radiological techniques, as an acceptable alternative to invasive post-mortem, and, with the support of the local Coroner, the number of full post-mortems in the Jewish Community of Manchester, has fallen from around 100 to fewer than 10 per annum. However, the Scottish legal framework is radically different. The Criminal Justice and Licensing (Scotland) Bill, which was just concluding its final stages in Parliament, might have provided an opportunity to clarify the law, but the Lord Advocate has now confirmed that no change in the law is necessary, and that all that is required is an instruction from her to local Procurators Fiscal.
Stuart Ballantyne, a consultant radiologist at Gartnavel Hospital in Glasgow, then gave a presentation about the use of MRI, x-ray, and CT scans in order to determine the cause of death, saying that the literature contains very little by way of comparative studies, but what there is encouraging though not conclusive.
Prof Derrick Pounder, Head of the Centre for Forensic and Legal Medicine at the University of Dundee, then explained how he had increased the proportion of non-invasive "view and grant" post-mortem examinations in Dundee, from around 15% in 1988 to 48% in 2007, by reducing the financial incentive in favour of a surgical post-mortem. He drew attention to local variations; in Glasgow the current percentage is zero; this had previously been the case in Edinburgh, but had recently improved. Of course a small number of full investigations would still be required, for example, where there was suspicion of foul play and the cause of death was not obvious, but in most cases all that was required was a detailed and careful external examination of the body, and consideration of medical records.
In the discussion that followed, a number of practical problems were noted, including the difficulty of getting all relevant medical records together, for example where a patient has been treated in one hospital but dies in another; the increasing use of GP deputising services, so that neither the GP nor the locum might be prepared to certify the cause of death, because the former was not present and the latter might know nothing of the patent's history; risk aversion in the aftermath of the Shipman scandal; access to radiological equipment and the additional cost; and the need for training for the medical staff involved .
Stewart Maxwell MSP, a member of the Scottish Parliament Justice Committee, explained that he had been prepared to move an amendment to the Criminal Justice and Licensing (Scotland) Bill, but he had received assurances from the Lord Advocate that this was not necessary. The meeting then concluded with Linda Cockburn, Principal Procurator Fiscal Depute at Crown Office, confirming that they were preparing to write to all Procurators Fiscal to remind them that there is no requirement for a surgical post-mortem, and that they have the authority to commission whatever reports appear appropriate in the circumstances. She also undertook that these concerns would be taken into account when the contracts with the various pathology services were shortly due for renewal.
This was the first time that the participants had met, and all agreed that they had learned much from the evening, as well as discovering how their interests coincide. Everyone agreed with Salah Beltagui, Convener of the Muslim Council of Scotland, who described it as “a very useful and productive meeting which gave us an opportunity to understand the science relating to the death certification process”.