Hey y’all, it’s Julie Mattson, and this week on Pushing Up Lilies we’re revisiting one of the most asked-about topics in my work as a death investigator: how to avoid an autopsy. This listener-favorite episode dives into the many reasons families may not want an autopsy, from religious beliefs to concerns about the body being “mutilated.” While the final decision lies with the Medical Examiner, especially in suspected suicides or homicides, I’m sharing what you can do now to minimize the chances of an autopsy later. Whether you’re new to the show or giving this one another listen, I hope it brings clarity to a subject many are curious about. Tune in! * Listener discretion is advised.
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00:06
Welcome to Pushing Up Lilies. I'm your host, Julie Mattson. Pushing Up Lilies is a weekly true crime podcast with spine tingling, unusual and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
00:24
Do I have some stories for you? Are you ready? We get a lot of questions about autopsies and whether or not people should have one done on their loved one or if they have to have one done. Back in the day, they used to do autopsies.
00:44
I would say just about on everyone. Of course, there's always those exceptions. But now, because of the population, it is absolutely impossible to do an autopsy, a full autopsy on everyone. The medical examiner is mandated by law to investigate deaths and the ME or the medical examiner is the one that determines if an autopsy is necessary.
01:12
But if a family doesn't want an autopsy, then they're really good about honoring the family's objection. And our office in particular has a form that the family can fill out asking that it not be done.
01:28
Of course, they have to sign it and it asks the reason. Most often, it's religious reasons and that form is reviewed by the doctor. Not all of them are honored in cases of infant homicide or sudden death of someone with no medical history or a young person.
01:51
Those are things that really need to be investigated. And in cases where the doctor does agree not to to do it, they will still do an external exam, which is where they will review the body and look for signs of trauma.
02:08
They'll look for bruises, scratches, petechiae in the eyes, anything that looks abnormal or anything that throws up red flags. And then they'll also do toxicology to rule out overdose, whether it be accidental or suicide.
02:27
And then they'll do some ancillary studies. So a lot of different religions have different beliefs about autopsies and what happens after death. They have rituals as well. I know that I've had some families before that have a ritual of putting oil in the ears at the scene many times.
02:53
That will have already taken place before I get there. A lot of them feel like... It's harmful to the body, disrespectful to the body. They don't want the person to be what they call mutilated. They don't want the autopsy to affect an open casket at the funeral.
03:20
They don't want a delay of the funeral. Example, the Muslim religion, they prefer burial usually within 24 hours. And they do like the body in its original form. Sometimes they may prefer a doctor of the same gender to perform the autopsy.
03:39
The Jewish religion, they are real big on respecting the body after death. They do usually ask for a timely burial. They like the body to remain intact. They believe that the body and soul are reunited at resurrection.
03:57
And if an autopsy is done, then that can't take place because the entire body is not intact for that to happen. The Amish are generally pretty open to it. So we do have to take those religious beliefs into consideration whenever a family member asks that an autopsy not be done.
04:20
At the same time, we have people who want an autopsy. And that's even if their loved one has a pretty extensive family history, because they want to know exactly what caused the death. Many times they will go have a private autopsy done after the medical examiner determines that it's not necessary to be done in our office.
04:46
So they may hire a private pathologist. They may pay upwards of $3,000, $4,000 to have a private autopsy done because they want more answers. I know. that a lot of people believe that an autopsy is going to show exactly.
05:07
But many times, if it's a sudden cardiac death, you're not really going to be able to see on autopsy exactly what happened at the time of death. Of course, some people are going to have underlying medical problems that they don't even know about that could be seen.
05:25
But generally, if someone dies and they have a history of, let's say, high blood pressure, diabetes, congestive heart failure, and they're followed by a doctor on a regular basis, we're not going to do an autopsy just because most likely that person died of one or more of those medical conditions.
05:50
So as long as we rule out suicide, homicide, and all those unnatural causes of death, we're not going to go in and do a full autopsy on an 85-year-old who has been going to the doctor for the last 50 years and that doctor has documentation of several medical issues and they're on a lot of medications.
06:16
Obviously, the chances are something that they have been diagnosed with in the past has caused their health to continue to decline to the point that they pass away, sometimes at a young age or sometimes when they're older.
06:30
But I know I've had friends call me sometimes and they'll ask me, should I have an autopsy done when one of their family members passes away and the medical examiner chooses not to do it? And I guess my answer to them is always, do you want to go through that when you may still not get an answer?
06:51
I highly encourage it if you suspect something, suspect something like an overdose that wasn't reported to our office after the fact, because a lot of times the autopsy can help if you do discover that there is some suspicion after we do our investigation.
07:14
So the autopsy is going to actually exclude any alternative cause of death. So the five manners of death are going to be natural, accident, suicide, homicide, and in many cases the cause of death may be undetermined because it's really difficult to tell, possibly because the person is decomposed or there's just not enough evidence to really lead the doctors to determine the actual cause.
07:46
But in many times the autopsy is really the only way to determine the information. There are also issues, especially since the recent pandemic, that if they believe that the death is a significant public health concern.
08:03
Like a threatening infectious disease or if someone who's not under medical care. So if it's a violent death, whether it be by homicide, suicide or accident, if it's sudden or unexpected and there's no disease process or illness reported in the past.
08:27
Of course, if there are suspicious circumstances, then those are gonna require further investigation and most likely autopsy, employment related accident. Of course, like I said before, deaths from diseases that can cause a public health risk or threat.
08:48
We also, and I'm sure all offices do, actually investigate if cremation is requested. Because we want to make sure, if it's a death that doesn't have to be reported to our office, or even if it's one that was reported to our office, that there are absolutely no signs of foul play and no reason for the doctor to look at the body, before we allow that cremation to take place. Because obviously once it does there's absolutely no chance for an autopsy and we do need to make sure that nothing was overlooked.
When a cremation is requested all of those requests are reviewed by our office, as I'm sure they are all offices, just to make sure that there's no foul play there's no need for toxicology. That no falls took place, and the death couldn't have possibly been an accident. All those are also investigated, not always like I said, by autopsy, but many times we may get a death certificate sent to us by a funeral home along with the request for a cremation. And then the death certificate will say subdural hematoma due to fall. And if that death wasn't reported to us, we have to call the agency where the sedent was and get some more information, because if that is in fact the reason for death, then we need to do further investigation. Because it's probably an accident, versus a natural death.
There are a lot of reasons to do an autopsy and there are many many reasons not to. All states are different. And particularly in Texas, and in a lot of our small towns, there is a justice of the peace, and they can actually determine the cause and manner and sign the death certificate. However, if they are unsure or there's any suspicion, they do have the ability to send those decedents to a nearby medical examiner's office and have them autopsied, or at least have further exam done, so that the pathologist, who is medically trained, can actually determine the cause and manner of death.
11:14
Of course during an autopsy they're gonna do a visual exam of the entire body that includes the organs and the internal structures and then like I said before they may do some different testing of the organs fluids and tissues.
11:32
Many times all the organs are removed for examination, they're weighed and they also sometimes take a section that's preserved for processing and then they will do microscopic slides so that they can really look at those organs closely those sections.
11:51
X-rays can be done. They will do an examination of the brain in many cases, but not all. And then the doctor's gonna actually initiate the autopsy report. And of course, that report is always available for families to get copies of.
12:09
Now, like I said, if there's no cause of death found, it's gonna be ruled undetermined because that means that the pathologist has done the exam and is unable to determine the actual cause and manner of death.
12:24
And in those cases, those are ruled undetermined. That happens a lot if we find, let's say, a human bone. If it can ever be identified, that person's death will most likely be ruled undetermined, especially if we are missing certain parts of the body where the doctor's unable to do the examination.
12:50
And of course, we don't have the skull. We can't see if there is possibly a defect of any kind in the skull indicating that the person was struck in the head or shot. So in those cases, there may not be enough evidence for the doctor to really say without a doubt 100% that that person died of homicide or suicide.
13:14
Of course, if you just have one bone, you don't have any way at all of knowing exactly what happened to that person. They may have drowned, of course, at which time the bones not gonna really show you anything, they may have been shot in the head and you don't have the skull to do that examination to determine anything about the death and what happened and what caused it and where it happened.
13:38
So there are cases occasionally where bones are found and sometimes there may be just one, there may be a skull, there may be an arm. And in those cases, there's just not enough evidence for the doctor to put together a true cause and manner of death.
13:56
And so they may make those cases undetermined. The absolute best way to avoid an autopsy would be, now, while you're living, go to a doctor and establish your medical care with one particular doctor.
14:16
Go yearly for physicals, have lab work done. If you do have a medical problem, get it diagnosed. Take the medications if they're necessary. And then if something does happen and we come to investigate, your family is going to know who your doctor is, pretty much when the last time you went was.
14:40
And because we are exempt from HIPAA, we are able to contact that physician. And they're going to give us a copy of your medical records, which means we can review those and... we can look to see what you've been diagnosed with in the past, what medications you're on, and it makes it a lot easier for us to say, okay, this person has been ill or this person has been diagnosed with diabetes.
15:04
Maybe your doctor documented that you weren't compliant with your insulin. That is significant because you know, it may be an issue with your diabetes that caused the death. So the absolute best way to avoid it would be to seek medical care, often if you have an issue and go to the same physician.
15:27
And of course, if you're ever referred to a specialist by that physician, they're going to have documentation as to who they sent you to for further testing or whatnot. And then we will know which other doctors you went to and we can also go to those doctors and request information.
15:47
So that will help our doctors or our investigators determine that your death was most likely natural related to those issues. But the problem that we have a lot is that many people don't have insurance and they're unable to go to the physician when they have a medical problem because they can't afford medical care.
16:09
I hate that more than anything because I know in the past when I did home health, I would go see some of my little patients and they would have really high blood pressure. I would ask them, you know, what's been going on?
16:23
Why is your blood pressure so high? Are you taking your medications like they're supposed to? I know that I had one client who actually sold all of his tools out of his garage to buy his medications and then the following month he didn't have any source of income.
16:42
So he was unable to take his medications and home health was hard for me because honestly, if someone can't afford their blood pressure, medication and I go visit them at home and their blood pressure is 200 over 110, guess what?
16:59
This nurse is going to CVS and I'm picking up that Metoprolol, I'm picking up that Lecenapril, I'm buying your medications, I'm not going to let you sit there with high blood pressure because you can't afford the medications.
17:13
I think it's so sad and it happens a lot. But many people don't have insurance and we hate to see that because in many, many cases, a lot of medical problems can be controlled if someone just took the prescribed medications.
17:27
So if you have questions about autopsies, how they're performed, whether or not they should be performed, always feel free to email me. My email address is julie at pushinguplilies.com. I'm always available for questioning and if I don't have the answers, I will find someone who does.
17:49
Thank you so much for joining me today on Pushing Up Lilies. If you like this podcast and would like to share with others, please do me a quick favor and leave a review on Apple Podcast. This helps to make the podcast more visible to the public.
18:03
Thanks again for spending your time with me, and be sure to visit me at PushingUpLilies.com for merchandise and past episodes.