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Coroners and Justice Bill

A number of crucial principles arise here. In the investigation of an unforeseen or totally unexpected death, the performance of a post-mortem examination is crucial. Admittedly, the use of imaging techniques by radiologists and the use of magnetic resonance imaging and X-rays play an important part, but they can never themselves substitute for a full and complete post-mortem examination. I suppose that I must declare an interest: although I am not a pathologist, I did some training in neuropathology in the Massachusetts General Hospital in Boston back in the 1950s. The Human Tissue Act, which was very fully debated in this House, arose as a result of what was called the Alder Hey scandal. A large number of human organs had been retained in the Alder Hey hospital and the great majority, if not all, of the families of the patients concerned said that they had not given consent for those organs to be retained. What many people in the profession, and particularly in the public at large, did not recognise is that, when a post-mortem is performed, organs are examined. You can identify without difficulty someone who has been killed by a bullet, someone who has been killed by a knife wound and sometimes someone who has been killed by direct trauma to the head. There are situations, however, which are extremely complex. We all know about the so-called paper-thin skull syndrome, where an individual suffering a minor head injury as a result of trauma subsequently dies and it turns out that the X-rays demonstrate that the individual had a skull that was so thin that even a minor injury could have produced serious underlying brain damage. There have been cases in which trauma to the chest has led to a person being accused of murder, but when a post-mortem was carried out it was discovered that the individual had had a heart attack due to natural causes or had had an inflammatory condition of the heart—a cardiac inflammation—which might well have been the primary cause of death. What people did not recognise after the Alder Hey situation was that, when the organs are taken out and examined by the pathologist during a post-mortem, however skilled the forensic pathologist, it is hardly ever possible—except in the most extreme circumstances—for the diagnosis of the cause of death to be made simply by inspection of the organs. The organs have to be retained. They have to be fixed in formalin over a period of two or three weeks. They then have to be subject to careful anatomical dissection, followed by examination of tissue sections under the microscope, before a diagnosis can ever be reached. This is particularly true in the field of neuropathology. It is just not the case that you can make a diagnosis simply by inspecting organs removed from a body at post-mortem. The organs must be retained. After coroners’ post-mortems, as indicated by the argument put forward so lucidly by my noble friend Baroness Finlay, there is a strong case to be made for retention. Before the Human Tissue Act, it is true that many pathologists—not necessarily in the coroner situation—would carry out a post-mortem examination and would not specifically, at that time, ask for permission for the organs to be retained. Perhaps they assumed knowledge on the part of relatives that those relatives did not possess; the relatives did not always recognise that the organs had to be retained, fixed and examined before the diagnosis could be made. Since the Human Tissue Act came into force, the organs retained in post-mortems not carried out for forensic purposes can be retained only with specific permission of the relatives. In the case of coroners’ post-mortems, however, I believe that my noble friend’s case is very powerful, and I hope very much that the Committee will accept Amendment 45. I also confirm her view that such coroners’ post-mortems must be carried out by a pathologist with appropriate forensic training. That is crucial. Otherwise there are likely to be miscarriages of justice. I strongly support her amendment.