REPORT ON

EXHUMATION AND AUTOPSY

EXHUMATION
Definition

Exhumation or Disinterment is the digging up of a buried body. It is generally sacrilege

or taboo by most cultures that bury their dead. In the Philippines, it is allowed only:

1. When the court orders the exhumation of the dead for the proper administration of
justice
2. Whenever the Solicitor General, provincial or city fiscal as authorized by laws,
deem it necessary for the purposes of determining the cause of death
3. Whenever the nearest kin requests in writing to the authorities for the purpose of
ascertaining the cause of death.

Is burial necessary?

No. It is not necessary as a public heath requirement. In fact, the WHO advises that only
corpses carrying an infectious disease strictly require burial.

Decomposition

Starts after 24 hours. The rate of decomposition is one week in open air equals two weeks
in water, equals eight weeks underground.

Why bury the dead?

Among the many reasons include, respect for the physical remains, to serve as an attempt
to bring closure to the family and friends and on a cultural note, it is believed to be a necessary
step to achieve eternal life

Burial Ceremonies or Processes

Generally involves embalming, a practice of preserving a body against decay.

Mummification is an extensive method of embalming.

Wrapped in a shroud or a coffin. These containers slow the decomposition process by

blocking bacteria and organisms that feed on the decaying body.

Premature burial
 Intentional burying as a form of torture, murder or execution. May also be voluntarily
done as a means to commit suicide or to escape.

Accidental burying happens in natural disasters or when a person is believed to be dead.

Premature burial leads to death as a result of asphyxiation, dehydration, starvation or
exposure. Normally, loss of consciousness takes place within 2 to 4 minutes and death by
asphyxia within 5 to 15 minutes. Permanent brain damage occurs after a few minutes even if the
person is rescued alive.

Trivia: Irrational fear of being buried alive is called taphephobia.

BURIAL SANITATION
Governing law is Presidential Decree No. 856 (Sanitation Code of the Philippines)

Burial Grounds Requirements (Section 90)

1. burial shall be allowed only in places authorized by law

2. at least 25 meters distant from any dwelling house and no house shall be
constructed within the same distance
3. no burial grounds shall be located within 50 meters from either side of a river
or any source of water supply.

Burial requirements (Section 91)

1. Death Certificate
2. Shipment of remains abroad shall be governed by the rules and regulations of the
Bureau of Quarantine
3. Graves shall be at least one and one-half meters deep and filled well and firmly
4. Cost borne by the nearest kin
5. Burial in the city or municipality shall not be prohibited on account of race,
nationality, religion or political persuasion

*should the person issuing a certificate of death has reasons to suspect that the cause of
death was due to violence or crime, he or she has the duty to notify the local authorities. No
burial shall be permitted unless permission is obtained from the provincial or city prosecutor, or
in their absence, by any government official authorized by law.

* Burial should take place within 48 hours after death except if required to be postponed
by legal investigation or when local health authority permits the same

*If death is a result of communicable disease, burial must be done 12 hours after death
and remains cannot be taken to any place of public assembly
 *In both cases disinterment may be permitted within a shorter time subject to the
approval of the Regional Health Director or his representative. But in all cases of disinterment,
remains must be disinfected and placed in a durable and sealed container prior to final disposal

Licensing and Registration of undertakes and embalmers (Sec. 94)

License can be issued to any person who desires to practice undertaking or embalming
must pass an examination. Limitations or restrictions are as follows:

1. Licensed undertakers or embalmers practice is governed by the requirements of

the DOH
2. Licenses must be displayed conspicuously in the workplace.
3. Licensees must apply annually for registration certificate and must pay annual
registration fee of 25 pesos to the Regional Health Office
4. Certificates for first registration cover the period from its issuance to the last day
of the current year. Subsequent certificates shall bear the date January 1, and shall
expire December 31 of the same year

Except that Government and private physicians may perform embalming without a
license and registration certificates as exigencies require.

Who has the authority to perform autopsies and dissection of remains (Sec. 95)

1. Health officers
2. Medical officers of law enforcement agencies; and
3. Members of the medical staff of accredited hospitals

Autopsies performed only in the following cases:

1. Whenever required by special law

2. Upon orders of a court, a mayor and a provincial or city prosecutor
3. Upon written request of police authorities
4. Whenever the Solicitor General, provincial or city prosecutors as authorized by
law deems it necessary to determine the cause of death
5. When the nearest kin requests in writing from the authorities to perform the same

Autopsies can be performed in the hospital where the patient died provided:

1. The hospital director notifies the next of kin of the death and after making a
request for permission to perform the same
2. Permission is granted or no objection was raised within 48 hours after death
3. Permission is, however, granted by local heath authority when the deceased has
no next of kin
4. After the autopsy, remains shall be interred in accordance with the sanitation
code.
Donation of Human Organs (Sec. 96)

Qualified donors: Any person may donate an organ or any part of the body to a person, a
physician, a scientist, a hospital or a scientific institution upon his or her death for transplant,
medical, or research purposes.

Limitations:

1. Donation must be in writing and signed by the donor specifying the recipient, the
organ or part of the body to be donated and the purpose for which it will be
utilized
2. For married persons, donation needs no consent of the spouse
3. After the death, the next of kin may authorize the donation
4. If no next of kin and the remains are in the custody of an accredited hospital, the
Director of such hospital may donate
5. A simple written authorization signed by the donor in the presence of two
witnesses is sufficient. A copy of the authorization shall be forwarded to the DOH
Secretary
6. Any authorization is binding on the executors administrators and members of the
family of the deceased

Use of Remains (Sec 97)

Unclaimed remains may be used by medical schools and scientific institutions for studies
and research

Handling of Cadavers (Sec 98)

Cadavers containing traces of radioactive isotopes do not require special handling

precautions. Those with large amounts of isotopes should be labeled properly identifying the
type and amount of radioactive materials present and the date of its administration. Prior to the
autopsy, the Radiation Health Officer or duly authorized representative should be notified for
proper advice. Embalmers and pathologists should also be warned of the radioactivity of the
cadaver.

Normal burial procedures may be carried out provided the radioactivity level has become
safe as determined by the Radiation Health Officer. Cremation needs no special handling except
if autopsies are performed to prevent any possible concentration of radioactivity at the base of
the stack of crematorium

Responsibilities of the Regional Heath Director (Sec 99)

1. Act on applications for the establishment of burial grounds; and

2. Close any burial ground which is a menace to public health.

Responsibility of Local Health Authority (Sec 100)

 1. Administer city or municipal cemeteries
2. Issue permits to inter, disinter or transfer remains,
3. Apply prescribed measures when cause of death is due to a dangerous
communicable disease
4. Keep records of death occurring within his area of jurisdiction
5. Authorize the delivery of unclaimed remains to medical schools and scientific
institutions for purposes specified in this Chapter and in accordance with the
rules and regulations of the Department.

Responsibility of Local Government

1. Reserve appropriate land for cemeteries

2. Utilize grants, gifts bequests of property or financial donations for the
establishment or improvement of cemeteries
3. Close cemeteries subject to the approval of the Regional Health Director

AUTOPSY
Also known as post mortem examination. It is a medical procedure that consists of a
thorough examination of a corpse to determine the cause and manner of death.

History

Term is derived from the Greek word autopsia, or to see for oneself, derived from
(autos) oneself and (opsis, eye). Ancient Egyptians were the first to practice the
removal and examination of the human internal organs as part of the mummification process. As
early as the third millennium BC, autopsies have been attested. Ancient cultures, however
believed that the outward disfigurement of dead persons prevented them from entering the
afterlife.

In Greece, notable Greek autopsists were Erasistratus and Herophilus of Chalcedon. The
Romans too had a share in the history of autopsy. In 44 BC, Roman Emperor Julius Caesar was
autopsied after being murdered by senators. In the physicians report, the second stab wound
Caesar received was the fatal one. By 150 BC, Ancient Roman legal practice established clear
parameters for autopsies.

Dissection for medical reasons continued to be practiced also by the Arabs as exemplified
by physicians Avenzoar and Ibn-al-Nafis. The modern autopsy process was, however, derived,
from the anatomists of the Renaissance. The likes of Giovanni Morgagni, who is also considered
as the father of anatomical pathology, wrote the first exhaustive work on pathology, De Sedibus
et Causis Morborum per Anatomen Indagatis (The Seats and Causes of Diseases Investigated by
Anatomy, 1769)
 In the 19th century, medical research has Rudolf Virchow and Car von Rokitansky built
on the Renaissance legacy, to derive the two distinct autopsy techniques.

Purpose

The principal aim is to determine the cause of death, the state of health of the person
before dying and whether any medical diagnosis and treatment before death was appropriate.

In medicine, autopsies help identify medical error and assist in the continuous
improvement of services. Studies suggest that approximately one third of death certificates are
incorrect and that half of the autopsies performed produced findings that were not suspected
before the person died. Missed diagnosis can thus be determined through autopsy.

Types

Forensic or coroners autopsies seek to find the cause and manner of death and to identify
the decedent. They are generally performed, as prescribed by applicable law, in cases of violent,
suspicious or sudden deaths, deaths without medical assistance or during surgical procedures.
(Natural, Accident, Murder, Homicide, Suicide, Undetermined)

Clinical or academic autopsies are performed for research purposes. They aim to
determine, clarify or confirm medical diagnoses that remained unknown or unclear prior to the
patients death.

The procedure starts with the receipt of the body wrapped in a brand new body bag or a
sterile evidence sheet. Toxicology, biochemical tests and/or generic testing are also
supplemented. It includes an external examination which would involve taking photographs,
examination of the clothes and on how they are positioned on the body, taking of samples of
hair, nails, and in some instances radiographically images are taken. This part is conducted by an
Anatomical Pathology Technician. After which, internal examination is initiated. It starts with
making incisions, either Y shaped or T shaped. Thereafter, the chest cavity is opened normally
through the use of an electric saw. Once organs are exposed, they are removed in a systematic
fashion. The removal can be either using the en masse technique of Dr. Letulle, whereby all
organs are removed as one large mass, or through the en bloc method of Dr. Ghon. Physicians
prefer removing the organs all in one block. With respect to the inspection of the brain, the
process requires first that the said organ be preserved in a large container of formalin for at least
two to four weeks.

Last Step of the Autopsy is the Reconstitution of the body. IN the UK, all organs and
tissue must be returned to the body unless permitted by the family.