Glossary of Terms Used by Pathologists for Cause of Death in Drug Related Cases Version 1.2 (September 2005) Purpose This glossary is provided as a resource for users of the National Coroners Information System (NCIS). It is intended to assist users of the database in the interpretation of pathology reports, particularly those for deaths relating to drugs, poisons or alcohol. The definitions of terms were provided by forensic pathologists around Australia and generally represent their individual professional opinions. As such, more than one interpretation is provided some terms. The definitions provided are not intended to be collectively exhaustive and other interpretations of the term may be relevant. While the glossary is provided to assist NCIS users, you should be aware that a given definition may not reflect the view of a pathologist who reported a particular case. In addition, the list of terms is not intended to include all terms used by pathologists in reporting cause of death in drug related cases. The definitions are in no way intended to be prescriptive to pathologists. The NCIS (previously referred to as MUNCCI) collated this glossary in good faith and assumes no responsibility for the accuracy of the definitions provided. The NCIS and Australian forensic pathologists have made this glossary available for the personal, non-commercial use of NCIS users. The glossary may not be used for any commercial purpose. Further, the glossary may not be used for any legal purpose. The definitions may not be taken from the glossary and reprinted in any form without the express written permission of the NCIS. Acknowledgments This glossary was collated by Natasha Redman, Project Officer – Drugs Module, in March 2001 based on definitions provided by forensic pathologists around Australia. The NCIS wishes to thank all pathologists who contributed to the glossary, in particular: Prof Stephen Cordner, Victorian Institute of Forensic Medicine, VIC Dr Peter Ellis, Institute of Clinical Pathology and Medical Research, NSW Prof Peter Herdson, Consultant Forensic Pathologist, ACT Dr Ross James, Forensic Science Centre, SA Dr Robert Kelsall, Dept of Forensic Pathology, Royal Hobart Hospital, TAS Dr Dianne Little, Institute of Clinical Pathology and Medical Research, NSW Dr Matthew Lynch, Victorian Institute of Forensic Medicine, VIC Dr Charles Naylor, John Tonge Centre, QLD Assoc Prof David Ranson, Victorian Institute of Forensic Medicine, VIC The Role of the Forensic Pathologist by Associate Professor David L Ranson 1 and Natasha C Redman 2 1 Victorian Institute of Forensic Medicine; 2 Monash University National Centre for Coronial Information Today, much of the function of the office of coroners in Australia is focused on prevention, with the coroner empowered to make broad recommendations surrounding the issues of public health and safety and judicial administration. Such an approach gives the coroner a dynamic function in contributing to the welfare of the community. In this modern framework the role of the forensic pathologist has been revitalised. The forensic pathologist is not involved only with the investigation of suspicious deaths that may have a criminal connotation. Rather, the forensic pathologist's role has been widened to include a wide range of natural and unintentional deaths, investigation of which can lead to improvements in the health and safety of the community. In conjunction with the coroner, the forensic pathologist is a watchdog who maintains a constant surveillance on potential fatal hazards in our society and ensures that preventable deaths are recognised and the issues surrounding them addressed. Legal jurisdictions differ in the way they organise death investigation services and the relationship between a coroner and police investigators is at times complex. Some general rules, however, appear to be common. The authority to investigate a death lies with a coroner and it is the coroner who institutes and authorises a pathologist to perform a post-mortem examination. The police have a similar duty to investigate a death and, with respect to certain aspects of the death investigation, they act as agents of investigation for the coroner. In this situation, the forensic pathologist is another co- investigator for the coroner. Traditionally, the forensic pathologist has been considered to be involved solely in the conduct of an autopsy. In practice, however, forensic pathologists play a much wider role. For example, they may become involved in the examination of scenes of death, or, in the case of criminal investigations, in the examination of suspects who may have inflicted injuries on the victim. They may evaluate medical records for both criminal and civil medico-legal purposes, and examine the statements of witnesses with regard to medical matters before a wide variety of tribunals. Despite this varied role, the forensic pathologist’s main task is still the conduct of autopsies for the coroner. The vast majority of autopsies conducted by forensic pathologists involve unconfirmed natural deaths which society requires to be scrutinised and confirmed. The investigation of non-suspicious natural deaths, accidents (fatal incidents), deaths from suicide, deaths from drugs and deaths from other forms of intentional and non-intentional injury form the vast majority of their case work. The information that can be gained from investigating these deaths is potentially very significant for the community. The investigation of suspicious deaths is another vital role of the forensic pathologist. In such cases, they are involved in the compilation of a brief of evidence that may form part of a prosecution within the criminal justice system. In such cases, the forensic pathologist assists with the evaluation and presentation of that evidence both before and during court proceedings, in addition to the other elements of the standard death investigation. One of the responsibilities of the forensic pathologist is to determine issues relating to the cause of death and circumstances of death of individuals. In this context, forensic pathologists have a specific interest in forensic toxicology. Where deaths are apparently the result of toxic substances, a forensic pathologist must collect the appropriate body samples and, together with a forensic toxicologist, arrange for the most appropriate analysis. Toxicological analysis is a routine part of most of forensic autopsies. The toxicologist analyses human tissues for the presence of drugs and other chemical agents that may have been taken into the body. Homicides, suicides and motor vehicle accidents are perhaps the most common cases in which drug analysis is involved. However, there is a wide variety of apparently accidental deaths, including those associated with work and recreation, where toxicology and drug analysis are important in analysing the circumstances of the death. An environment that provides a high level of communication between the disciplines of forensic pathology and forensic toxicology is ideal for the investigation of problematic suspicious deaths. Ultimately, the forensic pathologist must integrate the result of the autopsy and results of toxicology testing together with other laboratory tests to arrive at an overall expert opinion regarding the medical cause of death. Recommended Reading (Brodrick Committee Report.) Cmnd. 4810. Report Of The Committee On Death Certification And Coroners. November 1971. Published by the Home Office in the United Kingdom, London 1971. Busuttil, A. and Jones, J. S. P. Deaths in Major Disasters : The pathologist's role . The Royal College of Pathologists, London 1990. Crowther, M. Anne, and White, Brenda. On Soul and Conscience : The medical expert and crime: 150 years of forensic medicine in Glasgow . Aberdeen University Press, Aberdeen 1988. Gonzalez-Crussi, F. Three Forms Of Sudden Death : And other reflections on the grandeur and misery of the body . Picador, London 1987. Hill, Rolla B; and Anderson, Robert E. The Autopsy : Medical practice and public policy . Butterworths, Boston 1988. Knight, Bernard. Forensic Pathology. Edward Arnold, London 1991. Plueckhahn, V. D. and Cordner, S. M. Ethics, Legal Medicine & Forensic Pathology . 2nd Edition. Melbourne University Press, Melbourne 1991. Selby, Hugh. (ed.). The Aftermath of Death: Coronials. Federation Press, Leichhardt, NSW, 1992. Spitz, Werner U. (ed.) and Fisher, Russell S. Spitz And Fisher's Medicolegal Investigation Of Death: Guidelines for the application of pathology to crime investigation. Charles C. Thomas, Springfield, Ill. 1993. A ABUSE (eg. alcohol, ethanol, cigarettes, tobacco, drug, specific drug) To take a drug for non-therapeutic reasons; Non-therapeutic use; The excessive use of drugs without regard for health and wellbeing; Use of an illicit substance or overuse of a licit substance; May be used when there is a background of “abuse” but no significant toxicity. ACUTE ABUSE (eg. intravenous morphine) Acute toxicity / non-therapeutic use; The taking of a single dose of a drug without regard to health or wellbeing; Recent abuse (no evidence of chronic abuse). CHRONIC ABUSE (eg. alcohol, drug) Long term use of an agent resulting in a deleterious effect; To take a drug non-therapeutically over a long period of time; Long term non-therapeutic use; Long term excessive use of drugs without regard for health and wellbeing; Longstanding abuse. ABUSER One who uses a certain drug; Somebody who uses drugs to an extent that it could affect their health and wellbeing.