Legal framework to improve autopsy procedures in mexico

Introduction

We find that the increase and diversity of causes of death, whether natural or violent, are directly related to medical-legal nuances, since these require a very detailed and specific study that really contributes to the total investigation.

Based on the above, we must remember that omissions in the technical procedure, most of the time generate errors in the conclusions and the impossibility of preparing other types of essential technical opinions.

Nowadays it is mentioned that it is important and vital for the institutions that carry out activities in the field of Forensic or Legal Medicine, to unify the criteria, adhering to international quality guidelines and standards, however, it should be considered that said activities related to the The practice of medico-legal autopsy studies is limited, since at present there are different factors, be they cultural, social, economic, political, legal and even religious that make it difficult to carry out all the internationally recommended activities; For example, the foregoing is the fact that the expert does not go to the site of the event; In this sense, it is worth mentioning that although the forensic doctor may not be present at the scene,It is your obligation to get hold of all those informative documents available and that may be within your reach; Through the procedures or actions that are drawn up by experts specialized in their disciplines or ministerial authorities, the possibility of obtaining all those photographs taken by participating personnel of the Attorney General's Office or those responsible for taking them should be considered.

Based on the above, it is important to have legislation that regulates the legal aspects that in turn allow the study, improvement and development of the medical and scientific techniques of the Medical Legal Necropsy, since we find that its performance is not always completely correct, with the above, there would be a standardization and unification of techniques at the national level, but also at the international level, since the autopsy is of the utmost importance to determine the cause of death, its origin, that is, if it was accident, suicide or homicide, among others, that is why the doctors or scientists in charge of carrying it out, must do it in the best possible way to be able to find the answers that are expected to be found or are going to be tested.

objective

The objective that we seek with the present investigation is to be able to investigate and analyze what refers to the legal medical necropsy, its correct performance; We seek to be able to define and propose an adequate surgical technique to carry out the necropsy, by a trained doctor or specialized scientist; It seeks to make a small comparison of the performance of the necropsy, its techniques, its regulation, among Latin American countries. It seeks to establish and mention the guidelines and technical criteria required for the performance of necropsy studies, in order to define or propose the creation of a document that unifies and regulates the essential elements to be followed by experts, doctors or scientists forensics during your practice.

Development of the theme

I. Background

Concept of Legal Medicine: They are the medical knowledge that is applied to assist in the Procurement, Administration and Administration of Justice.

Talking about Medical-Legal Necropsy makes us enter into a debate, since it is a very broad topic that covers certain and certain criteria that are important for its understanding and study, in the same way it is important to mention that it is not a very recent topic.

II. Historical background

Egypt, the first known expert on the subject is IMHOTEP, who lived approximately 3000 BC was high judicial authority of King Djoser and architect of the great pyramid of Sakkara. Egyptian medicine at this time was socialized, the state paid doctors for their services and professional errors were punished.

Assyria and Babylon, the Code of Hammurabi (1700 BC) and the code of medicine and law, in the first one is the medical, civil and criminal jurisprudence, as well as the punishments that were applied for acts of negligence, and even the responsible's hands were even mutilated.

Hebrews, contributed the idea of a "unique God" in its divine origin, diseases are a punishment for man's faults, in mystical principle circumcisions, caesarean sections and bleeding were practiced.

China, the use of opium was allowed as a therapeutic resource, children were castrated to comply with certain religious rites, doctors practiced acupuncture that consists of the puncture with needles of different metals and in different parts of the human body, (Emperor Shen -Nung 2800 BC).

India, Suscruta, began teaching medicine and surgery, liquor was administered as anesthesia, the disciples had to renounce carnal pleasures, cruelty, anger, greed, ignorance, laziness, envy, revenge, pride, etc. known as a “Hippocratic oath” that are norms to guide medical ethics, Galen, developed the maximum of his ability in Rome.

Rome, a classical culture that has stood out for the advances of its time with the design of laws and the application of law, as well as the regulation of medical practice. Numa Pompilio, indicated the medical examination to pregnant women who died. The Roman emperor promulgated the "Aquilia Law", which held doctors responsible for professional negligence and imposed an exemplary punishment on them, the "Cornelia Law" prohibited abortion, and a registry and surveillance of prostitutes was exercised.

Middle Ages, the Greek heritage is preserved and transmitted mainly by the translations of the Arabs, who also complete some aspects. Innocent III demands that doctors with a court order visit the war-wounded and sick.

Renaissance, Leonardo da Vince (anatomist-sculptor), drew the heart and its great vessels, William Harvey, discovered the blood circulation, Andrés Vesalio, dissected in stolen corpses of executed (activity prohibited and punishable by law) and was able to with his experiences correcting mistakes of Galen, Miguel Servet, was burned alive at the stake for dissecting with corpses, Pablo Zachia, practiced and described the hydrostatic pulmonary docimasias and wrote his work "Medical-legal questions", Ambrosio Pare, born in Laval France in 1510, He practiced as "Barbier Chirugucen" at the Hotel Dieu, in 1536 he enlisted in the army of Francisco I, and accompanied him in Piedmont, for being self-taught he was despised by the medical surgeons, however on his own merits he became an expert,Being then appointed chief surgeon of Francisco II, in the battle of Turin, he substituted the boiling oil for the essences of roses and egg yolk to wash the wounds and promote their healing, Pare was also appointed surgeon of Henry II, who died in His hands when he was wounded by a spear in the eye, being judged as a regicide, but acquitted for his human and scientific quality, he also obtained the title of surgeon in chief of the armies of France with King Charles IX, he treated syphilis with mercury He used to tie broken blood vessels instead of cauterizing them during amputations, saying “I sell them and God heals them”, he also perfected some obstetric techniques and died in 1590.I substitute the boiling oil for the essences of roses and egg yolk to wash the wounds and promote their healing, Pare was also appointed surgeon of Henry II, who died in his hands when he was wounded by a spear in the eye, being judged as a regicide, but acquitted for his human and scientific quality, he also obtained the title of surgeon in chief of the armies of France under King Charles IX, treated syphilis with mercury, ligated broken blood vessels instead of cauterizing them during amputations, saying “ I sell them and God heals them ”, he also perfected some obstetric techniques and he died in 1590.I substitute the boiling oil for the essences of roses and egg yolk to wash the wounds and promote their healing, Pare was also appointed surgeon of Henry II, who died in his hands when he was wounded by a spear in the eye, being judged as a regicide, but acquitted for his human and scientific quality, he also obtained the title of surgeon in chief of the armies of France under King Charles IX, treated syphilis with mercury, ligated broken blood vessels instead of cauterizing them during amputations, saying “ I sell them and God heals them ”, he also perfected some obstetric techniques and he died in 1590.but acquitted for his human and scientific quality, he also obtained the title of surgeon in chief of the armies of France under King Charles IX, treated syphilis with mercury, ligated broken blood vessels instead of cauterizing them during amputations, saying "I I sell them and God heals them ”, he also perfected some obstetric techniques and died in 1590.but acquitted for his human and scientific quality, he also obtained the title of chief surgeon of the armies of France with King Charles IX, treated syphilis with mercury, ligated broken blood vessels instead of cauterizing them during amputations, saying “I I sell them and God heals them ”, he also perfected some obstetric techniques and died in 1590.

Modern and Contemporary legal medicine, the application of justice began to be illustrated more seriously with the appearance and assistance of Orfilia, Devergie, Tardieu, Brouardel, Pirogroff, Lombrosso, Vucetich, Bertillon, Vivert, Thoinot, Laccasagne, Bernard, Lister, Leevwenhoek, Teichman, among others and that they also give it a scientific basis.

Legal medicine in Mexico

During the conquest and the colony it was a dark time for medicine and law, influenced by magic and diabolical possessions, they applied provisions of the "Holy Inquisition".

It was not until 1833 that the establishment of medical sciences was founded, the creation of the chair of legal medicine was also achieved, the first holder being Don Agustín de Arellano, later Don Luis Hidalgo y Carpio, (recognized as a forerunner), who apart from writing the first literary work of legal medicine, collaborated with the integration of the Penal Code promulgated by Lic. Benito Juárez, his definition of injury is still in force today, he was also concerned about the correct classification of the Injuries, I contribute important ideas to base medical responsibility and professional secrecy.

Other doctors who have earned special mentions in their performance are: José Torres Torija, Alfonso Quiroz Cuarón, Rafael Moreno González, Luis Rodríguez Manzanera, Ramón Fernández Pérez, Mario Rivas Souza, among others.

The development of legal medicine has been slow, due to factors such as the economy and the little interest that the "New Doctors" have for this professional discipline and they believe that just being doctors will do a good role as legal experts., which constitutes an error, because it is quite true that: The forensic doctor does not improvise, but he acquires his knowledge through years of practice, patience and constant preparation. In addition, the lack of appropriate, dignified and functional premises, as well as the low salaries applied, coupled with the responsibility they acquire in their knowledge through years of practice, patience and constant preparation.

In addition, the lack of appropriate, dignified and functional premises, as well as the reduced salaries applied, coupled with the responsibility they acquire in their opinions, make those who have a certain sympathy or interest in this noble medical specialty move away.

We found that they began to talk about the obligatory nature of the necropsy and its assessment in the year 1220 within the Code of Sachsenspuegel, a document with which forensic medicine officially begins. With the passage of time and during Renaissance times, it was obliged that, in cases of infanticide and homicide, an inspection of the corpse was made and a written protocol was carried out.

That is why the medico-legal autopsy set itself a well-defined objective for some time: to find the cause of death.

It is worth mentioning the work of Ambrosio Paré, a French surgeon, who described in great detail the injuries caused by firearms, by sword, submersion, hangings, he tried to understand how poisons influenced the different organs of the body.

Later the Italian Turin Pablo Zacchias, wrote his work called "Medical - Legal Issues", it dealt with issues of abortion, murder, injuries, poisonings and rapes.

As an important and relevant piece of information, directly related to the objective of this study, we find that the Italian Juan Codronchi affirmed that doctors should be called to carry out expert opinions on the causes of injuries and death.

We found that over time scientists began to study the causes of death, the effects of objects produced in the body, injuries and patterns caused by violent agents on the body, this with the passage of time evolved and changed. Scientists made their discoveries and were contributing studies to legal medicine, the autopsy we find that it arises from very remote times. At first it was done for research purposes in relation to injuries or effects that occurred in the body, today we find that it is done to verify the causes of death, since, although the cause of death is evident, The medical legal necropsy must be performed to verify the aforementioned.

What is a necropsy?

We found that in practice or common use the terms “Autopsy and Necropsy” are used, from my point of view, this has caused some confusion, however, I would like to present the following observations:

“Auto” is a prefix of Greek origin that will mean “own” or “by itself.” “Necro” will refer to “dead” or “corpse” Psae, Greek prefix that refers to “sight” or "exam"

Once the above has been explained, we can deduce that when we refer to autopsy we are referring to seeing or examining oneself, on the other hand, and from my opinion, the term NECROPSY is more accepted, since etymologically it means “to see or examine what dead or a corpse ”.

That is why, in my opinion, the term necropsy should be used to refer to the specialized and instrumental technical procedure, through which the causes of death will be studied.

It is important to mention and remember that in Mexico there are three types of autopsies, the first is aimed at scientific research regarding the development, manifestations or effects of diseases and their treatments, this is known as a medical autopsy; the second is aimed at practice within medical schools, focused on the scientific training of the medical student in anatomical and surgical disciplines, this is the so-called didactic necropsy; the third and last is the one that concerns us as students of legal medicine, the medical legal necropsy, which requires an order issued by a competent authority, and which will be in charge of determining the causes that caused death.

Medical-legal necropsy:

As a first important point, we can mention that the medical-legal necropsy must be carried out within a rigorous order and fundamentally complying with the principles of medical ethics indicated in the Istanbul Protocol.

The medical legal necropsy can be of three forms, the first is the early medical legal necropsy, which must be performed as soon as possible after death, this with avoiding the phenomenon of autolysis that progressively alters the organs and provides expiration to certain supplemental exams.

We also find the methodological medical legal necropsy, which is aimed at the fact that the necropsy must be complete and systematic, each of the organs will be examined in principle within its anatomical environment and later in isolation and everything must be duly documented. Finally, we can observe the complete medical-legal necropsy, which is a unique act that should not be repeated, except in very special cases.

It is in this part of the work, we reach the key point of the present essay, we reach the climax on which this investigation is about.

In Mexico we find that the necropsy must be carried out by a doctor who specializes in legal medicine and who maintains a regular practice, must be updated both technically and scientifically, the necropsy is carried out under a strict and rigorous protocol, with an adequate technical plan.

First, the external recognition will be carried out, which consists of the anthropometric identification, consisting of weight, height, sex, race, complete half parentage and particular signs, followed by an external examination of the corpse, the examination of natural orifices, examination of hands and nails.

The opening of the cavities continues, starting with a pubic incision, the organs that are inside the thoracic and abdominal cavity will be examined, a detailed study of organs and viscera will be made, the cranial box must be reviewed, by means of a incision made behind the head from right ear to left ear, to remove the brain.

The skeleton, skull, spine, pelvis, limbs, etc. are examined. All of the above must be done in an orderly, careful and detailed manner, as well as, there must be complete sanitation and sterilization of materials.

Let us remember that you can have the help of special techniques such as radiography, in order to find or identify firearm projectiles, especially when the corpse is in decomposition or charred; to identify fractures and their evolution and, in the case of unidentified cadavers, to determine bone age or visualize a prosthesis.

It is worth mentioning that the Medical Legal Necropsy, in Mexico, must be carried out in accordance with medical ethics and respecting the dignity of the deceased, the date, start and end time must be noted, as well as the place of the study, it must be performed by a doctor and his assistants, who must have medical and practical knowledge about the performance, currently making use of technology, the entire necropsy procedure is video-recorded and in addition to the traditional ones such as photographically fixing the relevant aspects, The result of which is recorded in a "NECROPSY PROTOCOL" which concludes with an opinion or report, which is a document that is issued in response to the order issued by the Agent of the Public Ministry, within the Preliminary Inquiry, in addition to check cause of death.

Medical autopsy - comparative legal

It is from the above, where a comparative study is made in relation to the medicolegal autopsies carried out in different countries, this comparison is the one about this brief investigation.

In Mexico, the person in charge of performing the medico-legal necropsy must be a forensic medical expert, who must be aware of the importance of the necropsy procedure, and must take special care in cases where there is suspicion of torture, cruel and degrading treatment, he must note at all times the conditions of the necropsy practice, if they were suitable or if there was an incident that prevented the optimal development of the investigation, it must be conducted at all times in an objective, professional, impartial and supported with scientific bases so that their intervention is in the best possible and effective way.

In particular, the capital of the Country, being the main development center, presents the most advanced in terms of regulation in the theory and talk of a necropsy as it has a Manual of Procedures of the Forensic Medical Service as of February 25, 2010 approved by the Superior Court of Justice of the Federal District and the Council of the Judiciary, but nevertheless this is limited to the scope of the Capital, finding the disparity with the other states of the Republic, since this Manual for being the most complete in theory and practice of necropsy, may be elevated as a Regulation at the same time as the promulgation of the respective Law.

In countries like Colombia, in addition to the doctor and assistant, a person who is an expert in video recording and photography must be present, as well as an expert in biology to help the doctor-practitioner who performs the necropsy (The doctor who performs the necropsy must be expert in Pathology). In Chile and Argentina a pharmaceutical chemist must be in the same way. In some other countries, such as Honduras and Peru, it is the police officer who is in charge of narrating what is being done at the autopsy and sometimes participates in it in a practical way.

We found another comparison that, despite not being very important, it is necessary to mention it, in Mexico an incision is made that goes from the submental region to the symphysis pubis, and the cranial incision goes behind the ears from right to left. In Latin American countries such as Colombia and Argentina, we find that the thoracic-abdominal incision is in the shape of a "Y", and we find in the same way that in Chile and Colombia some doctors may choose to make the cranial incision in the forehead, which causes injuries. and disfigurement of the face of the corpse, said injuries threaten the integrity, respect and care of the corpse or deceased.

In Argentina, allusion is made that the person in charge of performing the necropsy is the Medical Examiner, assisted by an assistant and this only has to prove or verify that he has enough experience to perform it, while in Mexico and Colombia, he must verify that he has The experience and regular updating in their field, that is, they must be Medical Experts, accredited by an Institution, with a License to perform them, in Argentina it is enough to verify that they are capable of doing it.

In Argentina you cannot start with the autopsy if the plan to follow has not been drawn up, that is, a technical plan is required and it must be approved by the Public Security Institution in charge.

Another distinction is in relation to the place where the autopsies are carried out, this is in relation to the fact that in the past there was no specific place to carry out the autopsies and they were practiced in the pantheons or in totally contaminated and unsuitable places, such as is the example of Mexico, sometimes we have learned that in theory we were told that they must be specific places, in amphitheaters, aseptic places, but how many of us did not find out that the places where the autopsies were carried out were warehouses or rooms close to cemeteries, or in places close to forensic services, which do not have the necessary health and safety measures.

Let us remember that these are lifeless bodies that are entering a state of putrefaction and that sometimes this process has already begun or is about to end, which can cause diseases and infections.

In the same way, the substances that emanate from the corpse and the odors, can easily come into contact with the outside since there is no place intended for storage, or a specific place to dump these wastes, substances that will be cast by the corpse.

Let us remember that before, when autopsies were carried out in the pantheon, all the blood, waste and substances that resulted from the necropsy came into contact with the public drain and the aroma was perceptible in the streets.

Within the theory we are told that it must be a clean, aseptic place, with enough water and drains other than public ones, adequate ventilation and sufficient lighting, said place in Mexico is called an amphitheater, which will be a physical space where autopsies are performed, they are divided into two rooms, the first for normal corpses and the second for corpses in a state of putrefaction or infectious contagion, it has two areas, one for collecting evidence and washing the corpse and the other for photographic fixation. Similarly, it has two chambers, one for refrigeration and one for freezing, with a capacity for 198 bodies (speaking of the Federal District Amphitheater).

In places like Argentina and Chile, there are places destined for the performance of autopsies, but there is talk of little capacity for the bodies and even does not indicate a distinction of place for normal corpses and for corpses in a state of putrefaction or contagious, in Argentina the Amphitheater is located in the police stations and a commander is in charge of approving the performance of the autopsy.

In Colombia the necropsy has a specific place, which will be divided into three areas, one for the reception of the corpse, a refrigeration chamber and the place where the pathologist will carry out the necropsy process.

In Brazil, autopsies can be performed in Private or Public Hospitals, that is, if people have recognized the corpse, they can pay for the autopsy to be performed by a doctor in a private hospital, or ex officio in a public hospital, in the same way There are Public Forensic Services, for cases in which there is no recognition of the body by a relative or the same is not identified.

Finally, we find another small, but no less important distinction, this is in relation to the material or instruments used by Doctors, we find in the theory that they should be used, necropsy table and auxiliary table, scales, scalpels, scissors, dissection forceps and Kelly pliers, rulers, mechanical or electric saws, explorers, trays, suture needles, scoops, among others, and this is where we realize that sometimes in practice the appropriate instruments are not used.

A video of a necropsy carried out in Colombia circulates on the internet, in which we can see that the incision is not made with any scalpel, but is made with a butcher knife, we find that there is no respect for the corpse and it is not done with Due care, the corpse is very injured and damaged, they cut the ribs with the same knife and not with a small saw or something similar with which it should be made, the cranial incision is made in the forehead and not in a careful way.

In some countries such as Venezuela, Peru and Chile, carpenter's saws are used to make certain incisions or cut some bones, even so when it is pointed out that the appropriate material must be used for the correct treatment of the corpse, it should also be mentioned that those that Participate in the necropsy must have a biosafety clothing or equipment such as a cap, protective glasses, gloves, shoe protectors, gowns, etc., but in the video we can see that the assistant is dressed in a normal way and does not have the measures relevant biosecurity measures.

conclusion

Once we have analyzed, studied and investigated the small variations that occur in medicolegal autopsies in different Latin American countries, we can reach certain conclusions and proposals that would help this practice to be carried out in an adequate and correct way. respectful and unified.

We found that in none of the countries, including Mexico, there is no legislation that regulates the practice of necropsies, we found that there is a technical guide that can be taken into account, but there is no Law that obliges us or regulates the correct performance of In my opinion, this practice should be regulated, thus preventing them from being poorly performed, preventing people who are not doctors or scientists from performing autopsies, since in my opinion it is a practice that should be stopped to Legislative Physicians, experts and scientists. Similarly, the law should oblige the people who carry out this practice to be experts and are certified and have a License to be able to perform necropsies, that is,The person who wants or intends to perform autopsies must be certified and authorized by an Institution that is in charge of regulating the above, for example, SEMEFO can certify its doctors and scientists, this in order to carry out the necropsy in the best possible way. The possible Law and regulation that would regulate necropsies must indicate the places for their performance, the technique to be used, the instruments, the clothing, the care of the corpse, medical ethics, among others. This possible regulation opens the doors so that not only the Doctors who perform the autopsies must be experts and certified, but also that all the experts that make up the team of the Attorney General's Office, whether state or general, are also so.We find that the experts do not have a regulation or law on which they must submit and this is related to the fact that many times we find that the expert is only an expert in their field, but does not have a regulation or a basis on which they must submit to carry out their expert opinions.The person in charge of performing the necropsy must be a Medical, Scientific, certified, studied Expert.In the same way, they must seek the unification not only National, but International, we see that in countries like the United States, they are very advanced in autopsies, and in Latin countries we are still lagging behind. By unifying the techniques and practice of necropsy, it is sought that it fulfills its objective purposes since sometimes, due to the fact of not performing it correctly, the medical ethics and does not serve its purpose.It is an issue that lacks regulation, as for the Regulation that is the substantive support, establishing the procedure guide for the performance of medico-legal autopsies allows handling the principles and knowledge of medical sciences in the application of techniques and procedures received throughout systematic training, so that each expert witness, with prior planning and an adequate appreciation of the particular case, is fully capable of determining the cause and manner of death following a methodology. Technological advance in each of the areas of knowledge and the availability of resources increasingly requires us to take care of the expert activities that undoubtedly, guided by such an excellent result of a joint work product of the meeting of multiple efforts,allows in a practical way to link the MANUAL OF NECROPSY MEDICO LEGAL with a decalogue of basic components that, as a reminder, allow the support of all cases that are taken to forensic investigation.

Bibliography

BRAVO CASAS, Víctor Lisandro, End of the existence of the natural person, Colombia, Ariana Editions, 1982.GIRALDO G., Cesar Augusto, Forensic Medicine, 12th Edition, Colombia, Signal Editor, 2007.MUÑOZ LARA, Antonio Iran, Forensic Investigations in the Necropsy, 3rd Edition, Mexico, Ed. Porrúa, 2010.QUIROZ CUARON, Alfonso, Forensic Medicine, 9th. Edition, Mexico, Ed. Porrúa, 1999.ROJAS, Nerio A., Legal Medicine, 12th Edition, Argentina, Ed. El Ateneo, 1982.VAZQUEZ FANEGA, Héctor Osvaldo, Medical legal investigation of death, Argentina, Ed. Astrea de Alfredo and Ricardo Depalma, 2003.