Is a coroner the same thing as a medical examiner?

AnalysisA death removes the person best placed to explain it. Everything that follows has to be reconstructed from a body, a scene and other people’s accounts — and unlike most investigations, there is no complainant with an interest in pressing it. That is why systems create a standing duty to investigate certain deaths rather than leaving it to whoever asks.

England and Wales gives the duty to a judicial officer. Section 1 of the Coroners and Justice Act 2009 provides that a senior coroner who is made aware that the body of a deceased person is within that coroner’s area must as soon as practicable conduct an investigation if the coroner has reason to suspect that the deceased died a violent or unnatural death, that the cause of death is unknown, or that the deceased died while in custody or otherwise in state detention.

The duty is drafted so it cannot easily be avoided. It arises on the coroner being made aware of a body in the area, not on any application; the coroner may make whatever enquiries seem necessary to decide whether it arises; and where the body has been destroyed, lost or is absent, the coroner may report to the Chief Coroner, who may direct a senior coroner to investigate anyway.

The same jurisdiction also has medical examiners, and they are a different office. Under section 19 of the same Act a person may be appointed a medical examiner only if at the time of appointment they are a registered medical practitioner and have been throughout the previous five years, and practise as such or have done within the previous five years. Regulations govern training required as a precondition of appointment, procedure, and the functions conferred.

The Act protects the medical examiner’s judgement in terms. Section 19(5) provides that nothing in that section, or in regulations under it, gives an English or Welsh NHS body any role in relation to the way in which medical examiners exercise their professional judgment as medical practitioners — a statutory firewall between the employing health structure and the clinical opinion.

Germany has no coroner and no medical examiner. Section 87 of the Code of Criminal Procedure distributes the same work between the prosecution, the judge and physicians. The Leichenschau — the external examination of the body — is conducted by the public prosecution office, or on its application by the judge, with a physician called in unless that is obviously dispensable for clarifying the facts.

The autopsy is bounded more tightly still. The Leichenöffnung is performed by two physicians, one of whom must be a court physician or the head of a public forensic-medical or pathological institute, or a physician of that institute with forensic-medical expertise. The physician who treated the deceased in the illness immediately preceding death may not be entrusted with it, though they may be asked to attend to give information from the medical history. And the autopsy is ordered by the judge — the prosecution being competent to order it only where delay would endanger the success of the investigation.

• Common belief: A coroner and a medical examiner are the same thing under different names.

  In practice: England and Wales has both, created by the same Act and doing different things. The coroner is a judicial office under a duty to investigate defined deaths; the medical examiner is a registered doctor of at least five years’ standing appointed to a statutory function.

• Common belief: Every legal system has a coroner.

  In practice: Germany has none. Under section 87 the external examination is conducted by the prosecution or the judge, and the autopsy is ordered by the judge and performed by two physicians.

• Common belief: A death investigation begins when a family or the police ask for one.

  In practice: In England and Wales the duty arises on the senior coroner being made aware that a body is within the coroner’s area and having reason to suspect one of three matters. No application is required.

• Common belief: The doctor who treated the deceased is the obvious person to establish the cause of death.

  In practice: German law excludes that physician from performing the autopsy, while allowing them to attend and give information from the medical history. The knowledge is wanted; the finding is placed elsewhere.

• Common belief: Deaths in custody are investigated like any other death.

  In practice: In England and Wales death in custody or otherwise in state detention is one of three triggers for a mandatory coronial investigation, alongside violent or unnatural death and unknown cause.

Two systems, and no shared vocabulary.

• A senior coroner — a judicial office — under a statutory duty to investigate violent or unnatural death, unknown cause, or death in state detention — England and Wales, Coroners and Justice Act 2009 s. 1.
• Medical examiners as a separate office: registered practitioners of at least five years, with a statutory firewall protecting their professional judgment — the same Act, s. 19.
• No coroner and no medical examiner: the prosecution conducts the external examination, the judge orders the autopsy, two physicians perform it and the treating doctor is excluded — Germany, StPO § 87.

AnalysisA mandatory duty is what makes death investigation an accountability mechanism rather than a service. Nobody has to be persuaded to start it, and no relative has to know it exists — which matters most for people who die in custody, where the family is furthest from the institution and least able to insist.

Independence is engineered into both systems by exclusion rather than by assertion. England and Wales bars the NHS body from any role in the medical examiner’s professional judgment; Germany bars the treating physician from performing the autopsy. In neither case is the safeguard a statement that the person will be objective.

• Two systems are described from primary text. Scotland has a different arrangement again and is not described; nor is any system outside these two.
• Inquest procedure, what a coroner may conclude, and how findings are used were not researched and are not described.

Related: what forensic laboratories do, what remand detention is, and why justice systems need oversight.