Elker works as a pathologist for the Antwerp-based hospital groups GZA and ZNA. Before that, she worked for five years at Erasmus MC, where in 2010 she arranged for one of the autopsies she performed to be recorded on video. “The lady in question was in her eighties and had left her body to science,” explains Elker. On the screen, we see how the pathologist makes a V-shaped incision in the deceased’s chest. This is followed by an extended vertical cut along the centre of the thorax towards the lower abdomen. “Don’t be alarmed,” says Elker. She uses her light pen to indicate the incision that will be used to ‘open up’ the cadaver. “Most people have thick layers of fat under their skin. Unless you have a six-pack, of course,” she adds.
It’s not for the weak of heart, but no one leaves the hall when they’re given the chance. “The objective of this autopsy is to establish the cause of death,” continues Elker, while on the screen, she is seen cutting the deceased’s liver into thin slices. “That’s why we subject all parts of the body to the most detailed possible examination.” It is necessary to divide each of the organs into thin slices to determine whether it was affected by calcification or a tumour.
Other side of the story
The lecture is attended by over 50 people. Most of them are studying medicine or law, but a few of the onlookers are criminology students. “This lecture is intended for students who at some point in their career can expect to be involved in decision-making regarding autopsies or the legal presentation of autopsy results,” explains organiser Willem Scholten of Studium Generale. “The lecture is interdisciplinary, which means law students learn something about the human body – which isn’t covered by their regular curriculum – while medical students are introduced to the legal aspects of an autopsy.”
Part-time law student Ilona de Vroom finds the theme very interesting. “I’ll be starting a new job at the police in May,” says De Vroom. “I’m interested in working in criminal investigation, and this lecture seems like a good place to start.”
Law student Merel de Jong was also interested in learning more about the specifics of an autopsy. “I’m in my second year right now, and I haven’t decided what I will be specialising in for my master’s,” she says. “If I decide to work as a lawyer or on civil cases, this knowledge may prove very relevant.”
The same applies to medical students Sanne, Julia and Josje. “The most recent block included an autopsy,” says Julia. “While an autopsy is hardly new for us, they don’t tell us about the legal process that leads up to a cadaver being laid out on our cutting table, for example.”
“What is a corpse?” Nelleke Eken-de Vos of the Public Prosecution Service starts off her presentation with this question. One can only speak of a corpse when one finds one or more body parts that are required to support life – a head or a torso, for example. “You can’t simply say that you’ve found a corpse when you find a leg or arm,” she concludes.
Eken-de Vos then goes into the nature of the deceased’s death. “We speak of ‘death by natural causes’ when the only cause of death was a spontaneous disease,” she explains. “All other causes of death fall under the category ‘unnatural death’.”
In other words, death as a result of a punishable offence is unnatural. “But not every unnatural death is the outcome of a punishable offence,” notes Eken-de Vos. “Drowning or some horrible accident, for instance.” If the death is the outcome of a punishable offence, the surviving relatives have to surrender the body to the State. “At that point, the deceased’s body falls to the State, and the surviving relatives are not allowed to bar us from performing a legal dissection: an autopsy performed by a forensic pathologist, in other words.”
After a death by natural causes – and occasionally when an unnatural death is not linked to a punishable offence – the corpse is examined by a clinical pathologist. “Of course, not every deceased is the subject of an autopsy,” says Elker. “We only perform an autopsy when both the responsible physician and the surviving relatives feel this is necessary.”
‘We try to treat the deceased as respectfully as possible’
Another important consideration according to Elker is respect for the deceased. For this reason, both the deceased’s head and pubic area are covered with sheets during the autopsy. “We try to treat them as respectfully as possible,” says Elker. “For example, we never shave or cut the deceased’s hair.” And the V-shaped incision along the cadaver’s chest is also done for a purpose. “This means that in the case of a female deceased, she can still be buried wearing a dress with a low neckline.”
After the lecture, the students go over to Elker to ask questions. One student asks about the policy with regard to donor organs – is a clinical pathologist ever involved in a donor transplantation? (the answer: no). Another student asks when a cadaver is officially released for embalming (the answer: only after the autopsy has been rounded off). “I think my fellow students from other disciplines raise such interesting questions,” remarks medical student Sanne. “They have such a completely different perspective on autopsies – one that we would never have thought of as medical students.”