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PSYCHIATRY: The Psychiatric Autopsy and Its Application in Law

At first blush, “Psychiatric Autopsy” appears to be a misnomer. The historical mainstay of psychiatric assessment and treatment is the psychiatric interview and psychotherapy. Obviously, a decedent is unable to participate in traditional psychiatric a

By Dr. N.L., M.D.

 

At first blush, “Psychiatric Autopsy” appears to be a misnomer. The historical mainstay of psychiatric assessment and treatment is the psychiatric interview and psychotherapy. Obviously, a decedent is unable to participate in traditional psychiatric assessment. However, death does not preclude a valid psychiatric assessment, and the tool that psychiatrists and other mental health professionals use to assess the decedent preceding death is the psychiatric autopsy – at times termed psychological autopsy.

Unlike a typical psychiatric evaluation where a patient is interviewed, a psychiatric autopsy relies on record review and interviews with those who knew the decedent. Developmental, family, medical, and prior psychiatric history is obtained from interviews of family and friends of the decedent and this information is confirmed with review of medical and mental-health records. This process is similar to the psychiatric assessment of a patient where collateral sources of information are used to validate the patient’s account of his or her history. As with a typical psychiatric evaluation, a carefully performed history will establish a strong foundation on which to base an assessment.

Substituting for a mental status examination and psychological testing is an assessment of the decedent’s mental state prior to death by review of mental-health and medical records and interviews with family and friends of the decedent. Also, within the context of a forensic evaluation, records of attorneys, emergency personal or law enforcement may be available for review. By integrating this information with the history of the decedent, the mental status of the decedent is determined.

The methodology of the psychiatric autopsy is similar to the work of the pathologist determining the mode of death via autopsy. In fact, the first applications of the psychiatric autopsy were to assist pathologists in cases of suspected suicide. For example, the Department of Coroner for Los Angeles County has an established Forensic Medicine Division where psychiatrists provide psychiatric autopsies to assist the coroner.

The application of this type of psychiatric autopsy does have a bearing on those outside the coroner’s office. Life insurance policies can have provisions that decline a claim for beneficiaries based on suicide. Contesting or validating a coroner’s determination of suicide is the cornerstone of such a dispute, and a psychiatric autopsy is a significant asset for the attorney involved in this type of litigation.

The psychiatric autopsy has other applications in law, and has been utilized in criminal matters when there is suspected neglect of caregivers contributing to death. Here the psychiatric autopsy can illuminate if the decedent had the mental capacity to refuse or consent to medical treatment and if the decedent was manipulated.

Below are findings from a psychiatric autopsy performed in such a case:

There is no information from this autopsy that would indicate that the decedent was forced or manipulated in her decision not to seek allopathic treatment. There are three significant aspects of the decedent’s personality and life experiences that contributed to her refusing medical treatment: 1) The decedent was born and raised in a rural border town and was immersed in a culture that relies on home remedies, rather than allopathic care; 2) The decedent had witnessed family members suffer the severe arthritis that she also suffered from, and saw that they did not improve with allopathic treatment; 3) The decedent had a stubborn, rigid personality that was not conducive to weighing the risks and benefits of allopathic treatment.

The use of psychiatric autopsy to assess mental capacity also has a role in probate court. Changes in a will or trust by the decedent close to death can lead to legal challenges to these changes. A psychiatric autopsy can be used to assess if there is any type of mental conditions, such as delirium, dementia or other mental illness, affecting the testamentary capacity of the decedent or if the decedent was unduly influenced.

The psychiatric autopsy is used in civil court. In wrongful death cases, monetary damages are based on the impact of the loss of the decedent. The quantification of these damages is related to the decedent’s biopsychosocial functioning and life expectancy. A psychiatric autopsy can generate an assessment of the decedent to assist the attorney or court in determining monetary damages.

In addition to other applications in law, the psychiatric autopsy is used in clinical and forensic research and public health.