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How to reconcile religious prohibitions on autopsies with the need to determine a cause of death

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(Virtual autopsy image courtesy of the Center of Forensic Imaging at the Institute of Forensic Medicine, University of Bern, Switzerland.)

A three-year-old Israeli girl was strangled to death by her father earlier this year, and the nation was shocked—by the luridness of the crime, by the father’s subsequent suicide attempts, by the divorce-gone-bad story it emerged was behind the crime, and, not least, by the fuel the child’s mother poured on an ongoing battle between ultra-Orthodox circles and the country’s law enforcement agencies over the permissibility of autopsies when she initially refused to allow one on her daughter’s body.

The objection grew from the Talmud’s interpretation of the biblical imperative for a speedy burial, first spelled out in Deuteronomy, where it states that a hanged man “shall not remain all night upon the tree, but thou shalt surely bury him the same day.” Not only must he be buried within 24 hours of death, according to the tractate Sanhedrin, but there can be no “disfigurement of the body as a result of postmortem dissection.” In other words, Jewish law mandates that the body, whenever possible, should be kept whole. An autopsy—with its incisions and tissue extractions, preservations and excisions—violates that mandate.

The U.S. Department of Health and Human Services reports that the number of autopsies performed annually in this country has fallen in recent decades, but these post-mortem examinations are still conducted regularly. For states where medical examiners govern autopsy procedure, the Model Post-Mortem Examination Act (adopted in 1954) mandates that those who die in a suspicious manner—by suicide, homicide, accident, or undetermined cause—must undergo an autopsy, yet this legal requirement brushes up against religious obligations.

New York City, which has the largest and most active medical examiner’s offices in the country (and where I interned during the summer of 2002), has procedures in place when a religious objection to autopsy is raised. (Jews aren’t the only group to raise such objections; the Amish, Hmong, and many Muslims also try to avoid the procedure.) Instead of conducting the standard post-mortem, with the entire body exposed under bright lights and completely dissected, forensic pathologists perform what they term as “minimally invasive autopsy,” wrapping the body in a white shroud and dissecting only where it’s absolutely necessary. If a body has come in with neck trauma, for example, a neck dissection is necessary to distinguish between suicide by hanging or strangulation at the hands of another.

Other parts of the country are catching on to ways of coping with religious concerns about autopsies. In December 2008, David Fowler, Maryland’s chief medical examiner, met with a delegation of Orthodox rabbis and other local ethnic community leaders to review the state’s autopsy guidelines. “Up until then, there was no accommodation in the state law for religious objections to autopsy,” said Rabbi Ariel Sadwin, who was at the meeting and is Maryland director for Agudath Israel, the national network of ultra-Orthodox Jewish communal organizations. “Cases went straight to the medical examiner without considering the needs of the Jewish community to respect the dead and keep organs and tissues intact.” As a result of the meeting, the state has committed to working harder to familiarize pathologists with Jewish protocols.

After Liviu Librescu, an engineering professor and Holocaust survivor, was killed in the 2007 Virginia Tech massacre in Blacksburg, his ultra-Orthodox family faced a problem. The city had a small Jewish community with no permanent rabbi, and the family, specifically his son in Israel, worried that an autopsy of Librescu’s body would violate Jewish law. The task of asking the State of Virginia to release Librescu’s body as quickly as possible and forgo a full autopsy fell to Rabbi Isaac Lieder, the Chabad leader in the capital of Richmond. The medical examiner’s office allowed Librescu’s body to undergo a minimally invasive autopsy (specifically, removing bullets and performing x-ray procedures) as an alternative, and Librescu was eventually buried in Israel.

Developments in medico-legal technology now allow pathologists to perform “virtual autopsies” as an alternative to traditional, invasive ones. In a virtual autopsy, pathologists use CT scans and MRIs to ascertain details about the insides of a cadaver. Three-dimensional visualizations, many of which are breathtaking, can approximate the body’s condition, allowing coroners to determine the cause and manner of death without making a single incision. It’s also cheaper: the cost of an autopsy runs between $4,000 and $5,000, while a virtual autopsy costs five times less.

Around the world—in Britain, New Zealand, Israel, and elsewhere—virtual autopsies are becoming more commonplace and increasingly accepted by religious leaders since they are considered to be halachically okay. “As long as the integrity of the body stays intact and is not violated, there’s no problem,” said Moshe Tendler, a professor of bioethics at Yeshiva University. (Tendler added that he was one of the first rabbis to advocate for the use of a CT scan as a substitute for autopsy when a rabbinical colleague was killed in a traffic accident.) The drawback to a virtual autopsy is that current technology for conducting it can only approximate the full spectrum of what a traditional autopsy uncovers, especially with respect to microscopic analysis. But as medical researchers and pathologists refine their methodologies and improve their equipment, even that hurdle could soon be overcome.

Sarah Weinman writes monthly online crime fiction columns for the Los Angeles Times and the Barnes & Noble Review and contributes to the Washington Post, the Wall Street Journal, the Guardian, and New Hampshire Public Radio’s “Word of Mouth.”

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Jonathan says:

Thanks for the informative article. When my wife’s uncle passed away in his sleep last year at the age of 55, I was surprised by the alacrity with which his family had him buried. When a middle-aged man dies without any apparent illness, foul play must be considered as a cause of death, but burial without autopsy subverts the investigation and may enable homicides and those who cause them to go undetected.

Why do you suppose we have to fall back on technology to solve this problem, Sarah?

The initial passage you quote seems to recommend respect for the body. Does autopsy violate respect? We can find and even codify respectful ways to butcher and eat animals. (I can see this analogy going bad already, possibly). Can’t we find respectful ways to honor the deceased while trying to discover the cause of their death?

Isn’t there a mindset which makes autopsy a gift or show of respect in some way, a promise that their story will be told?

Indeed, the differences between church and state linger. Interesting though that this time it includes autopsy (of course I am familiar with the more common disputes like corporal punishment, birth control, abortion, and euthanasia). One is led to believe that when a relative dies and causes seem to point towards murder or there are suspicions of foul play, one will immediately submit the body of the deceased to or even demand for an autopsy. Well, different religions, different beliefs I suppose, and I respect that. It is a good thing that science has paved the way to settle this amicably through their developments in virtual autopsies. Until these virtual autopsies equal the real autopsy though, some points need to be settled clearly. Personally, my take on the matter is, if push comes to shove, and a thorough investigation is imperative (ex. murders or serial killings), I will go with the Romans when they say… when in Rome, do as the Romans do. If the law dictates that they conduct a thorough autopsy on the body, the bereaved should comply. The state though should delicately and sensitively handle the matter, and of course exhaust all means to 1. properly conduct only “minimal (and necessary) invasion” of the body and 2. lead the bereaved to accept the procedure, through counseling perhaps, that as they lay their departed to rest, they are also helping put a murderer behind bars and/or are actually saving lives in the process. This is a very informative read. Thank you.

Science and religion often has a lot of disputes. And with this article I am thankful that they have found a way to brush off the controversy by just performing virtual autopsies in sensitive cases like this where religious beliefs are an issue. One shall give way and respect the other, thanks to our technology nowadays, it has been solving a lot of problems and that of which includes science and religious conflicts. :)

As a person with Jewish heritage I know how hard it is sometimes the find a path between religion beliefs ans science or law issues. I think that this breakthru of virtual autopsies can help a lot in such sensitive cases.

This poor girl. A postmortem should be carried to gain as much information about this case as possible. Most religious laws where made out of common sense at the time of no cooling facilities.

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Body Image

How to reconcile religious prohibitions on autopsies with the need to determine a cause of death

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