Structural problems of the external examination of corpses

The plight of the death certification system in Germany is caused by many reasons and can be differentiated into structural and situational reasons on the one hand and reasons due to the doctors and the police staff on the other hand. Of extreme importance is of course misclassification of the manner of death. However, the classification of the manner of death is closely connected to the determination of the cause of death. This is extremely difficult when no case history is available and external signs are missing on the body. Causal complexes for the plight of the death certification system are: in certain cases objective over expectation of the person carrying out the examination without flexible solution options, a lack of precedence cases when dealing with problem cases, a lack of administrative autopsies for causes of death which cannot be clarified by the examination, combining medical and criminalist tasks, tendency to a facile attestation of natural death to simplify the matter for the examiner and the relatives, nsufficient reflection on the chain of events leading to death despite known medical history. The main systematic mistake in the German death certification system is that only cases with unnatural or unclear manner of death are reported to the authorities but not cases which are unclear from a medical point of view.