An assessment of attitudes towards the post-mortem examination in suspected suicidal hanging in the United Kingdom

Despite suspected suicidal hanging being a common referral to death investigation services there is variation and ongoing debate within the United Kingdom (UK) as to the extent of the postmortem investigations undertaken. This study aimed to gather opinions from Coroners/Procurator Fiscals and consultant autopsy pathologists within the UK on their views on the value of the key components of the traditional invasive autopsy in cases of suspected suicidal hanging. Online questionnaires were distributed to Coroners/Procurator Fiscals and consultant autopsy pathologists within the UK. The data was analysed using quantitative and reflexive thematic analysis. A total of 171 practitioners completed the questionnaire; 86 pathologists and 85 Coroners/Procurator Fiscals. Analysis revealed a wide range of opinion and practice concerning the role of each stage of the investigation in the decision making process. However, reflexive thematic analysis primarily identified that decisions on the approach to the investigation should be made on a case-by-case basis and the quality of each key component was imperative. Due to the variation in circumstances surrounding each case and the wide range of resources available to and approaches taken by death investigation services throughout the UK the study did not allow a firm recommendation to be made on the extent/limit of the examination required for the Coroner/Procurator Fiscal to conclude, on a balance of probabilities, that the death was due to suicidal hanging. The extent of any postmortem examination should be considered on a case-by-case basis, and the initial stages of the investigation should be used to triage decisions. The quality of all stages of a death investigation is imperative and practitioners should be suitably qualified and experienced. Each stage of the death investigation should be used to corroborate or discredit the other components, and there should be a low threshold to review the findings and if required proceed to additional investigative options, such as an invasive autopsy. Whilst there is typically a lack of significant findings in cases of suspected suicidal hanging, excluding atypical features, such as excessive bruising of the neck muscles and additional significant trauma, is important. Whilst homicide masked as suicidal hanging was considered rare, detecting this was the greatest concern for Coroners and pathologists.