In 2009, 22% of all deaths in England and Wales underwent autopsy on the instruction of coroners – one of the highest rates of medico-legal autopsy in the world. The fundamental review of death certification and investigation reported that the autopsy rate was between double and triple the rates of all the other jurisdictions it surveyed (Canada, Australia, New Zealand, Northern Ireland and Scotland). Yet the overwhelming majority of the deaths investigated were from natural causes.

As a forensic pathologist, I am well aware of the importance of the autopsy as a tool in modern death investigation. But we must find a proper balance between the need for the state to seize the corpse and dissect it for investigative purposes, and the sensitivities of the dead person’s family.

The decision on whether or not to dissect a body should always be based on the added value the procedure is likely to offer for the legal investigation as a whole. Any medical investigation ordered by the coroner, whether autopsy or other test, should be to clarify a defined uncertainty or range of uncertainties about the death and should, as a matter of course, be as minimally invasive as possible.

There is a general lack of evidence to warrant the number of coroner autopsies. The Office for National Statistics has observed only a ‘weak’ relationship between the quality of mortality data and the autopsy rate.

The high demand for these dissections, combined with a national shortage of autopsy pathologists, inevitably means that standards fall. The National Confidential Enquiry into Patient Outcome and Death looked into the standard of coronial autopsies, and found that one-quarter of reports were poor or unacceptable.

So if that’s the problem, what’s the answer? A possible model for change is the forensics autopsy service provided by the University of Dundee to the Tayside region in Scotland. Since 1988 we have, wherever possible, used external examinations instead of dissections. In Scotland there are, of course, no coroners and deaths are investigated by procurators fiscal. Not all deaths of which they receive notification are investigated, but those which are investigated are subjected to police inquiry with a resulting comprehensive police report.

The procurators fiscal authorise dissection of a body where this is needed to gain information but, where there is no clear indication that this is needed, they can give the pathologist the discretion to perform either an external examination or a dissection in order to complete the death certificate. Using the police report and/or medical records, the pathologist makes the initial choice of whether to go ahead with either an external examination or a dissection before viewing the body.

The external examination is extremely thorough. It includes the examination of clothing and a head-to-toe examination of the body to record all identifying features, old and recent injuries, and recent medical interventions, and minor incisions to obtain tissue samples for testing.

Adopting this process to maximise the use of external examinations has reduced our region’s medico-legal dissection rate to 6%. In 2006, with the cooperation of NHS pathologists, the programme was extended to Fife and central regions and now serves a population of 1.1 million.

The change did not happen overnight. A different mindset is required to challenge the existing philosophy and practice of investigating deaths. But I firmly believe that if such a system were to be adopted in England and Wales, we would see a similar reduction in the autopsy rate – perhaps as much as 80,000 fewer dissections every year. And that can only be good for relatives, practitioners and the quality of the autopsy service.

Derrick Pounder is professor of forensic medicine at the University of Dundee and author of the paper How can we reduce the number of coroner autopsies?, published in the Journal of the Royal Society of Medicine