# Medicolegal obstacles in pre-hospital care: An overview of practice in the North of France in 2023

Cécile Bossaert, Sébastien Volant, Paul Andrey, Valery Hedouin, Eric Wiel

► To cite this version:

Cécile Bossaert, Sébastien Volant, Paul Andrey, Valery Hedouin, Eric Wiel. Medicolegal obstacles in pre-hospital care: An overview of practice in the North of France in 2023. Archives of Legal Medicine, 2025, Archives of Legal Medicine, 16 (4), pp.200623. 10.1016/j.aolm.2025.200623. hal-05512994

HAL Id: hal-05512994

https://hal.science/hal-05512994v1

Submitted on 16 Feb 2026

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
<figure><img src="image_2.png" /></figure>

ELSEVIER

Available online at

ScienceDirect
www.sciencedirect.com

Elsevier Masson France

EM|consulte
www.em-consulte.com

<figure><img src="image_3.png" /></figure>

ORIGINAL ARTICLE

# Medicolegal obstacles in pre-hospital care: An overview of practice in the North of France in 2023

<figure><img src="image_4.png" /></figure>

Obstacle médico-légal en pré-hospitalier : une revue des pratiques dans le Nord de la France en 2023

Cécile Bossaert<sup>a,*</sup>, Sébastien Volant<sup>b</sup>, Paul Andrey<sup>c</sup>, Valery Hedouin<sup>d</sup>, Eric Wiel<sup>e</sup>

Available online 10 October 2025

## KEYWORDS

Medicolegal obstacle;
Pre-hospital death;
Legislative framework

## Summary

**Objective.** — In the absence of clear French law on the application of a medicolegal obstacle (MLO) when drawing up a death certificate, the objective of the present study was to evaluate pre-hospital practice by emergency medical team (EMT) physicians in Northern France.

**Material and methods.** — This retrospective, observational study was based on the extraction and analysis of data from the information system used by EMT physicians to fill out medical records during pre-hospital care for deaths between August 1st, 2023 and October 31st, 2023. The proportion of death certificates with an MLO was calculated. Data on age, the cause of death, the type of intervention site, the patient's medical history, and the reasons for intervention were extracted and compared in the MLO group versus the no MLO group. To measure the consistency of MLO application, a logistic regression model was trained on the study data.

**Results.** — An MLO was recorded on 100 (29%) of the 238 death certificates. Individuals with an MLO were significantly younger and more likely to have a trauma-related cause of death. The regression model demonstrated that the MLO was applied consistently.

<footnote><sup>a</sup> Pôle de l'urgence, CHU de Lille, University Lille, ULR 2694 Metrics, 59000 Lille, France</footnote>

<footnote><sup>b</sup> CHU de Lille, service de médecine légale, Lille, France</footnote>

<footnote><sup>c</sup> CNRS, Inria, Centrale Lille UMR 9189 – CRISTAL, University Lille, 59000 Lille, France</footnote>

<footnote><sup>d</sup> Service de médecine légale – CHU de Lille, unité de taphonomie médico-légale et anatomie ULR 7367, université de Lille, Lille, France</footnote>

<footnote><sup>e</sup> Pôle de l'Urgence, University Lille, ULR 2694 Metrics, 59000 Lille, France</footnote>

<footnote>* Corresponding author.</footnote>

<footnote>E-mail addresses: cecile.bossaert@chu-lille.fr (C. Bossaert), sebastien.volant@chu-lille.fr (S. Volant), valery.hedouin@chu-lille.fr (V. Hedouin), eric.wiel@chu-lille.fr (E. Wiel).</footnote>
## MOTS CLÉS

Obstacle médico-légal ;
Décès pré-hospitalier ;
Cadre législatif

**Conclusion.** — Although the MLO appeared to have been applied in a consistent manner when drawing up a death certificate, some situations had been missed. Additional training on MLOs for EMT physicians would be useful.

© 2025 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

## Résumé

**Objectif.** — En l'absence de législation française claire sur l'application d'un obstacle médico-légal (OML) lors de l'établissement d'un certificat de décès, l'objectif de la présente étude était d'évaluer la pratique préhospitalière des médecins urgentistes (MRU) du Nord de la France.

**Matériel et méthodes.** — Cette étude observationnelle rétrospective s'est basée sur l'extraction et l'analyse de données du système d'information utilisé par les médecins ambulanciers pour remplir les dossiers médicaux lors des soins préhospitaliers pour le décès survenu entre le 1er août 2023 et le 31 octobre 2023. La proportion de décès avec MLO a été calculée. Les données sur l'âge, la cause du décès, le type de site d'intervention, les données médicales du patient et les raisons de l'intervention ont été extraites et comparées dans le groupe MLO versus le groupe sans MLO. Pour mesurer la cohérence de l'application du MLO, un modèle de régression logistique a été pratiqué sur les données de l'étude.

**Résultats.** — Un MLO a été enregistré sur 100 (29 %) des 238 certificats de décès. Les personnes ayant un MLO étaient significativement plus jeunes et plus susceptibles d'avoir une cause de décès liée à un traumatisme. Le modèle de régression a démontré que le MLO était appliqué de manière cohérente.

**Conclusion.** — Bien que les MLO semblent être appliqués de manière cohérente lors de l'établissement d'un certificat de décès, certaines situations ont été oubliées. Une formation complémentaire sur les MLO pour les médecins urgentistes serait utile.

© 2025 Les Auteurs. Published by Elsevier Masson SAS. Cet article est publié en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).

## Introduction

According to official data from the French Ministry of Health, emergency medical teams (EMTs) in mainland France carry out around 550,000 so-called primary interventions per year [1]. With more than one million emergency calls received and over 11,000 primary interventions in 2022 [2] (including 600 by helicopter), the emergency call dispatch centre in the Hauts de France region of northern France is one of the busiest in the country [1]. In France as a whole, around 50,000 (9%) of the primary interventions per year concern a death; in Northern France, this corresponded to 2,300 deaths in 2023 [1,3]. In these situations, the death certificate is drawn up and signed by the EMT physician, who has the option of recording a medicolegal obstacle (MLO). According to article 74 of the French Criminal Procedure Code, ticking the death certificate's MLO box will trigger a judicial investigation and suspend funeral arrangements, after a duty police officer or magistrate has been contacted [4]. As a result, the body is left at the disposal of the authorities for the duration of the investigation, which may include a forensic autopsy. The latter differs from a medical autopsy, which is intended to establish the cause of death in the absence of any suspicious circumstances and can be initiated by the physician having attended to the deceased person. At the end of the investigation, a burial or cremation permit is issued by the judicial authority. The deceased person's body can then be returned to the next of kin, and the funeral arrangements can go ahead.

The French legislation does not give a detailed definition of the circumstances that should trigger an MLO; article 81 of the French Civil Code simply states 'when there are signs or indications of violent death, or other circumstances giving

reason to suspect it [...]' - [5]. A French government circular dated July 5th, 1976, mentions 'deaths that pose a medicolegal problem are those that may result from a crime, an offense, a suicide, a work accident (including a commuting accident), an occupational disease, and an illness or injury giving rise to a military pension' [6]. However, this circular does not have any legal value. Other legal texts exist (e.g. article R 1112-73 of the French Public Health Code, on in-hospital suspect deaths) but are no more precise ([7]). On a day-to-day basis, EMT physicians are therefore confronted with patients who have died in circumstances that may correspond to these criteria but do not have objective tools to help them make a decision - even though a list of circumstances that may justify an MLO is given on the back of the death certificate: '[...] suspicious conditions (violent or unknown), notably in cases of suspected murder, suicide, sudden death (except sudden unexpected infant death), the possible liability of a third party (a road accident or work accident, etc.), an overdose, or an unidentified body'. As a result, the decision to record an MLO may be difficult to take and depends on a subjective assessment of the situation [8]-even when the physician has meticulously examined the body and the circumstances in which it was found.

A Council of Europe recommendation R (99) 3 [9] gives a non-exhaustive list of the circumstances of death that should trigger an autopsy: '[...] autopsies should be carried out in all obvious or suspected unnatural deaths, even where there is a delay in causative events and death, in particular (a) homicide or suspected homicide, (b) sudden unexpected death, including sudden infant death, (c) violation of human rights, such as suspicion of torture or any other form of ill treatment, (d) suicide or suspected suicide, (e) suspected
medical malpractice, (f) accidents, whether transportation, occupational, or domestic, (g) occupational disease and hazards, (h) technological or environmental disasters, (i) death in custody or associated with police or military activities, (j) unidentified or skeletalized bodies". Although the decision on whether or not an autopsy is performed depends ultimately on the magistrate in charge of the case (and not on the EMT physician or the forensic physician who recovered the body), one can reasonably consider that the Council of Europe's list might serve as an appropriate benchmark for guiding the EMT physician with regard to MLOs. Furthermore, in 2001, the French National Academy of Medicine provided a list of circumstances in which the death certificate's MLO box should be ticked [10]. This list complements the other tools that physicians can use to help them make decisions when filling out death certificates.

Due to the French legislation's lack of precision concerning MLOs, we decided to assess the proportion of pre-hospital MLOs in the Nord county and evaluate the MLOs' compliance with the above-mentioned texts.

# Material and methods

## The study population

This retrospective, observational study was based on the extraction and analysis of data from the BISOM information system (BISOM SAS, Marcq-en-Baroeul, France), which is used by EMT physicians to fill out medical records during pre-hospital care. In accordance with the national MR-004 methodology (approved by the French National Data Protection Commission (Commission nationale de l'informatique et des libertés, Paris, France; reference: 2023-193), the medical data were anonymized immediately after their extraction, and each record was given a unique patient identifier.

The inclusion criterion was death (regardless of whether or not an attempt to resuscitate was made) between August 1st, 2023 and October 31st, 2023. Patients for whom the MLO status was not specified (neither ''YES'' nor ''NOT'') in the BISOM software were excluded. Patients who did not die, or who died in hospital, were also excluded and considered to be erroneous records. Lastly, patients for whom the stated medical circumstances did not necessarily contribute to the death or for whom the cause of death was not specified were grouped into the ''unknown'' category (see below).

## Data collected

The following variables were extracted: the patient's sex and age, the cause of death, the reason for the intervention, the type of intervention site (i.e. the place of death), the patient's medical history, and whether or not an MLO was recorded on the death certificate.

So as not to modify the EMT physician's interpretation of the clinical data made at the scene, the cause of death was transcribed exactly as noted on the death certificate. Next, the cause of death was classified into one of nine categories: unknown (either not specified or non-contributory, i.e. a factor that could not contribute to death *per se*), cardiac arrest, other cardiovascular causes (including myocardial

infarction and pulmonary embolism), asphyxia (drowning, hanging, etc.), sudden death (unexpected, sudden death in a patient with no relevant medical history), a neurological cause, trauma, or ''other'' (infrequent causes, such as hypovolaemia, infections, burns, overdoses, and poisoning). The type of intervention site was classified into the following categories: home, public highway, other public places, workplace, nursing home/institution, or prison. The patients' pre-existing medical conditions or diseases were classified as cardiovascular, respiratory, neurological, toxicological, psychiatric, or malignant. Lastly, the reasons for the intervention were classified as a road/agricultural accident, cardiac arrest, respiratory distress, hanging, injury by a weapon, loss of consciousness, convulsive seizure, chest/abdominal pain, fall, or hypovolaemia.

## Statistical analyses

The statistical analyses were descriptive and carried out using Python (x,y)®. Firstly, the proportion of deaths with an MLO was calculated for the sample as a whole. This was followed by a description of the age distribution, the causes of death, the types of intervention sites, and the pre-existing medical conditions. Lastly, the proportion of deaths with an MLO was calculated for each of the above categories. Patients with missing or erroneous (negative) age data were excluded from the age distribution analysis. The chi-squared tests was used to assess the significance of the association between MLO status on one hand and the cause of death and the type of intervention site on the other. The Kolmogorov-Smirnov was used to test the normal distribution of the ''MLO'' and ''no MLO'' groups with regard to age. In order to determine whether certain causes of death were significantly more frequent in the MLO group. P-values for groups with more than 10 patients (unknown, cardiac arrest, other cardiovascular cause, and asphyxia) were calculated.

For all results, the 95% confidence level was used to decide whether or not to reject the test hypothesis. Lastly, a logistic regression model based on the limited-memory Broyden - Fletcher - Goldfarb - Shanno algorithm was trained on all the data, in order to measure the consistency of the MLO status with regard to the other variables identified. With the exception of age (expressed in years), all the variables were binary and thus lacked a reference modality. The P-value for statistical significance was calculated in a z-test. Each variable was evaluated independently of the others.

# Results

## Characteristics of the study population

According to the BISOM data, 380 patients had died in a pre-hospital setting (Fig. 1). Next, 142 of these patients were excluded because the MLO status was not specified or because the patient had survived or had died in hospital; hence, 238 patients were included in the final analysis. Sixty-three percent of the individuals were male, 31% were female, and the sex was not recorded for 6%. Patients for whom the age was not provided or was negative (when the
<figure><img src="image_5.png" /><figcaption>**Figure 1** Study flow chart.</figcaption></figure>

age was not registered by the EMT physician) were excluded. Among the remaining 233 patients, the age range was 14 to 98 (median: 68; mean: 65) (Fig. 2).

Among patients for whom a MLO was applied, most of them died from unknown causes (44.29%), then from asphyxia (21.43%) and cardiac arrest (10.00%) (Table 1). Other causes were weakly represented.

## Characteristics of deaths with an MLO

An MLO was recorded on 29% of the death certificates. Males accounted for 63% of the individuals in the MLO group (Supplementary Table 1). The patients in the MLO group were significantly younger than those in the ‘‘no MLO’’ group (median age: 45 and 75, respectively, *P* < 0.001) (Fig. 2).

With regard to the causes of death, cardiac arrest was significantly more frequent in the ‘‘no MLO’’ group than in the MLO group (*P* = 0.046) (Table 1 and Supplementary Table 2). In contrast, asphyxia and trauma were significantly more frequent in the MLO group than in the no MLO group (*P* = 0.023 and *P* < 0.001, respectively). The two groups did not differ significantly with regard to the frequency of

<table><caption>**Table 1** The presence or absence of a MLO, by cause of death.</caption><thead><tr><th>Cause of death (n)</th><th>MLO, n (%)</th><th>No MLO, n (%)</th></tr></thead><tbody><tr><td>Unknown (116)</td><td>31 (44.29)</td><td>85 (50.60)</td></tr><tr><td>Cardiac arrest (44)</td><td>7 (10.00)</td><td>37 (22.02)</td></tr><tr><td>Other cardiovascular cause (21)</td><td>2 (2.86)</td><td>19 (11.31)</td></tr><tr><td>Sudden death (3)</td><td>2 (2.86)</td><td>1 (0.60)</td></tr><tr><td>Asphyxia (31)</td><td>15 (21.43)</td><td>16 (9.52)</td></tr><tr><td>Neurological cause (5)</td><td>3 (4.29)</td><td>2 (1.19)</td></tr><tr><td>Trauma (6)</td><td>5 (7.14)</td><td>1 (0.60)</td></tr><tr><td>Other (13)</td><td>5 (7.14)</td><td>7 (4.16)</td></tr><tr><td>Total</td><td>70 (100)</td><td>168 (100)</td></tr></tbody></table>

unknown causes of death (*P* = 0.456) and cardiovascular causes of death (*P* = 0.065).

With regard to the place of death (Table 2), the application of an MLO was significantly more likely when the intervention took place on the public highway or in a public place (*P* < 0.001). In contrast, the application of an MLO was significantly less likely when the intervention took place at home (*P* = 0.0097). There was only one case of death in prison and one case of death at the workplace in which an MLO was not present.

With regard to the reason for the intervention, road accidents and injuries with a weapon always resulted in an MLO. However, as mentioned above, one case of death by hanging (in prison) did not result in an MLO. Only 34% of cardiac arrest cases resulted in an MLO (Supplementary Table 3). We also note that patients whose death resulted in an MLO often had an unremarkable medical history, with the exception of deaths with a history of psychiatric conditions or overdoses/poisoning (Supplementary Table 4).

Lastly, the logistic regression model predicted 93% of the MLOs, with a sensitivity of 91% and a positive predictive value

<figure><img src="image_6.png" /><figcaption>**Figure 2** Box plot of the ages in the study population. *P* < 0.001.</figcaption></figure>
<table><caption>**Table 2** The presence or absence of an MLO, by intervention site.</caption><thead><tr><td>Intervention site (n)</td><td>MLO</td><td>No MLO</td><td>P-value</td></tr></thead><tbody><tr><td>Home (184)</td><td>46 (65.71)</td><td>138 (82.14)</td><td>P = 0.0097</td></tr><tr><td>Public highway/other public place (32)</td><td>22 (31.43)</td><td>10 (5.96)</td><td>P < 0.001</td></tr><tr><td>Workplace (2)</td><td>1 (1.43)</td><td>1 (0.60)</td><td>Not evaluable</td></tr><tr><td>Nursing home/institution (1)</td><td>1 (1.43)</td><td>0</td><td>Not evaluable</td></tr><tr><td>Prison (1)</td><td>0</td><td>1 (0.60)</td><td>Not evaluable</td></tr></tbody></table>

of 84%. The determinants of an MLO were age (P < 0.001), sudden death (P = 0.003), death due to trauma (P = 0.026), death on the public highway (P = 0.001), and death in other public places (P = 0.003) (Supplementary Table 5).

Discussion

The results of the present study showed that an MLO was recorded on 29% of death certificates; this proportion is high, given that only 10% of deaths in France are considered to be unnatural [11]. A high proportion (63%) of the MLOs involved males, which is consistent with the fact that men are more prone to violent death than women [12,13].

Our results also showed that an MLO was more common among younger people; this is correlated with the fact that death at a young age is more often considered to be unexpected. In contrast, the death of an older adult (aged 65 or over) with comorbidities is more likely to be natural [8]. Our study showed that patients whose death resulted in an MLO often had an unremarkable medical history, apart from psychiatric conditions and overdoses. People with psychiatric conditions and drug abusers are more exposed to the risk of violent or suspicious death (e.g. suicides in prison or in public places) [14–16]. Furthermore, the fact that the patients in the MLO group were significantly younger than those in the ‘‘no MLO’’ group is in line with the recommendations issued by the Council of Europe and the French Academy of Medicine, which state the need for an autopsy and therefore (indirectly) an MLO in cases of unexpected death (e.g. that of a young person with an unremarkable medical history) [9,10].

Cardiac arrest was more frequent in the ‘‘no MLO’’ group than in the MLO group. This finding might be explained by the age and comorbidities of the patients in the ‘‘no MLO’’ group. It is important to note that in France, EMT physicians should consider cardiac arrest as the mechanism of death, rather than the cause. It should be noted that a large proportion of patients in the MLO group died of unknown causes (43%). Although it is normal to register an MLO when the cause or circumstances of death are not clear when the death certificate is being filled out, this high proportion might indicate that EMT physicians confuse a forensic autopsy (intended to determine whether or not a third party was involved in the death) with a medical autopsy (intended to determine the cause of a natural but initially unexplained death) [17]. Unfortunately, we did not have any data on whether the EMT physicians in our study requested a medical autopsy. Furthermore, an MLO was registered in only 83% of trauma-related deaths; this proportion is not in accordance

with the recommendations issued by the Council of Europe and the French Academy of Medicine [9,10], which indicates that an MLO and then an autopsy are required for all trauma-remedied deaths. Furthermore, an MLO was more frequent for interventions on the public highway or in another public place; this may be because a physician considers death in a public place to be suspicious. However, the fact that around 80% of EMT interventions take place at home [3] limits our ability to interpret this result. It should also be noted that for during intervention outside the home (e.g. on the public highway or in another public place), it may be difficult to record comorbidities or the patient’s medical history. As a result, the EMT physician might not be able to determine easily whether the death was ‘‘natural’’ or not.

We found that all ‘‘violent’’ deaths (those due to a road accident or injury with a weapon) resulted in an MLO, as recommended by the Council of Europe [9]. However, one case of death by hanging in prison – a death that should be classified as violent – did not result in an MLO. Likewise, one that occurred at the workplace should have been the subject of an MLO, according to the recommendations.

Lastly, the logistic regression model built from the study data had a satisfactory sensitivity and positive predictive value and thus showed that EMT physicians applied the MLO with consistency. It should be borne in mind that the model’s data resulted from the EMT physicians’ subjective interpretation of the circumstances of death [8]. Reassuringly, however, the factors that appear to have the greatest impact on decision-making (age, sudden death, death due to trauma, and death on the public highway or in another public place) are mentioned in recommendations issued by the Council of Europe and the French Academy of Medicine.

The study’s results might have been influenced by various sources of bias. Firstly, some of the BISOM data were missing or vague, and the quantity and quality of the data were variable. This heterogeneity might be explained by the absence of a standardized file format at the county and national levels. In fact, the study data were extracted directly from the BISOM files and were not coded as a binary variable by the software. This also explains the large proportion of deaths for which the stated cause was non-contributory or not given (i.e. those in the ‘‘unknown’’ category). Moreover, ‘‘cardiac arrest’’ could be considered as a clinical condition, rather than a cause of death. Furthermore, there was sometimes a difference between the cause of death and the reason for the intervention; this was the case for trauma (concerning six patients) and road/agricultural accidents (concerning 11 patients). The physician may have specified the circumstances of the death (e.g. a car crash) rather than
the cause (e.g. the driver's myocardial infarction). These problems limit the interpretation of our data. Furthermore, potentially useful, detailed information on the circumstances of death or the presence of a third party were not always available and further limited the interpretation of the results.

Secondly, the small size of our sample led to low numbers in certain sub-groups, which limits extrapolation of the results. These numbers could have been increased by the use of a medico-legal classification of the mode of death, e.g. unknown cause, accidental death, natural death, suicide or, homicide.

Lastly, the findings of this purely descriptive study of a population in northern France cannot necessarily be extrapolated to other areas and health systems.

## Conclusion

Our results show that the EMT physician's decision to record an MLO in a pre-hospital setting depended on the circumstances and tended to agree with the current non-legally-binding guidelines [9]. However, there still appear to be grey areas (such as low detection of homicides), due perhaps to a lack of training for physicians (as already mentioned in the literature [18,19]) and/or a lack of awareness of the guidelines [20]. Furthermore, the current French legislation appears to be poorly suited to pre-hospital practice [21]. Consequently, we feel that it would be appropriate for expert forensic physicians to train EMT physicians on this topic. Lastly, standardization of the software-based pre-hospital medical records would facilitate data collection and increase reliability.

## Disclosure of interest

The authors declare that they have no competing interest.

## Acknowledgement

Docteur Roch JOLY, chef de service du SAMU 59.
Monsieur Nicolas WEBER, CTO-founder, BISOM®.

## Appendix A. Supplementary data

Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.aolm.2025.200623.

## References

[1] DREES. Les disparités d'activité des SMUR s'expliquent en partie par les moyens dédiés et les caractéristiques des terri-toires. Études et Résultats 2019;1136:1–6.

[2] CHU de Lille. Rapport d'activité 2022.

[3] Statistiques internes au SAMU 59.

[4] Article 74 du Code de procédure pénale. Légifrance. https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000020632053/2014-06-02.

[5] Article 81 du Code civil. Légifrance. https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000006421264/.

[6] Circulaire du 5 juillet 1976. Légifrance. https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000000661904/.

[7] Article R1112-73 du Code de la santé publique. Légifrance. https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000006908260/.

[8] Roupioz T, Giordano A, Fragnieres D. L'obstacle médico-légal en pratique pré-hospitalière. Poster. Congrès Urgences SFMU Paris 2021.

[9] Recommandation Européenne N° R (99). 3. Conseil de l'Europe; 1999.

[10] Les indications de l'autopsie médico-légale en France. Académie nationale de médecine; 2001, https://www.academie-medecine.fr/les-indications-de-lautopsie-medico-legale-en-france/.

[11] Touabi K. L'équipe SMUR face à une mort suspecte. Congrès Urgences SFMU Paris 2012;106.

[12] Attree L, Möller-Loswick A. Promouvoir l'avènement de sociétés pacifiques et ouvertes à tous aux fins du développement durable, assurer l'accès de tous à la justice et mettre en place, à tous les niveaux, des institutions efficaces, responsables et ouvertes à tous. Chronique ONU 2015;51:36–9.

[13] Chesnais J-C. Les morts violentes dans le monde. Popul Soc 2003;395:1–4.

[14] Carpentier C, Costes J-M. Mortalité et morbidité des toxicomanes. Actual Doss Santé Publique 1998;22:11–20.

[15] Coldefy M. Personnes suivies pour des troubles psychiques sévères : une espérance de vie fortement réduite et une mortalité prématurée quadruplée. Quest Econ Santé 2018;237:1–7.

[16] Groenemeyer A. Politiques en matière de drogues et mortalité des toxicomanes en Europe. Bull Inf CESDIP 1996;14:4–7.

[17] Les différentes variétés d'autopsie. Propositions pour un renouveau de l'autopsie médicale et scientifique. Académie nationale de médecine; 2001, https://www.academie-medecine.fr/les-differentes-variétés-dautopsie-propositions-pour-un-renouveau-de-lautopsie-medicale-et-scientifique/.

[18] Sarra B, Abderrahim A, Belhaj C, et al. Modalités de pose de l'obstacle médicolégal sur le certificat médical de décès. Tunis Med 2021;99:721–6.

[19] Laborie J-M, Ludes B. L'obstacle médicolégal, pour un mode d'emploi. Rev Med Leg 2016;7:16–21.

[20] Guillaume Crane A. The medico-legal obstacle is under-utilized in France! Rev Prat 2023;73(9):939–40.

[21] Laborie J-M, Ludes B. L'obstacle médicolégal en pratique. Ann Fr Med Urgence 2015;5:77–84.