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Principles to Promote Research in Medicolegal Death

Investigation

A resource document prepared by the Organization of Scientific Area Committees (OSAC) for 

Forensic Science’s Medicolegal Death Investigation (MDI) Subcommittee, part of the 

Medicine Scientific Area Committee

Correspondence may be directed to Laura Gould (Laura.Gould@nyulangone.org)

Keywords: autopsy; biospecimens; cause of death; informed consent; manner of death; 

medicolegal death investigation; medicolegal death investigation system; next of kin; research

Summary

The National Institute of Standards and Technology (NIST) Organization of Scientific Area 

Committees (OSAC) for Forensic Science Medicolegal Death Investigation (MDI) Subcommittee,

which is comprised of stakeholders including medical examiners, coroners, medicolegal death 

investigators, public health researchers and others, have identified several barriers to research

in MDI.

This white paper outlines some of those barriers to strategically advancing medical research in 

the field of MDI and the efforts U.S. states and jurisdictions can make to address them. This will 

address sorely needed improvements to access biospecimens and reduce legal barriers to 

improve public health, justice, and the rights of next of kin. This document is designed for use 

by U.S. states, other jurisdictions, and medicolegal death investigation systems. 

Background and Rationale

Medical examiner and coroner offices are important to the national biomedical research 

enterprise. Access to biospecimens is a “critical component to the further advancement of 

justice, forensic sciences knowledge and the care of Next of Kin.”1

Forensic Pathology Research: The MDI community should be involved in forensic pathology 

research.1-3 The MDI community exists for the recognized societal need to establish the causes 

of death and such research advances this interest. The National Institutes of Health and other 

biomedical researchers only rarely study such topics and the expertise to perform such 

research resides in forensic pathologists who work in medical examiner and coroner offices. 

Investigations of the causes of sudden death, of head trauma, and of drug overdoses are all 

areas ripe for more research. While research in forensic pathology is valuable for the practice of 

forensic pathology, collaborative research at the intersection of forensic pathology with other 
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disciplines often results in findings that have more widespread importance to medicine, health 

and our society. For example, forensic pathology and psychiatry for suicide prevention, forensic 

pathology and trauma surgeons for the development of new trauma care protocols, and

forensic pathology and radiology to better understand the pathology of COVID lung disease.

Public Health Research: Public health research is another important research area of the MDI 

community. Research on trauma victims could improve safety measures.4 In determining death 

rates from accidents and diseases, it is important to capture the deaths that fall outside the 

hospital and for that medical examiner and coroner officers are critical. Furthermore, 

community surveys of exposures to chemicals or prevalence of infectious diseases, such as 

seropositivity of SARS-CoV-2 can be performed on the cases seen by the MDI community. The 

importance of the autopsy to the understanding of COVID-19 disease has been much 

heralded.5,6 

Among many good examples, we can look at the research needs of sudden infant death, which 

still plagues our society with over 3,500 deaths annually. Standard autopsy procedures have 

failed to provide clarity on such deaths, and high-quality research in partnership with the MDI 

community is required to better understand and ultimately eradicate sudden infant death 

causes. State statutes, such as those that have existed in California since the 1980s for such 

cases,7-9 have successfully enabled research to the benefit of public health. These research 

findings have led to the triple risk model in Sudden Infant Death Syndrome (SIDS) and the 

identification of abnormalities in the brainstem.10

Research of the Greater Biomedical Enterprise: Moreover, information and biospecimens 

generated by medical examiner and coroner offices should be made available for appropriate 

research. Case records provide important information for criminal justice and public health 

researchers.11 Autopsies present an important source of tissues for biomedical research and 

quality controls.12,13 Research utilizing biospecimens has provided significant benefits for the 

medical intervention of living persons with natural disease.

14 A New Hampshire state statute 

recognizes the value of research by allowing for biospecimens to be retained for research and 

released to educational institutions.15

Considerations of the Next-of-Kin: Concerns of the next-of-kin should always be a consideration 

in proposing research on MDI case material. Informed consent of the next-of-kin will be 

necessary for research when not waivered or of minimal risk.

3 However, it should also be 

recognized that research is an avenue for the next-of-kin to help provide a positive aspect from 
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a tragic event. Furthermore, research may provide a sort of second opinion or other 

information that families and support groups may find valuable.16 

Impediments to Research: Advancements in MDI medical research are limited due to structural 

and resource issues.1-3 Research is not clearly a mission of medical examiner and coroner offices 

that generally, but with notable exceptions, are apart from academic medical institutions, 

unlike most other medical endeavors.3 In fact, authorizing state statutes may pose legal 

obstacles to research.3 Medical examiner and coroner offices are poorly funded and poorly 

staffed, making research difficult even if it were a priority. Lack of time to perform research due 

to overwhelming casework was the number one complaint in a survey of academic forensic 

pathology programs,1 and the caseload has dramatically increased since then. Medical 

examiner and coroner offices generally do not have staff to help write and support grant 

applications. Forensic autopsies are performed by statutory authorization rather than consent 

of the next-of-kin; thus the need for informed consent to conduct biomedical research is 

outside normal procedures. Moreover, there is little incentive for research in these service 

offices. 

There are very few academic forensic pathologists in the US. Academic centers should be the 

stronghold of research in our discipline. Academic forensic pathologists have limited time for 

research because it is not prioritized over service work by their institutions. Not all academic 

centers with forensic pathologists have fellowship programs. Those that have programs provide 

limited training in research. A much greater volume of research emanates from Europe, where 

forensic pathologists are typically found in universities, where their careers are dependent 

upon publication. 

State Statutory Law: Research in medical examiner and coroner offices is a function of state 

law. There is no uniformity among the various states on this issue.

1-3,17-19 Compounding the 

problem is the absence of any one agency to help guide states. In many states, legal restrictions 

limit research and thus inhibit the efforts of medicolegal death investigation entities to advance 

science in public health, forensic science, and justice. State and local policies and statutes “may 

severely restrict or entirely preclude use of materials, even anonymous specimens destined for 

disposal.”2 In addition, state and local policies may inadvertently restrict families from pursuing 

promising research avenues that seek to benefit science, as well as contribute to the health 

outcomes of surviving family members following a sudden death. It is incumbent on state 

legislatures to reduce the barriers to scientific research and remove constraints. Such efforts 

would recognize the critical role of forensic research and allow the use of research samples, 

records, images and other media in the advancement of justice and health. 
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Recommendations

Variations in State statutes and local policy often impose onerous restrictions on medicolegal 

death investigation research and advances necessary to provide the scientific basis for the 

discipline. 

In order for progress to be made in research in medical examiner and coroner offices, States 

should:

• Specifically authorize use of information and biospecimens for approved research use 

and any legal barriers to such use be removed. 

• Allow for the utilization of anonymized biospecimens and contextual information, 

including imagery, that are retained during a medicolegal death investigation to

determine cause and manner of death for research and education. 

• Establish IRB oversight of research projects in compliance with Federal Regulations. 

• Ensure an appropriate IRB is available to MDI offices to review, approve, and oversee 

research. 

• Indemnify medicolegal death professionals and any parties in compliance of such laws.

• Facilitate academic appointments of forensic pathologist staff in state academic medical 

institutions.

The National Forensic Science Commission recommended the establishment of a National 

Office of Medicolegal Death Investigation.19 An area for federal consideration may include 

establishing an office of forensic medicine that has authority to provide grant funded research. 

The NIH and the NSF do not fund forensic pathology research. The National Institute of Justice 

(NIJ) funds limited forensic pathology research, but the Department of Justice had determined 

that medicolegal death investigation is outside their scope. The Centers for Disease Control and 

Prevention provides the most logical home. 

Federal support could be used to bolster forensic pathology research by: 

• Supporting two to three forensic pathology centers of excellence that provide strong 

death investigation including surveillance efforts, excellent training to residents and 

fellows, and a robust research portfolio. 

• Establishing research fellowships, career development awards and mentoring awards 

for forensic pathologists who engage in intra-disciplinary and cross disciplinary research. 

In academia, money is time. If a faculty forensic pathologist gets a career development 

award they need to be provided release time by both institutional and federal effort 

certification requirements. 

• Providing basic research education (human subjects and other compliance functions, 

tissue use ethics, etc.) to each cohort of forensic pathologist fellows through a 

combination of online and in-person training. Such training might foster some fellows to 

become researchers. However, what is more important is that they might embrace 
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collaborating with cross-disciplinary investigators or providing data and other resources 

to outside investigators in the future.

Conclusion

This document describes the need for increased research in medical examiner offices and the 

need to make information and biospecimens available for research. State law should specifically 

authorize such research and incentivize it through academic appointments. The federal 

government should consider establishing an office specific to medicolegal death investigation 

and, among other forms of assistance, provide support for external research. 

This document was developed using information sourced from government and professional 

publications widely accepted in the MDI community as representative of best practice 

standards. 

Bibliography

1. Nolte KB. Research Issues in Forensic Pathology: A Survey of Academic Institutions Employing 

Forensic Pathologists. Hum Pathol. 2004; 35(5):532-535. DOI:10.1016/j.humpath.2004.01.010. 

2. SWGMDI. Research in Forensic Pathology/Medicolegal Death Investigation: A Report and 

Recommendations Prepared by the Research Committee of the Scientific Working Group on 

Medicolegal Death Investigation (SWGMDI). June 2014. Available from:

https://www.nist.gov/system/files/documents/2018/04/25/swgmdi_research_in_forensic_path

ology_medicolegal_death_investigation.pdf. 

3. Weedn VW, Holdsworth MT, Barron AM. Legal and Ethical Considerations in Forensic Pathology 

Research. Acad For Pathol. 2011; 1(3):288-301. DOI:10.23907/2011.040.

4. Ventura-Spagnolo E, Mondello C, Cardia L, Ventura-Spagnolo O, Cardia G. Death by Facial and

Skull Injuries of a Motorcyclist Wearing a Full-Face Helmet: Case Report and Literature Review

Case Report: J For Res. 2016; 7(5)/349:1-4. DOI:10.4172/2157-7145.1000349.

5. Sandomir R. Dr. Mary Fowkes, 66, Dies; Helped Science Understand the Pandemic. New York 

Times. Nov. 26, 2020, Updated Dec. 1, 2020. 

6. Maiese A, Manetti AC, La Russa R, Di Paolo M, Turillazzi E, Frati P, Fineschi V. Autopsy findings in 

COVID-19-related deaths: A literature review. Forensic Sci Med Pathol. 2020; Oct:1-18.

DOI:10.1007/s12024-020-00310-8.

7. New Jersey Statutes (Unannotated): NEW JERSEY GENERAL AND PERMANENT STATUTES 

(updated through P.L. 2019, ch. 123 and J.R.15): TITLE 26. HEALTH AND VITAL STATISTICS: 26:6B14. Findings, declarations relative to causes of deaths, sudden deaths. N.J. Stat. Ann. § 52:17B88.10 et seq.

8. California Code, Government Code - Cal. Government Code § 27491, § 27491.4, § 27491.41, Cal.

Health & Safety Code § 102865.
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9. Sudden Unexpected Infant Death Legislation. National Conference of State

Legislatures.https://www.ncsl.org/research/health/sudden-infant-death-syndromelaws.aspx#:~:text=Cal.,-

Health%20%26%20Safety%20Code&text=The%20law%20requires%20the%20department,follow

ing%20a%20death%20from%20SIDS.

10. Kinney HC, Haynes RL. The Serotonin Brainstem Hypothesis for the Sudden Infant Death

Syndrome. J Neuropathol Exp Neurol. 2019;78(9):765-779. DOI:10.1093/jnen/nlz06.

11. Lu N, Butler CC, Gogineni A, Sarmiento, et. al. Redefining preventable death—Potentially

survivable motorcycle scene fatalities as a new frontier. J Surg Res. 2020; 256:70-75.

DOI:10.1016/j.jss.2020.06.014.

12. College of American Pathologists Ad Hoc Committee on Stored Tissue (W Grizzle, WW Grody, 

WW Noll, ME Sobel, SA Stass, H Travers, V Weedn, K Woodruff). Recommended Policies for Uses 

of Human Tissue In Research, Education, and Quality Control. Archiv Pathol Lab Med. 1999; 

123(4):296-300. DOI:10.1043/0003-9985(1999)123<0296:RPFUOH>2.0.CO;2. 

13. Roberts LW, Nolte KB, Warner TD, McCarty T, Rosenbaum LS, Zumwalt R. Perceptions of the 

Ethical Acceptability of Using Medical Examiner Autopsies for Research and Education. Archiv 

Pathol Lab Med. 2000; 124(10):1485-1495. DOI:10.1043/0003-

9985(2000)124<1485:POTEAO>2.0.CO;2. 

14. Fronczek J, van de Goot FRW, Krijnen PAJ, van der Wal AC, Niessen HWM. Diagnosing

Lymphocytic Myocarditis in Adult Autopsies Combining the Dallas Criteria with

Immunohistochemical Stainings. J For Res. 2016; 7/325(4):49-59. DOI: 10.4172/2157-

7145.1000325.

15. NH Rev Stat § 611-B:18 (1996 through Reg Sess) 611-B:18 Retention and Disposal of Organs,

Unidentified Remains, Body Fragments, and Body Fluids.

16. Views of the Commission: Communication with Next of Kin and Other Family Members, adopted

September 13, 2016, National Commission on Forensic Science.

https://www.justice.gov/archives/ncfs/page/file/1004661/download. 

17. Marsh, Tanya, The Law of Human Remains. Lawyers & Judges Publishing Company, Inc.; 1st 

Edition. 2015. 

18. Cantor NL. After We Die: The Life and Times of the Human Cadaver. Georgetown University

Press. 2010.

19. Recommendation on Model Legislation for Medicolegal Death Investigation, adopted January 9, 

2017, National Commission on Forensic Science. 

https://www.justice.gov/archives/ncfs/page/file/934406/download. 

20. Recommendation on Formation of a National Office for Medicolegal Death Investigation, 

adopted September 13, 2016, National Commission on Forensic Science.

https://www.justice.gov/archives/ncfs/page/file/905561/download. 
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Appendix A: Terms and Definitions

For purposes of this document, the following definitions apply:

Anonymized: the removal of identifying information from materials for research purposes.

Biospecimen: any biologic specimen derived from a decedent.

Cause of Death: a medical opinion of the disease or injury that resulted in a person’s death.

Informed Consent: the process for obtaining permission to perform research using materials.

Disposition: the action of transferring, distributing or disposing of materials (biospecimens).

State Chief Medical Officer: the senior state official designated as head of medical 

services within the state.

Institutional Review Board (IRB): an administrative body established to protect the 

rights and welfare of human research subjects recruited to participate in research 

activities conducted under the auspices of the institution with which it is affiliated.

Manner of Death: a classification system developed for public health statistics based on 

the circumstances under which death occurred; currently includes accident, homicide, 

natural, suicide, and undetermined. 

Medicolegal Death Investigation: the practice of a formal inquiry into the circumstances 

surrounding the death of a human; investigative information may be considered with 

autopsy findings and adjunctive studies (if performed) to determine the cause and 

manner of death. 

Medicolegal Death Investigation System: medicolegal death investigation office(s) 

(usually a medical examiner or coroner office) within a state or district that is a 

jurisdictional unit with a single chief medicolegal death investigation officer. 

Next of kin: the legally determined hierarchy of interested parties who have authority 

over the decedent. 
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Appendix B: Normative/Informative References

SWGMDI, Research in Forensic Pathology/Medicolegal Death Investigation: A Report and 

Recommendations Prepared by the Research Committee of the Scientific Working Group on 

Medicolegal Death Investigation (SWGMDI). June 2014 Available from: 

https://www.nist.gov/system/files/documents/2018/04/25/swgmdi_research_in_forensic_pat

hology_medicolegal_death_investigation.pdf

SWGMDI, Infrastructure Committee Report 1: Death Investigation Systems and NAME, ABMDI, 

IACME Representation in States, March 21, 2011 Available from: www.swgmdi.org

Department of Justice, Office of Justice Programs, National Institute of Justice. Death 

investigation: A guide for the scene investigator (technical update). Washington, DC. 2011. 

Available from: https://www.ncjrs.gov/pdffiles1/nij/234457.pdf

Middleton et. al. National Association of Medical Examiners Position Paper: Retaining 

Postmortem Samples for Genetic Testing. Acad Forensic Pathol. 2013 3 (2): 191-194 Available 

from: https://doi.org/10.23907/2013.024.

National Association of Medical Examiners (NAME), Forensic Autopsy Performance Standards. 

2016. Available from: https://name.memberclicks.net/assets/docs/684b2442-ae68-4e64-9ecc015f8d0f849e.pdf.

Scientific Working Group for Medicolegal Death Investigation (SWGMDI), Principles for 

Communicating with Next of Kin During Medicolegal Death Investigations. 2012. Available from:

https://www.nist.gov/system/files/documents/2018/04/25/swgmdi_principles_for_communic

ating_with_next_of_kin_during_medicolegal_death_investigations.pdf

Scientific Working Group for Medicolegal Death Investigation, SWGMDI’s Guide for Interactions 

Between Medical Examiner/Coroner Offices and Organ and Tissue Procurement Organizations 

and Eye Banks. 2013. Available from: 

https://www.nist.gov/system/files/documents/2018/04/25/swgmdi_standards_for_interaction

s_between_medical_examinercoroner_offices_and_organ_and_tissue_procurement_organizati

ons_and_eye_banks.pdf
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Scientific Working Group for Medicolegal Death Investigation, Facilities Workplace Locations of 

Board-Certified Forensic Pathologists in the United States who Perform Medicolegal Autopsies 

for Medical Examiner/Coroner Systems. Available from: 

https://www.nist.gov/system/files/documents/2018/04/25/swgmdi_workplace_locations_of_b

oard_certified_forensic_pathologists_in_the_us_who_perform_medicolegal_autopsies.pdf

Laura Weiss Roberts, Kurt B. Nolte, Teddy D. Warner, Teresita McCarty, Lizabeth Stolz 

Rosenbaum, and Ross Zumwalt (2000) Perceptions of the Ethical Acceptability of Using Medical 

Examiner Autopsies for Research and Education. Archives of Pathology & Laboratory Medicine: 

October 2000, Vol. 124, No. 10, pp. 1485-1495.

New Jersey Statutes (Unannotated): NEW JERSEY GENERAL AND PERMANENT STATUTES 

(UPDATED THROUGH P.L. 2019, ch. 123 and J.R.15): TITLE 26 HEALTH AND VITAL 

STATISTICS::26:6B-14 Findings, declarations relative to causes of deaths, sudden deaths. Stat. 

Ann. § 52:17B-88.10 et seq.

Victor W. Weedn MD JD, Mark T. Holdsworth PharmD BCOP, A. Marie Barron MA Legal and 

Ethical Considerations in Forensic Pathology Research, AFP, Vol 1, Issue 3, 2017

Marsh, Tanya, The Law of Human Remains. Lawyers & Judges Publishing Company, Inc.; 1st 

Edition. 2015

National Conference of State Legislators, Sudden Unexpected Infant Death Laws. Webpage 

Available at: http://www.ncsl.org/research/health/sudden-infant-death-syndrome-laws.aspx

California Code, Government Code - GOV § 27491.41 Available from:

https://codes.findlaw.com/ca/government-code/gov-sect-27491-41.html

U.S. Centers for Disease Control and Prevention. Public Health Professionals Gateway, Death 

Investigation Systems. Webpage. Available At: 

https://www.cdc.gov/phlp/publications/coroner/death.html

NH Rev Stat § 611-B:18 (1996 through Reg Sess) 611-B:18 Retention and Disposal of Organs, 

Unidentified Remains, Body Fragments, and Body Fluids Available at: 

https://law.justia.com/codes/new-hampshire/2015/title-lix/chapter-611-b/section-611-b-18/