A death is a coroner’s case if it is unexpected or if there is any possibility that a law has been broken. Not every death that occurs outside a hospital is a coroner’s case. If the deceased had a physician who is reasonably certain of the cause of death and is willing to sign a death certificate, further medical examination may not be required.

The coroner system in the United States is in difficulty. Only the largest cities have forensic pathologists to act as coroner and do the medical examinations. In small, rural counties, the coroner may be a physician who has no forensic training, or it may be the sheriff or the mortician. A physician who is asked to act as county coroner should try to learn something about forensic medicine and should be quick to ask for assistance from experts when it is needed. The time of death or the angle of gunfire may determine whether the person committed suicide or was murdered.

The percentage of deaths that are autopsied has been falling for many years. Autopsies benefit society by providing information about hidden pathologies and about the accuracy of medical diagnoses. But they do not benefit the patient, and they are sometimes opposed by physicians who do not want the accuracy of their diagnoses challenged. Because of these factors, there is little money available to pay for autopsies. Even when it is feasible to do an autopsy, many physicians do not know how to obtain consent. Physicians should be familiar with the state law in their jurisdictions governing the persons who may consent to an autopsy. If there is any question of criminal activity, the autopsy may be ordered by a court or the coroner.