Most Canadian’s die of natural causes – cardiovascular disease, cancer, diabetes, Alzheimer’s disease – to name a few. The timing of these deaths is usually unsurprising, and rarely warrants further investigation to allow the loved one of those affected to have closure. In instances of accident, homicide, suicide, or when a cause of death cannot be easily determined, the circumstances surrounding the death may warrant expert opinion. This information is important to families, the justice system, public health, and future health care planning.
From 2006 to 2017, 14 per cent of deaths that occurred in Canada were investigated by a coroner or medical examiner. Over the last few decades, the ‘autopsy’ – the examination of a body by a pathologist to evaluate disease and injury – has become less common. Approximately six per cent of all deaths in Canada lead to an autopsy, a number that was closer to 13 per cent in the early 1990s. The dissection itself combined with the additional testing done on tissue can become a fairly expensive endeavour. As our understanding of normal disease timelines has improved, the decline in the number of autopsies numbers is unlikely a major issue.
The problem with death investigation in Canada lies more in the resources allocated to the cases that are investigated. One might wonder: How is cause of death determined, and why should we invest millions of dollars in the process?
In Canada, there is no overarching federal authority over death investigation.
Death investigation is the responsibility of each province and follows either the coroner’s system or the medical examiner’s system.
In a medical examiner system, like in Alberta, all suspicious deaths are investigated by a medical examiner who is a trained forensic pathologist. Medical examiners review the deceased person’s medical information and the circumstances around the death, complete autopsies, and synthesize all of this information into their opinion on cause of death.
In the coroner’s system, a coroner is assigned to oversee death investigations and decides on the additional testing required before formulating an opinion as to an individual’s cause of death.
In Ontario, coroners are required to be physicians, usually general practitioners, and work closely with local forensics units to further delineate an individual’s cause of death.
In BC, coroners in charge of death investigation are not required to have formal medical training but they decide whether an autopsy by a pathologist is necessary. Ultimately, coroners make conclusions about cause of death based on the best information available to them. Given the lack of formal medical training, it is difficult to be confident that the accuracy of these conclusions will always be sound. And accurate information surrounding death has important implications for the living.
Many death investigation systems in Canada have had a tumultuous relationship with provincial governments and issues with adequate staffing and funding. In 2011, all of Calgary’s medical examiners resigned, and the same office saw four out of five medical examiners resign in 2018.
In Ontario, the Hamilton General Hospital forensic unit has been shut down as of July 2019 with cases being transferred to Toronto, despite being the second busiest of seven facilities in the province.
The Canadian public deserves better. In a tight fiscal climate, it is not surprising that it is hard to convince governments to invest in death investigation infrastructure. The reality is that the number of deaths requiring investigation is relatively low. While the upfront costs of updating morgues and investing in a handful of forensics experts for each province is high, it is a worthy investment with implications for families and the living.
Ontario has taken some steps in the right direction – the 2008 Goudge inquiry examined the system for forensic pathology in Ontario as a whole and identified a number of systemic problems, including incorrect determinations of causes of death in serious legal cases. Since then, systemic changes, including a new centre for forensic science in Toronto and the appointment of several forensic pathologists as coroners, are underway.
When will other provinces step up?
*A version of this opinion was first published in the Vancouver Sun
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Actually many Coroners in BC do have formal medical training and are very qualified to do this work. In many cases more qualified than those churned out of med school, simply because they have life experience, people skills and investigative experience. Ever meet a doctor truly interested in solving anything for their patients? Good luck in the job market Multan!
Thank you for your response and clarification. It is true as you say that some coroners have some medical training (prior nurses, foreign trained physicians, family docs, paramedics, etc), but this is not true in all cases. Of course, a freshly graduated MD would not be qualified to do this work. There are pros and cons to various was of approaching death investigation. In Canada we have a public health care system which necessitates that we prioritize government funding for the living. But I think most people would agree that many of our provincial death investigation systems could be modernized, improved, and better staffed (i.e. more qualified investigators and pathologists). Thank you for the luck! :)
I think we should model our death investigation system on CBC’s Coroner. Have only one Coroner for a city of 6 million people, who investigates nothing but wacky murders, and ends up hooking up with unusually attractive witnesses who not only help the exhausted doctor battle mental illness, but are also handy around the house.
In all seriousness, federal oversight of anything in Canada typically equates to federal overreach in the eyes of the provinces. The suggestion also presupposes that the federal government has the required expertise to build and coordinate a national death investigation system. Since, as the author points out, death investigation falls under provincial jurisdiction, one would assume that’s where all the expertise lies. It would probably make more sense to let bodies/conferences like the National Forum of Chief Coroners and Chief Medical Examiners develop the system model and best practice guidelines. Press each province to work towards the optimum from the ground up.
” It would probably make more sense to let bodies/conferences like the National Forum of Chief Coroners and Chief Medical Examiners develop the system model and best practice guidelines. Press each province to work towards the optimum from the ground up.”
This is an excellent point. I think what is alarming is how discrepant things are province to province – maybe even more so than in clinical medicine, which is certainly not “universal” either when you compare services available in rural communities compared to urban centers, and even between provinces. Most people don’t really understand the differences between the ME and Coroner’s system, and these differences are important and have serious implications when cases are mishandled.
The death investigation system requires significant improvements in all provinces. Ontario should not be used as an example of course correction. The 2019 Annual Report from Ontario’s Auditor General identified serious deficiencies and a lack of oversight in Ontario’s Coroner and Forensic Pathology Service that threaten to undermine the recommendations made in the Goudge Report. Unproven but unrefuted allegations have been made in various media outlets that Hamilton’s forensic pathology service was forcibly closed as retaliation against whistleblowers.