Postmortem: How Medical Examiners Explain Suspicious Deaths.
Stefan Timmermans' new book Postmortem resides at the intersection of the sociology of the professions and the sociology of science. In six substantive chapters he examines, from different perspectives, the process whereby medical examiners arrive at cause-of-death determinations. These determinations are monumental to a diverse array of audiences. Police use them for criminal investigations and health officials monitor them for demographic changes in mortality rates, and also for signs of potential outbreaks of disease. Grieving families often hope to find in the reports some meaning in a loved one's death, and are occasionally outraged at official determinations of "suicide." Insurance companies are always interested to learn that someone might have died in a way that voids his/her life insurance policy.
The primary research took place in a medical examiner's office where Timmermans attended autopsies over a period of three years. In the classic model of laboratory studies, this allowed him to develop a process-oriented account of the creation of facts. While each chapter takes a slightly different angle on the topic, each revolves around the central question of how examiners establish and maintain their authority. To accentuate such processes the author dedicates specific chapters to situations which potentially challenge a medical examiner's authority; challenges which are most acute when they involve potential wrongdoing by a medical examiner's usual allies: the police and medical professionals.
Audiences interested in the dynamics of "science in the courtroom" will enjoy the chapter on how forensic authority was contested in the "Nanny Trial." Timmermans, however, makes the insightful observation that for medical examiners the law is not confined to the courtroom, but permeates almost every aspect of their practice. Just about everything done in a medical examiner's office involves anticipating how it might be interpreted in the courtroom.
Although the book is not sensationalistic, it might still prompt uncomfortable moments for some readers such as when, immediately prior to cutting open a corpse that had been immersed in a pond, a medical examiner casually advises Timmermans: "If something jumps out, kill it." As the parent of a young child, I flinched at the details of a medical examiner sawing out the rib cage of an infant who had died in a suspected case of child abuse, and then twisting and torturing the bones in search of previous fractures. Timmermans' brief conclusion reflects upon how he was able to cultivate a detached orientation to dismembering corpses. Even for longstanding medical examiners such professional detachment is never perfect and certain classes of cases--often those involving children--continue to pose difficulties in treating bodies exclusively as inanimate objects.
I experienced an entirely different level of discomfort when reading the chapter-length examination of the relationship between forensic examiners and the now thriving organ and tissue trade. Years ago I overheard a comment that a corpse is almost commercially worthless, valued at only a few dollars worth of chemicals. Such a valuation clearly predated the emergence of the contemporary market for all manner of human detritus, including skin, corneas, bones, glands, tissues and assorted organs. While transplant authorities claim moral authority in asserting that they are working for the benefit of humanity, the tissue trade in the United States operates largely on a for-profit basis, and much of what is harvested is nonvital tissue, often used for aesthetic procedures. The end result is that a healthy cadaver--if that is not an oxymoron--can be worth up to $220,000. Medical examiners therefore now often confront increasingly aggressive transplant authorities who accuse them of destroying useful (and valuable) organs in conducting what they deem to be "unnecessary" autopsies.
A medical examiner's findings as to cause of death typically becomes the determination of historical record. Nonetheless, questions linger about the accuracy of their findings. Medical examiner's decisions reside at the intersection of science and law, and are informed by organizational dynamics and human processes. So, while determinations are typically sound and fair--in that they follow the rules, employ the best available science, and show little evidence of outright bias or corruption (something that has traditionally plagued coroner's offices)--questions remain about, for example, whether a single car accident might have been a suicide, or whether a death in custody could have involved police violence.
Assorted factors limit a medical examiner's ability to arrive at an accurate determination. Some lethal substances, such as insulin, become undetectable very quickly. Still other poisons are almost impossible to sense on a body that has been immersed in water for a long time. Medical examiners also employ questionable heuristics to arrive at their decisions, as with the routine practice of assigning "coronary artery disease" as the cause of death for individuals who have 75% of their coronary arteries occluded and who demonstrate no other evidence of contributing factors. This informal working rule rests uncomfortably with the fact that it is not unheard of for people to live with up to 95% of their arteries occluded. Perhaps most intriguingly, Timmermans notes that it is very unlikely that a person who dies from their first heart attack will have "heart attack" listed as their cause of death, as a fresh heart attack leaves no pathological traces (59).
That such cause of death determinations are contingent and open to question would appear to be a transparently important point deserving of considerable publicity in a culture currently celebrating the authority of forensic science. For my tastes, however, while this point was certainly apparent to the attentive, it was curiously under-emphasized. Hence, it is fair to speculate as to why this might be the case, particularly as, in a highly reflexive way, the answer might affirm one of Timmermans' general points. As noted above, Timmermans found that the practice of medical examiners was shaped by their need to be keenly attuned to how powerful institutional audiences might interpret their findings. Timmermans, in conducting his research, found himself in a comparable structural situation. Having negotiated access to a medical examiner's office, which is itself quite an accomplishment, he found that the chief medical examiner wanted to read every chapter of his book to ensure that he did not breach confidentiality. Such a situation could not help but shape the tone and emphasis of his findings. Unfortunately, Timmermans quickly passes over this situation in just one line, but such practices deserve more detailed consideration from qualitative researchers who might also want to conduct research in otherwise inaccessible sites of professional power.
Kevin D. Haggerty, University of Alberta
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|Author:||Haggerty, Kevin D.|
|Publication:||Canadian Journal of Sociology|
|Article Type:||Book review|
|Date:||Mar 22, 2007|
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