Postmortem: How Medical Examiners Explain Suspicious Deaths (review)

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...