More autopsies here than in other Nordic countries
Despite serious crimes such as murder, the high number of autopsies is relatively rare in Iceland. One student’s fascination with forensic pathology and the potential value of an autopsy led her to find out more. Sara Jóhannsdóttir decided to look for answers as part of her master's project in forensic science, which she undertook at Uppsala University in Sweden. Sara worked for two summers at the police’s technical department and examined how deaths are investigated here in Iceland.
“So I contacted Pétur Guðmann, a forensic pathologist, and we saw an opportunity to actually examine what causes autopsies to happen relatively frequently in Iceland. We decided to do a 10-year retrospective study, in which I reviewed the data of all forensic autopsies performed in Iceland from 2011 to 2020.”
Sara says that the profession has developed greatly recently, with new and exciting working methods being introduced. Forensic science involves a series of data investigations that may contain biological samples. Sara looked at such data in all kinds of cases, such as sexual offences and physical assaults.
The frequency of forensic autopsies is high here
Sara's investigation is the first of its kind in Iceland but shows that the frequency of forensic autopsies in Iceland is the second highest among Nordic countries. Only in Finland are there more autopsies carried out, proportionally, than in Iceland. In 2020 the frequency of autopsies here was 11.5 per cent compared to under three per cent in Denmark, where the fewest autopsies are performed.
Here, it’s up to the police to decide if an autopsy is needed. Sara says they happen relatively frequently here partly because of the law on death certificates and autopsies in Iceland, which says a forensic autopsy must be performed when the cause of death cannot be determined medically. By contrast, in Denmark, a forensic autopsy won’t happen if it is obvious that the death does not look like a police case.
“Forensic autopsies were only performed in 20% of suicide cases in Denmark, while in Iceland it happens in all suicide cases.”
The common belief that forensic autopsies are only carried out if a death is suspicious is unfounded because, according to Sara's research, only 2.8 per cent of deaths were thought to be suspicious based on the police's working theory at the scene.
“And what was interesting, was that the results of the study showed that the most common type - 40% of all cases - looked like sudden natural death before autopsy. That is, there was no obvious external cause of death at the scene, and most of these cases were later found to involve natural deaths at autopsy. However, 8.8% of those deaths were later found to be unnatural: a large number of those were caused by poisoning, for example, by alcohol, sedatives, stimulants, opioids – really any kind of poisoning or overdose.”
Autopsies are more common in rural areas than in the capital
Poisoning was the most common unnatural cause of death, accounting for 20% of all autopsies during this period.
There is a big difference between the sexes regarding the frequency of autopsies - 72% are men and only 28% of women. This, says Sara, was not surprising because the ratio is comparable with other foreign studies. Still, there are various reasons for the difference. Men are, for example, more likely to die in accidents and suicides, and heart diseases happen earlier in their lives than women. According to Sara’s work, the most common natural cause of death was heart disease, accounting for 30 per cent of all cases.
One of the things that surprised Sara, however, was that the frequency of forensic autopsies was slightly higher in the countryside than in the capital area, despite the likelihood of greater difficulty due to the distance from technology and pathology departments.
“I don't have any obvious explanation for this, but we wonder if it’s because at certain times of the year, the number of people in Iceland rises significantly due to tourists. Popular tourist spots tend to be in more rural parts and not in the capital area, so when somebody dies and that triggers an autopsy [for whatever reason], this could possibly have an effect.”
Sara's research is comprehensive. Data was reviewed in all 1878 autopsies performed during the ten-year period, and she says the results provide an opportunity to improve and update the investigation system after someone’s death. She thinks it could be important and interesting to look further at poisonings, given that they turned out to be the most common unnatural cause of death recorded in forensic autopsies over the last ten years.