Medicolegal investigative system and sudden death in Scandinavia.

The Nordic region consists of Denmark, with the autonomous territories of the Faeroes and Greenland, Finland, with the autonomous Aland Islands, Iceland, Norway, and Sweden. However, this review deals only with the situation in Norway, Denmark, Sweden and Finland. In these four countries only a physician can confirm that a person is dead and practically any physician can certify a death due to natural causes if he knows the cause of death. A clinical autopsy can be performed to confirm the diagnosis with the permission of the relatives. The regulations concerning the reporting and investigation of sudden unexpected and non-natural deaths are very similar in all Nordic countries. In general those deaths, which are criminal, suspicious, accidental, suicidal, sudden and unexpected, unexplained or in any way not due to natural causes, cannot be certified by a doctor and must be reported to the police for medico-legal investigation. Forensic Medicine exists as a medical specialty at present only in Finland and Sweden. The total autopsy rates vary from country to country, with the lowest autopsy rate in Norway-10.6% of all deaths, followed by Denmark-16%, Sweden-22% and Finland-31.1%. Despite the apparent similarities in legislation regarding those deaths which should be referred for medicolegal examination, the practices differ so much in the different countries that it is, in fact, not possible to make many valid comparisons. The number of Group XVI-cases (symptoms and ill-defined causes of death) of the International Classification of Diseases (ICD) in the mortality statistics of each Nordic country seems to be inversely correlated to the autopsy rate. This gives some indication of the efficacy of the certification of death in a given country. Finland, having the highest autopsy rate, has the lowest number of ill-defined causes of death. The declining autopsy rate in all Nordic countries seems to be in line with the international trend. If this tendency continues, it will, without doubt, have a negative impact on the reliability of mortality statistics in general and, in the individual case, increase the possibility of incorrect classification of the mode of death. In the worst instance this might result in failure to detect homicide.