Exhumation requests most often come from surviving relatives who want to move the remains to another burial site or who want to cremate long-buried remains. In criminal investigations, exhumation is unusual, and in the absence of permission from the surviving spouse or next of kin requires a court order. Such an order must be based on the reasonable expectation that the examination will yield important evidence for the prosecution or the defense of a criminal charge. In areas with competent medicolegal systems, the majority of such exhumations will be for suspected poisoning. A policy of retaining toxicology specimens on all deaths that come under medical examiner or coroner jurisdiction can reduce the number of exhumations. Of course, this policy does not address the cases that were never referred to these officials.

In areas with low rates of medicolegal autopsies, exhumation may be for the purpose of performing a primary autopsy to detect a homicide that may have been masquerading as an accident or a suicide. Or, exhumation may be to identify the decedent, to develop evidence in a medical malpractice case, or to search for lost objects. In one instance, a body was exhumed to complete an autopsy in which neck organs or cranial contents had not been removed (33). Thus, autopsies on exhumed bodies may be done both in criminal and in civil court cases.

State laws define who may authorize disinterment and under what circumstances this may be done. If the exhumation is pursuant to court order, the prosecuting attorney or civil attorney with the interest in the exhumation will draw up the order, and make application to a court. If the judge approves, he merely signs the order prepared by the attorney. The interested parties, including the pathologist, will normally be informed about date, time, and other particulars before the order is signed. After the autopsy, the remains are re-interred, the pathologist prepares a report, and makes copies as he would for a routine autopsy.

The principal participants in an exhumation are the petitioner, the cemetery director, the funeral director, and the pathologist. For the pathologist, the procedures differ little from those used in any other autopsy. The pathologist's assistant usually has to remove the remains from the casket, undress them, and redress them after the autopsy. The funeral director arranges with the cemetery director for the timely arrival of the back hoe operator and the diggers, both for disinterment and re-interment.

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