[Problems of the medicolegal system for unnatural or unexpected deaths in Japan].

Each area in Japan has its own system for postmortem examination of unnatural death or sudden unexpected death. Large cities like Tokyo, Yokohama, Osaka and Kobe have the medical examiner system. In the areas autopsies are performed for the unknown cause of death and for other reasons. Kyoto and Nagoya used to have the system but it was repealed in 1985. In the most part of Japan, the areas without the system, the causes of death are estimated by external examination without autopsy. Medical Examiner's Office, Tokyo Metropolitan Government, examines approximately 7,000 corpses for a year. This number accounts for 15% of total number of death in the area concerned. The author has been a medical examiner since 1969. He has examined 6,084 corpses for 21 years. The 38.4% out of his cases were autopsied. The causes of death suspected at the external medicolegal examinations and the causes determined by autopsies were compared. Not a few diagnoses had serious errors: some extrinsic death was primarily diagnosed as intrinsic diseases, and vice versa. In conclusion, the proportion of cases with serious errors was 15.5% of the total cases of his external examinations. It is extremely difficult to determine the cause of unnatural or unexpected death without autopsy. An error in the postmortem examination infringes on the right of the deceased and his or her family. It still exert a baneful influence upon the public health, social security, life insurance and other related matters. The author insists on the need for medical examiner system all over Japan. This is already asserted by Prof. Kuniyoshi Katayama in 1889. However, it was not until 1946 that the system was applied only to above mentioned areas, and no more than that still now.