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Sometimes, autopsies aren’t what people want

Sarah Traynor, 7 years old and mildly autistic, was found hanging by a jump rope attached to the top bar of a swing set in her backyard.

The Supreme Court of Victoria at Melbourne, Australia, ruled for Sarah’s parents and against the coroner and directed that no autopsy be done.

My first reaction to the ruling was that it’s crazy. My second reaction was to ask myself why the coroner and her forensic pathologist weren’t able to sway the court.

Sarah was playing in the yard after school. Her mother, who was in the house, heard nothing amiss. Sarah had been unobserved for half an hour at most when her father found her.

The rope was knotted about halfway down. Sarah’s head was through the rope; her feet barely touched the ground. Marks on her neck corresponded to the rope’s position.

Nothing in a CT scan “led to the conclusion that anything was amiss.” Toxicology tests detected nothing suspicious. Sarah’s doctors had no misgivings because her parents were “wonderful to her.”

Perhaps Sarah died accidentally, as the police thought. Perhaps she mimicked something she’d seen on television. Perhaps she’d heard about the “choking game” foolish children play. To get a high, kids constrict their throats by hand or with a ligature or allow someone else to do so. Some die. An autopsy wouldn’t clarify Sarah’s thinking.

Suicide by the very young is rare but not unheard of. Well-documented cases have been reported. An autopsy couldn’t prove Sarah’s intent.

Sarah’s hanging could have been staged by someone who strangled her or killed her by some other means. Staged hangings are at least as rare as childhood suicides, but all forensic pathologists worry about the possibility.

CT scans can’t detect the subtle differences between hanging and strangulation or reliably rule out all forms of head injury. I’d want to examine Sarah’s body with my own eyes to confirm that her injuries were typical of hanging and not suggestive of strangulation and to make sure she had no additional injuries or indications of a struggle.

It’s highly unlikely that anybody killed Sarah silently, in broad daylight, with her mother in the house, in such a short window of opportunity. But I’m more suspicious than most because I’ve seen more bad stuff than most. I’d autopsy Sarah out of an abundance of caution.

My argument is the same as that of the coroner’s pathologist: “Whilst the cause of death appears … to be neck compression, an autopsy is necessary to ensure there is no evidence of non-accidental injury in such a young child who has died in extremely unusual circumstances.”

The court found that the anguish of Sarah’s parents outweighed the public interest in a procedure intended “to exclude a hypothetical scenario which does not appear to be indicated by the evidence or circumstances.”

When I studied forensic pathology under Dr. Charles Hirsch, staff members sometimes got a little huffy over objections to autopsies. Hirsch would take a family to court to override an objection if he felt strongly that an autopsy served the public interest. But in a lot of cases, he acquiesced without a fight.

It’s not our job to mandate what society should want, he’d say. It’s our job to provide the service that society does want.

I know Hirsch was right and that the court’s decision isn’t crazy. It’s just hard for me to accept that sometimes the service I’m trained to provide isn’t what society wants.

Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at chuser@durangoherald.com.