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Investigation of suspicious deaths and deaths

related to violence - A Malaysian perspective

Article in Journal of Clinical Forensic Medicine · October 2003

DOI: 10.1016/S1353-1131(03)00041-5 · Source: PubMed

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Journal of Clinical Forensic Medicine (2003) 10, 173–178

2003 Elsevier Science Ltd and AFP. All rights reserved.
doi:10.1016/S1353-1131(03)00041-5

REVIEW

Investigation of suspicious deaths and deaths related

to violence – a Malaysian perspective
Kasinathan Nadesan,1 Beng Beng Ong,2 P. Nambiar3
1
Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; 2Queensland Health Scientific
Services, Qld, Australia; 3Oral Radiology Division, Faculty of Dentistry, University of Malaya,
50603 Kuala Lumpur, Malaysia

Keywords: Death investigation; Coroner; Suspicious death; Violent death; Criminal procedure code

Journal of Clinical Forensic Medicine (2003) 10, 173–178

INTRODUCTION EVOLUTION OF THE CORONER AND OTHER

Investigation of suspicious and violent deaths forms
an important aspect of the administration of justice.
In a routine medico-legal practice the need often
arises to investigate various types of deaths. In some
deaths the cause and manner of death are obvious
and therefore an elaborate investigation may not be
necessary. However, for some deaths owing to the
nature and because of apparent suspicious circum-
stances surrounding the death a detailed investigation
becomes important. Legal, law enforcement and
medical personnel who are involved in the investiga-
tion of sudden, unnatural, violent and suspicious
deaths, in addition to various knowledge should
ideally have some background information regarding
the historical evolution of the death investigation
system. This paper explores the Malaysian perspec-
tive of routine death investigation.
Received 4 December 2002
Accepted 23 March 2003
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Kasinathan Nadesan MBBS, MD, FRCPath, FRCPA, DMJ(Path),
DMJ(Clin), DLM, Professor in Forensic Pathology, Faculty of
Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Beng Beng Ong MBBS, MPath, FRCPA, DMJ(Path), Forensic
Pathologist, Queensland Health Scientific Services, Queensland,
Australia.
P. Nambiar BDS, BSc, MSc(For. Odont), MSc(Dent.Rad), PG
Dip.Dent(Maxfac Rad), Associate Professor and Head, Oral
Radiology Division, Faculty of Dentistry, University of Malaya,
50603 Kuala Lumpur, Malaysia.
Correspondence to: Prof. Kasinathan Nadesan, MBBS, MD,
FRCPath, FRCPA, DMJ(Path), DMJ(Clin), DLM, Tel.: +603-
7950-2912; Fax: +603-7955-6845; E-mail: nadesan@um.edu.my
SYSTEMS OF DEATH INQUIRY
There have been in existence for many centuries now
two basic death inquiry systems, both of European
origin. Other countries have cautiously adapted those
systems with various modifications to suit their local
needs.
Broadly speaking the English death inquiry system
evolved from Norman modifications of Anglo-Saxon
Laws and the other from the European continental
law, originating from the Roman Law, strongly in-
fluenced by the Napoleonic Code.1
With time the English system gradually evolved
into the well-known office of the ‘‘coroner’’. From
there the coroner’s system slowly spread to Wales,
Ireland and other British colonies. The death in-
quiry system that now exists in Malaysia, India and
Sri Lanka are to some extent similar to one an-
other, and derived from the British colonisation.
The coroner system of death inquiry in the United
States has been gradually transformed into the
medical examiner system, though coroner system
still exists in certain states. The medical examiner
system was first introduced in the United States in
1887.2
THE INQUEST SYSTEM OF DEATH INQUIRY
The role of the inquest in modern society is to de-
termine the medical cause of death, to allay rumours
or suspicion, to draw attention to the existence of
circumstances which, if unremedied, might lead to
further deaths, to advance medical knowledge and to

173
174 Journal of Clinical Forensic Medicine
preserve the legal interests of the deceased person’s
family, heirs or other interested parties.
The English coroner investigates deaths in the
following situations:
• Deceased not attended to by a doctor or the
doctor treating the deceased not having seen the
patient within 14 days of death
• Death was violent, unnatural or suspicious
• Cause of death not known or uncertain
• Death during surgery, anaesthesia, etc.
• Death caused by industrial disease
• Death in prison, custody, etc.
In Malaysia inquests are referred to as ‘‘inquiries of
death’’ in Chapter 32 of the Criminal Procedure Code
(Act 593), (CPC).3 In Section 329 of this chapter a
police officer is authorised to investigate the follow-
ing deaths under this section:
• A person has committed suicide
• A person killed by another, an animal, by ma-
chinery or accident
• A person has died under suspicious circumstances
and that some other person may have committed
an offence
• Cause of death not known
• A person had died a sudden death
The investigating police officer under Section 330
of the above chapter may request a ‘‘government
medical officer’’ to conduct the postmortem exami-
nation.
In addition according to Section 334 of the above
Chapter the magistrate is expected to conduct an in-
quiry when a person dies in the following situations.3
• in police custody
• in prison
• in mental hospital
It is believed that deaths that occur in remand,
detention centres, rehabilitation centres and refor-
matories too should be included in the above list
though no specific references are made in the Crimi-
nal Procedure Code (CPC).
The magistrate who holds an inquiry:
• may order the medical officer to hold a post-
mortem
• may order a body to be exhumed
• may view a body
• determine who, when, where, how and after what
manner the deceased came by his death
• determine whether any person is criminally con-
cerned in the cause of death
In Malaysia there is no full time coroner or coro-
ner’s court. The magistrate acts as the coroner, and
the police conduct all routine death investigations. In
certain deaths magistrate conducts the inquiries.
Chapter 32, Section 329(1) of the Malaysian CPC
which enumerates the deaths that should be subjected
to an inquiry/inquest is confusing and lacking in de-
tails.3 It may be useful to refer to the practices in
England and even in neighbouring Singapore. In
England separate reference is made to deaths that
occur during surgery, anaesthesia or any other ther-
apeutic procedures and an inquest is mandatory in
such deaths. In Singapore too similar situation pre-
vails. But there is no such reference in the Malaysian
CPC. However, in Section 328 of the Malaysian CPC
there is reference to ‘‘death resulted in any way from,
or was accelerated by any unlawful act or omission
on the part of any other person’’ to be subjected to an
inquest. But since this statement is very subjective
and non-specific, many surgical deaths or deaths due
to any other therapeutic procedures are not subjected
to inquests and instead the bodies are released by the
doctors with a probable cause of death that seems to
satisfy the police. Unless the deaths are due to some
form of intentional violence the police are not gen-
erally interested in such deaths. There is less aware-
ness that inquests in such deaths may be essential to
protect the interest of the next of kin. Inquest and
postmortem may be the only way to exclude negli-
gence on the part of the doctors or the institution
where the deceased was treated. It is also important
to realize that inquest not only serves the interest of
the next of kin but also protects the interests of the
doctors and the institution from unnecessary allega-
tions and even possible litigation. Furthermore
postmortem in such deaths is educative, serves the
larger interest of the society and plays an important
role in quality assurance. At present therefore in
Malaysia such deaths very rarely are subjected to
inquests or postmortem. Religious and cultural sen-
sitivities certainly play an important role and con-
tribute to this contentious situation.
In the English inquest system all deaths due to
industrial diseases should be reported to the coroner.
Invariably such deaths are subjected to postmortem
in order to establish the accurate medical cause of
death because such deaths involve the payment of
compensation. In Singapore too a similar system
exists and specific reference is made to deaths that
occur due to industrial or occupational diseases. In
the Malaysian CPC, however, there is no such specific
reference.
In Malaysia magistrate acts as a coroner, and very
rarely he conducts a public inquiry (inquest). If the
need arises for a public inquiry then the magistrate
court premises are used for this purpose, as there are
no separate coroner’s court. Also no jury is present

during such inquiries (even otherwise there is no jury
system in Malaysia). The coroner in Malaysia does
not play a visible role in the investigation of sudden
deaths. Ideally there should be a full time coroner
who should inquire into various types of deaths. He
should visit the scene of death and decide whether a
postmortem examination is necessary. The coroner
should issue the order for postmortem, and based on
the doctor’s findings he may finally issue the medical
cause of death similar to the English coroner system,
referred to as the coroner’s certificate of cause of
death (Section 23(1) of the Births and Deaths Reg-
istration Act 1953). Ideally it is the coroner who
should peruse the available documents and facts in-
cluding medical records before deciding whether a
postmortem is necessary or not. In Singapore the
coroner examines the records and discusses with the
pathologist and then decides on the need for post-
mortem, particularly in hospital deaths. However,
indictable offences such as murders and road traffic
deaths are invariably subjected to postmortem. But in
Malaysia the police undertake this task and decide on
the need for postmortem. Police issues a document
‘‘P61’’ that authorizes the doctor to perform a med-
ico-legal postmortem which is referred to as a ‘‘police
case’’. This may not be a very satisfactory practice.
In Malaysia the doctor who has treated the de-
ceased in non-inquest cases and the doctor who
conducted the postmortem in inquest cases issue the
certificate of cause of death and the burial permit.
Ideally it is the coroner who should issue the burial
permit. According to Chapter 32, Section 330 of the
Malaysian CPC, if the investigating police officer is
satisfied as to the cause of death and that the de-
ceased came by his death by accident he may order
the body to be buried forthwith. Even though the
CPC does not elaborate on this section, it is related to
obvious cases of non-indictable accidents. For ex-
ample when a child while playing in the river with
other children get accidentally drowned in front of
many people then the investigating police officer may
give the verdict as accidental drowning and request
the body to be disposed of. In cases of deaths oc-
curring at home, where the deaths are believed to be
due to natural causes, the police or the local authority
issues the burial permit and certificate of cause of
death. Unfortunately the medical causes of death
given by these officials are often very unscientific.
There are, however, moves to take away the duty of
issuing death certificates from the hands of the police
to a central local authority. Only in cases where
postmortems are performed one may expect a scien-
tific cause of death. Disposal of the dead is by burial
or by cremation. While Muslims bury their dead,
Hindus and Buddhists invariably cremate. Once the
Investigation of suspicious deaths 175
body is cremated then all the evidence is lost. In the
UK to dispose of a body by cremation a special
‘‘cremation order’’ has to be obtained (certificate E).
In cases that are subjected to inquest the English
Coroner often consults the pathologist before per-
mitting cremation although wide-ranging inquiries
are reviewing this system. In some countries the in-
quiring authorities are reluctant to permit cremation
in certain types of deaths due to fear of losing any
evidence if the need arises for subsequent investiga-
tion.
INVESTIGATION OF DEATHS IN POLICE
CUSTODY, PRISONS, AND RELATED
PLACES
When a person dies in police custody, prison or a
mental institution invariably the body is subjected to
postmortem examination. There is provision in the
Malaysian CPC under Section 334 Chapter 32 for the
magistrate to inquire all such deaths immaterial
whether the deaths are due to natural or unnatural
causes and where the medical cause of death is cer-
tain. Death occurring in police custody may cause
apprehension in the minds of the relatives and even
the public. Some of these deaths may even have se-
rious political implications.4 A thorough medico-
legal investigation followed by an inquest conducted
by a magistrate may allay the anxiety of the relatives.
Besides, it protects the police or other institutions
from unnecessary allegations.
Death in police custody does not necessarily mean
that the detainee had died of police assault or ill-
treatment. However, one should not ignore the exis-
tence of police excesses, torture and other forms of
degrading and inhuman treatment.5 Sometime the
detainee may have committed suicide but there could
be underlying reasons for that act and the police may
be incriminated. It is the responsibility of the agency,
which retains these persons to ensure that they are
physically protected and to be aware of, and to take
preventive measures if they suspect that a detainee
may commit suicide. Another issue is the fitness to
detain in custody. This aspect does not receive serious
consideration, in some countries. Police in some
countries are not suitably trained on these matters
and suspects are detained who may be suffering from
various medical conditions that need medical atten-
tion or regular treatment. If something untoward
happens to the detainee who is already suffering from
a natural disease condition, by virtue of being locked
up and denied access to suitable medical treatment
may place the police in a vulnerable situation. Often
ignorance is attributed to unnecessary deaths in cus-
176 Journal of Clinical Forensic Medicine
tody. Sometimes drug addicts, or persons suffering
from highly infectious conditions such as open tu-
berculosis, are locked up with other detainees. As a
result the other detainees too are exposed to unnec-
essary risk of getting infected and the police may
become liable for litigation in the event a detainee
contracting a disease while in custody. Of course
police also face various logistical problems which
naturally compromise safety standards.
For the first time in Malaysia the next of kin of
two detainees who died in police custody requested
for a second postmortem in spite of the magistrate
inquiring into the deaths and postmortems have al-
ready been performed. These two deaths were unre-
lated but occurred within a short time of one
another. The victims were arrested by the police for
alleged involvement in various criminal activities. A
second postmortem is some thing entirely new to
Malaysia. This is the first time where such a request
had been made, especially in custodial death. Natu-
rally this led to some anxiety and controversy in the
minds of doctors and the police. The forensic unit of
the University of Malaya Medical Centre (UMMC)
Kuala Lumpur handled these two cases, and every
known protocol was followed while performing the
second postmortem. At the UMMC there is a pro-
tocol in place for performing the so-called private
autopsies at the request of the relatives or private
hospitals. However, so far all these cases were deaths
due to natural causes and also first postmortems.
There were instances where the doctors treating the
patients in private hospitals were prepared to issue
death certificates and release the bodies without
postmortem but yet the relatives insisted on a private
clinical postmortem as they were possibly not satis-
fied with the quality of treatment rendered. At least
some of the forensic medical practitioners considered
such requests to be a progressive step as it enhances
the quality of care and may become the basis for
quality assurance and auditing. Being the first expe-
rience in undertaking second postmortem, unfortu-
nately there was room for the doctors who
performed the first postmortems to view this proce-
dure as an inquiry into their work and conduct.
There is no restriction to perform a second post-
mortem, even in medico-legal cases, in the Malaysian
CPC. Section 335(2) of the Malaysian CPC em-
powers the magistrate holding the inquiry in custo-
dial deaths to request a medical officer to perform a
postmortem in order to discover the cause of death
even where a postmortem has already been per-
formed under Section 331 of the CPC. Section 331
refers to the postmortems arising from routine in-
quiries of death. Section 335(2) also states that the
inquiring magistrate could order the body to be ex-
humed for the same purpose. Therefore it was as-
sumed that unless the body is already buried, there is
no documented objection for performing a second
postmortem at the request of the relatives even in
medico-legal cases.
INQUIRY INTO SUSPECTED TORTURE
VICTIMS
Torture is a serious problem in many developed and
developing nations. According to 1975 Declaration
of Tokyo, torture is defined as ‘‘the deliberate, sys-
tematic or wanton infliction of physical or mental
suffering by one or more persons acting alone or on
the orders of any authority, to force another person
to yield information, to make a confession, or for
any other reason’’.6 Torture is a perverted form of
human interaction, extreme degradation, humilia-
tion and dehumanisation. There is severe pain and
or psychological suffering experienced by the victim.
The victim is entrapped in a double blind situation
where he is deprived of all rights and is forced to
choose between two impossible options.7 Physical
torture takes various forms and the list is endless.8
Many victims do survive while others may die. In
the event of death there will be desperate attempt to
cover up the crime. There should be an independent
judicial inquiry in such deaths and there is definite
advantage in having the jury in such inquests. But
there is no jury system in Malaysia. Medical exam-
ination of both the living and fatal victims of torture
is essential and the examining doctor should have
specialised knowledge regarding various torture
methods so that he can interpret his findings in an
objective manner.9 There may be misleading testi-
mony and even ‘‘pressure’’ may be brought upon
doctors to cover up or ‘‘soften’’ up the crime.10 They
may be requested to fit in their findings to some
fabricated story to explain the injuries or even
death.
Therefore the doctor should preferably be an ex-
perienced forensic specialist and should be able to
follow established protocols in handling such cases.
At present there is a dearth of qualified forensic
practitioners in Malaysia and major bulk of medico-
legal duties are handled by medical officers who do
not have the necessary training or experience in
handling such cases.4
EXHUMATION
Exhumation or disinterment is to take the human
body or remains of a body or the coffin containing a

body out of the place of burial or disposal. Place of
burial may be public burial grounds, family burial
grounds or places of surreptitious disposal in cases of
concealment of death. There is provision in the Ma-
laysian CPC for exhumation under Chapter 32, Sec-
tion 335. Authority for exhumation lies with the
magistrate. When a request being made by the police
or a petition is filed by interested parties for exhu-
mation, the court if satisfied will grant permission for
exhumation. If the court approves then arrangement
for exhumation is made after consulting all the in-
volved parties such as the relatives, cemetery keeper,
pathologist’s team and other interested parties.
Medico-legal exhumation may provide answers for
the following issues:
(a) Determination of identification of the dead person
(b) Verify identification of the dead
(c) New evidence may be discovered
(d) May help in the determination of the medical
cause of death and the manner of death such as
accident, suicide, homicide or a natural cause
(e) May help in reconstruction of the event that led to
the death
(f) Forensic evidence could be collected from the
body or the location of the site of burial
(g) May help to identify pre-existing natural disease
that may directly or indirectly contributed to
death
(h) May help in resolving civil issues such as comm-
orientes
(i) Most importantly it may help the family in getting
over various apprehensions based on previous
findings or rulings
In Malaysia exhumation is very rare. As a result
forensic pathologists also lack experience or exper-
tise in handling exhumation. There are certain pro-
tocols to be followed besides actual examination of
the exhumed remains. Interpretation of the findings
needs care and experience because several post-
mortem artifacts would have been introduced.
Failure to recognise such artifacts may lead to
miscarriage of justice. Mass grave exhumation or
excavation has become a major problem in many
countries. This is a situation where several bodies
are buried in a single grave without coffins following
mass killing by rival groups or extrajudicial execu-
tion carried out by members of the armed forces or
politically backed death squads. Exhumation in such
situations is carried out mainly on a humanitarian
level to inform thousands of families about the fate
of their loved ones and to act as a deterrent to those
who might commit similar abuses. The findings will
also provide evidence for criminal trials to bring the
culprits to books and also for the payment of
Investigation of suspicious deaths 177
compensation.11 Mass grave exhumation always in-
volves teamwork and it involves time, effort and
trained personnel. The personnel involved should be
familiar with the model protocol for exhumation of
human remains, skeletal remains and mass graves.12
It is very fortunate that Malaysia is free from such
problems.
TEACHING OF FORENSIC MEDICINE IN
MALAYSIA
Forensic medicine is not taught as a separate, com-
plete subject in medical schools and is not tested in
the professional MBBS examination in Malaysia.
However, when the medical students qualify as doc-
tors they are expected to undertake full medico-legal
responsibilities.13 There is no designated post of fo-
rensic clinician who is trained to undertake the
medico-legal issues pertaining to the living. There are
forensic pathologists but their main responsibility is
to deal with the medico-legal issues involving the
dead. There is also a misconception in the minds of
many that postmortem is conducted only to deter-
mine the cause of death. Therefore, if the cause of
death is already known in an unnatural death then it
is wrongly interpreted that a postmortem is no longer
necessary.
Even though there are areas of overlaps between
forensic pathology and clinical forensic medicine still
there are several areas that are of particular interest
to the respective fields. In Malaysia the postgraduate
training is only available in forensic pathology.
Clinical forensic medicine is a totally neglected sub-
ject. Clinical cases are handled by doctors who had
no training in the subject.14
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