Death Without Diagnosis: Autopsy Refusal and Avoidance, And the Erosion of Forensic Evidence in Uninvestigated Hospital Deaths in Nigeria

Abstract

The determination of cause of death is central to forensic science, medico-legal accountability, and the integrity of criminal justice systems. In many legal systems, deaths occurring shortly after hospital admission are reportable deaths requiring medico-legal investigation through autopsy. In Nigeria, this requirement frequently collapses in practice either due to autopsy refusal by relatives of deceased patients, motivated by cultural norms, religious beliefs, financial constraints, or autopsy avoidance where hospitals systematically fail to enforce autopsy requirements due to regulatory weakness, institutional risk aversion, and infrastructural constraints. Anchored in forensic epistemology and socio-legal pluralism, this article argues that autopsy refusal produces a systemic form of medico-legal uncertainty that erodes the evidentiary foundations of forensic death investigation. While legal positivism presumes compliance with statutory mandates on death investigation, the Nigerian context reveals a persistent disjunction between formal law and lived social practices. Using a doctrinal and comparative methodology, the article analyses Nigerian laws on death certification and medico-legal autopsy alongside coronial and forensic frameworks in the United Kingdom, South Africa, and India, where public interest-based autopsy regimes and state-funded forensic systems mitigate evidentiary loss despite cultural sensitivities. The article finds that routine autopsy refusal and avoidance undermines accountability for medical negligence, weakens criminal investigation, distorts mortality statistics, and compromises public health surveillance. It concludes by advancing a reform model grounded in public interest theory, proposing conditional mandatory autopsies, state-subsidized forensic services, culturally responsive consent mechanisms, and strengthened coronial oversight as necessary to preserve forensic evidence while respecting human dignity and cultural diversity.

Keywords: Autopsy Refusal, Autopsy Avoidance, Forensic Epistemology, Medico-Legal Accountability, Comparative Forensic Law

DOI: 10.7176/JLPG/155-02

Publication date: August 28th 2026