Background Despite public inquiries, and some changes to legislation following high-profile multiple homicides that were not detected by autopsy, coroners continue to rely largely on the autopsy. Regardless of the extent of quality failings and excess deaths at some hospitals, not detected through the coroner system, the autopsy is scarcely used by hospitals to monitor standards and educate.

Objective To explore when a compulsory medicolegal autopsy should, and should not, be used.

Method Two hundred and thirty-six cases referred to a senior coroner were evaluated by pathologists with long experience of forensic, coronial and hospital autopsies, using detailed antecedent medical and circumstantial information: after their advice, the senior coroner decided what kind of autopsy provided sufficient information for his purposes.

Results In nearly 40% (n=88) of deaths where the senior coroner accepted jurisdiction, issues raised could be resolved through analysis of medical records and antecedent information, supplemented only by detailed external examination of the body.

Conclusions Timely provision of sufficient information allows informed decisions about the requirement for, and nature and extent of, medical investigations into a death: unnecessary post mortem dissection is avoided, protecting the rights, under Articles 8 and 9 of the Human Rights Act 1998, of the bereaved to privacy, family life and religious practice. Although improvements in healthcare can undoubtedly result from detailed coroners’ inquiries, those deaths where the matters investigated relate only to the accuracy of a natural cause of death or sit with a healthcare provider’s internal quality assurance, should be investigated by the healthcare system in collaboration with the bereaved.