Coroners (Ireland) Act 1829
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A coroner is a government or judicial official who is empowered to conduct or order an
inquest An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine the cause of a person's death. Conducted by a judge, jury, or government official, an inquest may or may not require an autopsy carried out by a coro ...
into the manner or cause of death, and to investigate or confirm the identity of an unknown person who has been found dead within the coroner's jurisdiction. In medieval times, English coroners were Crown officials who held financial powers and conducted some judicial investigations in order to counterbalance the power of
sheriff A sheriff is a government official, with varying duties, existing in some countries with historical ties to England where the office originated. There is an analogous, although independently developed, office in Iceland that is commonly transla ...
s or
bailiff A bailiff (from Middle English baillif, Old French ''baillis'', ''bail'' "custody") is a manager, overseer or custodian – a legal officer to whom some degree of authority or jurisdiction is given. Bailiffs are of various kinds and their offi ...
s. Depending on the jurisdiction, the coroner may adjudge the cause of death personally, or may act as the presiding officer of a special
court A court is any person or institution, often as a government institution, with the authority to adjudicate legal disputes between parties and carry out the administration of justice in civil, criminal, and administrative matters in accordance ...
(a " coroner's jury"). The term ''coroner'' derives from the same source as the word '' crown''.


Duties and functions

Responsibilities of the coroner may include overseeing the investigation and certification of deaths related to mass disasters that occur within the coroner's jurisdiction. A coroner's office typically maintains death records of those who have died within the coroner's jurisdiction. The additional roles that a coroner may oversee in judicial investigations may be subject to the attainment of suitable legal and medical qualifications. The qualifications required of a coroner vary significantly between
jurisdiction Jurisdiction (from Latin 'law' + 'declaration') is the legal term for the legal authority granted to a legal entity to enact justice. In federations like the United States, areas of jurisdiction apply to local, state, and federal levels. Jur ...
s, and are described under the entry for each jurisdiction. Coroners, medical examiners, and
forensic pathologist Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases an ...
s are different professions. They have different roles and responsibilities.


Etymology and history

The office of coroner originated in medieval England and has been adopted in many countries whose legal systems have at some time been subject to
English English usually refers to: * English language * English people English may also refer to: Peoples, culture, and language * ''English'', an adjective for something of, from, or related to England ** English national ide ...
or United Kingdom law. In Middle English, the word "coroner" referred to an officer of the Crown, derived from the French ''couronne'' and Latin ''corona'', meaning "crown". The office of the coroner dates from approximately the 11th century, shortly after the
Norman conquest of England The Norman Conquest (or the Conquest) was the 11th-century invasion and occupation of England by an army made up of thousands of Normans, Norman, Duchy of Brittany, Breton, County of Flanders, Flemish, and Kingdom of France, French troops, ...
in 1066. The office of coroner was established by ''
lex scripta ''Lex scripta'' pl. ''leges scriptae'' is a Latin expression that means "written or statutory law". It is in contrast to ''lex non scripta'', customary or common law. The term originates from the Roman legal tradition. Emperor Justinian divides ...
'' in Richard I's England. In September 1194, it was decreed by Article 20 of the "
Articles of Eyre The office of coroner was formally established in England by Article 20 of the Articles of Eyre in September 1194 to "keep the pleas of the Crown" (Latin, ''custos placitorum coronae'') from which the word "coroner" is derived. The eyre of 1194 wa ...
" to establish the office of ''custos placitorum coronae'' (
Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
for "keeper of the pleas of the Crown"), from which the word "coroner" is derived. This role provided a local
county A county is a geographic region of a country used for administrative or other purposesChambers Dictionary, L. Brookes (ed.), 2005, Chambers Harrap Publishers Ltd, Edinburgh in certain modern nations. The term is derived from the Old French ...
official whose primary duty was to protect the financial interest of the Crown in criminal proceedings. The office of coroner is, "in many instances, a necessary substitute: for if the
sheriff A sheriff is a government official, with varying duties, existing in some countries with historical ties to England where the office originated. There is an analogous, although independently developed, office in Iceland that is commonly transla ...
is interested in a suit, or if he is of affinity with one of the parties to a suit, the coroner must execute and return the process of the courts of justice." This role was qualified in Chapter 24 of
Magna Carta (Medieval Latin for "Great Charter of Freedoms"), commonly called (also ''Magna Charta''; "Great Charter"), is a royal charter of rights agreed to by King John of England at Runnymede, near Windsor, on 15 June 1215. First drafted by the ...
in 1215, which states: "No sheriff, constable, coroner or bailiff shall hold pleas of our Crown." "Keeping the pleas" was an administrative task, while "holding the pleas" was a judicial one that was not assigned to the locally resident coroner but left to judges who traveled around the country holding assize courts. The role of custos rotulorum or keeper of the county records became an independent office, which after 1836 was held by the
lord-lieutenant A lord-lieutenant ( ) is the British monarch's personal representative in each lieutenancy area of the United Kingdom. Historically, each lieutenant was responsible for organising the county's militia. In 1871, the lieutenant's responsibility ...
of each county. The person who found a body from a death thought sudden or unnatural was required to raise the " hue and cry" and to notify the coroner. While coronial manuals written for sheriffs, bailiffs, justices of the peace and coroners were published in the sixteenth and seventeenth centuries, handbooks specifically written for coroners were distributed in England in the eighteenth century. Coroners were introduced into
Wales Wales ( cy, Cymru ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by England to the Wales–England border, east, the Irish Sea to the north and west, the Celtic Sea to the south west and the ...
following its military conquest by
Edward I of England Edward I (17/18 June 1239 – 7 July 1307), also known as Edward Longshanks and the Hammer of the Scots, was King of England and Lord of Ireland from 1272 to 1307. Concurrently, he ruled the duchies of Aquitaine and Gascony as a vassa ...
in 1282 through the Statute of Rhuddlan in 1284. Going further back in time, we find that the term comes from antiquity, namely when the deceased was entrusted to the ''coronator'', that is to a necrofore who prepared the corpse according to custom and, among other things, put a small laurel or myrtle wreath (Lat. ''corona'' or ''serta'') on his head so that he might be accepted in glory in the afterlife. The use was already of ancient Greece and see e. g. Theophilus Christophorus Harles (''Bionis smyrnaei and Moschi syracusani quae supersunt etc.'' P. 40. Erlangen, 1780), who quotes Euripides, Clement of Alexandria, Chionus of Heraclea and others in this regard; see also James Claude Upshaw Downs: "The origin of official death investigation is traced to at least 44 B.C. with the Greek Physician Antistius's examination of Julius Caesar'' (Fisher 1993; Gawande 2001). ''The history of the office of coroner extends well over a millennium and has seen major evolution etc." (''Coroner and Medical Examiner'' in ''Handbook of Death and Dying'' ed. by Clifton D. Bryant. V. 1, p. 909. 2003.)


By region


Australia

Australian coroners are responsible for investigating and determining the cause of death for those cases reported to them. In all states and territories, a coroner is a
magistrate The term magistrate is used in a variety of systems of governments and laws to refer to a civilian officer who administers the law. In ancient Rome, a '' magistratus'' was one of the highest ranking government officers, and possessed both judici ...
with legal training, and is attached to a local court. Four states –
New South Wales ) , nickname = , image_map = New South Wales in Australia.svg , map_caption = Location of New South Wales in AustraliaCoordinates: , subdivision_type = Country , subdivision_name = Australia , established_title = Before federation , es ...
,
South Australia South Australia (commonly abbreviated as SA) is a state in the southern central part of Australia. It covers some of the most arid parts of the country. With a total land area of , it is the fourth-largest of Australia's states and territories ...
, Victoria and
Western Australia Western Australia (commonly abbreviated as WA) is a state of Australia occupying the western percent of the land area of Australia excluding external territories. It is bounded by the Indian Ocean to the north and west, the Southern Ocean to th ...
– also have state coroners and specialised coronial courts. In
Tasmania ) , nickname = , image_map = Tasmania in Australia.svg , map_caption = Location of Tasmania in AustraliaCoordinates: , subdivision_type = Country , subdi ...
, the Chief Magistrate also acts as the state coroner.


Canada

The office of coroner was transplanted to Canada from the British-derived system of government that existed in the land prior to 1867. Because of the grafting of a multi-cultural system especially after the 1982 Charter of Rights and Freedoms, several provinces have found it beneficial to use a de-focused "medical examiner" style of investigative reporter. In 21st-century
Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
the officer responsible for investigating all unnatural and natural unexpected, unexplained, or unattended deaths goes under the title "coroner" or "medical examiner" depending on location. They do not determine civil or criminal responsibility, but instead make and offer recommendations to improve public safety and prevention of death in similar circumstances. Coroner or Medical Examiner services are under the jurisdiction of provincial or territorial governments, and in modern Canada generally operate within the public safety and security or justice portfolio. These services are headed by a Chief Coroner (or Chief Medical Examiner) and comprise coroners or medical examiners appointed by the executive council. The provinces of
Alberta Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
,
Manitoba Manitoba ( ) is a Provinces and territories of Canada, province of Canada at the Centre of Canada, longitudinal centre of the country. It is Canada's Population of Canada by province and territory, fifth-most populous province, with a population o ...
,
Nova Scotia Nova Scotia ( ; ; ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the four Atlantic provinces. Nova Scotia is Latin for "New Scotland". Most of the population are native Eng ...
and
Newfoundland and Labrador Newfoundland and Labrador (; french: Terre-Neuve-et-Labrador; frequently abbreviated as NL) is the easternmost province of Canada, in the country's Atlantic region. The province comprises the island of Newfoundland and the continental region ...
now have a Medical Examiner system, meaning that all death investigations are conducted by specialist physicians trained in Forensic Pathology, with the assistance of other medical and law enforcement personnel. All other provinces run on a coroner system. In
Prince Edward Island Prince Edward Island (PEI; ) is one of the thirteen Provinces and territories of Canada, provinces and territories of Canada. It is the smallest province in terms of land area and population, but the most densely populated. The island has seve ...
, and
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
, all coroners are, by law,
physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
. In the other provinces and territories with a coroner system, namely
British Columbia British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
,
Saskatchewan Saskatchewan ( ; ) is a Provinces and territories of Canada, province in Western Canada, western Canada, bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, to the northeast by Nunavut, and on t ...
,
Quebec Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirtee ...
,
New Brunswick New Brunswick (french: Nouveau-Brunswick, , locally ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the four Atlantic provinces. It is the only province with both English and ...
,
Northwest Territories The Northwest Territories (abbreviated ''NT'' or ''NWT''; french: Territoires du Nord-Ouest, formerly ''North-Western Territory'' and ''North-West Territories'' and namely shortened as ''Northwest Territory'') is a federal territory of Canada. ...
,
Nunavut Nunavut ( , ; iu, ᓄᓇᕗᑦ , ; ) is the largest and northernmost Provinces and territories of Canada#Territories, territory of Canada. It was separated officially from the Northwest Territories on April 1, 1999, via the ''Nunavut Act'' ...
, and
Yukon Yukon (; ; formerly called Yukon Territory and also referred to as the Yukon) is the smallest and westernmost of Canada's three territories. It also is the second-least populated province or territory in Canada, with a population of 43,964 as ...
, coroners are not necessarily physicians but generally have legal, medical, or investigative backgrounds.


Hong Kong

The Coroner's Court is responsible to inquire into the causes and circumstances of some deaths. The Coroner is a judicial officer who has the power to: * Grant: ** Burial orders ** Cremation orders ** Waivers of autopsy ** Autopsy orders ** Exhumation orders ** Orders to remove dead bodies outside Hong Kong * Order police investigations of death * Order inquests * Approve removal and use of body parts of the dead body * Issue certificates of fact of death The Coroner makes orders after considering the pathologist's report.


Ireland

The Coroners Service is a network of Coroners situated across Ireland, usually covering areas based on Ireland's traditional counties. They are appointed by local authorities as independent experts and must be either qualified doctors or lawyers. Their primary function is to investigate any sudden, unexplained, violent or unnatural death in order to allow a death certificate to be issued. Any death due to unnatural causes will require an
inquest An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine the cause of a person's death. Conducted by a judge, jury, or government official, an inquest may or may not require an autopsy carried out by a coro ...
to be held.


New Zealand

Two coronial services operate in New Zealand. The older one deals only with deaths before midnight of 30 June 2007 that remain under investigation. The new system operates under the Coroners Act 2006, which: * Established the office of the chief coroner to provide leadership and coordination * Moved to a smaller number of full-time legally-qualified coroners who are Judges of the Coroners Court * Ensured families are notified of significant steps in the coronial process * Introduced wide-ranging cultural matters to be considered in all aspects of dealing with the dead body * Introduced a specific regime for attention and release of body parts and body samples * Enhanced inquiry and inquest processes


Sri Lanka

In Sri Lanka, the
Ministry of Justice A Ministry of Justice is a common type of government department that serves as a justice ministry. Lists of current ministries of justice Named "Ministry" * Ministry of Justice (Abkhazia) * Ministry of Justice (Afghanistan) * Ministry of Just ...
appoints ''Inquirers into Sudden Deaths'' under the ''Code of Criminal Procedure'' to carry out an inquest into the death of a sudden, unexpected and suspicious nature. Some large cities such as
Colombo Colombo ( ; si, කොළඹ, translit=Koḷam̆ba, ; ta, கொழும்பு, translit=Koḻumpu, ) is the executive and judicial capital and largest city of Sri Lanka by population. According to the Brookings Institution, Colombo me ...
and
Kandy Kandy ( si, මහනුවර ''Mahanuwara'', ; ta, கண்டி Kandy, ) is a major city in Sri Lanka located in the Central Province. It was the last capital of the ancient kings' era of Sri Lanka. The city lies in the midst of hills ...
have a City Coroners' Court attached to the main city hospital, with a Coroner and Additional Coroner.


United Kingdom


Overview

In the United Kingdom a coroner is an independent judicial office holder, appointed and paid for by the relevant
local authority Local government is a generic term for the lowest tiers of public administration within a particular sovereign state. This particular usage of the word government refers specifically to a level of administration that is both geographically-loca ...
. The
Ministry of Justice A Ministry of Justice is a common type of government department that serves as a justice ministry. Lists of current ministries of justice Named "Ministry" * Ministry of Justice (Abkhazia) * Ministry of Justice (Afghanistan) * Ministry of Just ...
, which is headed by the Lord Chancellor and Secretary of State for Justice has the responsibility for the coronial law and policy only, and no operational responsibility. There are separate services for
England and Wales England and Wales () is one of the three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. The substantive law of the jurisdiction is Eng ...
, and for
Northern Ireland Northern Ireland ( ga, Tuaisceart Éireann ; sco, label= Ulster-Scots, Norlin Airlann) is a part of the United Kingdom, situated in the north-east of the island of Ireland, that is variously described as a country, province or region. Nort ...
. A different system applies in
Scotland Scotland (, ) is a country that is part of the United Kingdom. Covering the northern third of the island of Great Britain, mainland Scotland has a border with England to the southeast and is otherwise surrounded by the Atlantic Ocean to the ...
, which does not have a coroner service.


Jurisdiction

The majority of deaths are not investigated by the coroner. If the deceased has been under medical care, or has been seen by a doctor within 14 days of death (no time limitation in the United States), then the doctor can issue a death certificate. However, if the deceased died without being seen by a doctor, or if the doctor is unwilling to make a determination, the coroner will investigate the cause and manner of death. The coroner will also investigate when a death is deemed violent or unnatural, where the cause is unknown, where a death is the result of poisoning or industrial injury, or if it occurred in police custody or prison. Any person aware of a dead body lying in the district of a coroner has a duty to report it to the coroner; failure to do so is an offence. This can include bodies brought into England or
Wales Wales ( cy, Cymru ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by England to the Wales–England border, east, the Irish Sea to the north and west, the Celtic Sea to the south west and the ...
.''Coroners''
at cps.gov.uk; retrieved 6 July 2018
''General information about the coroner service''
at manchester.gov.uk; retrieved 6 July 2018
The coroner has a team of coroner's officers (previously often ex-police officers, but increasingly from a nursing or other paramedical background) who carry out the investigation on the coroner's behalf. A coroner's investigation may involve a simple review of the circumstances, ordering a post-mortem examination, or they may decide that an inquest is appropriate. When a person dies in the custody of the legal authorities (in police cells, or in
prison A prison, also known as a jail, gaol (dated, standard English, Australian, and historically in Canada), penitentiary (American English and Canadian English), detention center (or detention centre outside the US), correction center, correc ...
), an inquest must be held. In England, inquests are usually heard without a jury (unless the coroner wants one). However, a case in which a person has died under the control of central authority must have a jury, as a check on the possible abuse of governmental power. The coroner's court is a court of law, and accordingly, the coroner may summon witnesses. Those found to be lying are guilty of perjury. Additional powers of the coroner may include the power of subpoena and
attachment Attachment may refer to: Entertainment * ''Attachments'' (novel), a 2011 novel by Rainbow Rowell * ''Attachments'' (TV series), a BBC comedy-drama that ran from 2000 to 2002 Law * Attachment (law), a means of collecting a legal judgment by lev ...
, the power of arrest, the power to administer
oath Traditionally an oath (from Anglo-Saxon ', also called plight) is either a statement of fact or a promise taken by a sacrality as a sign of verity. A common legal substitute for those who conscientiously object to making sacred oaths is to ...
s, and sequester juries of six during inquests. Coroners also have a role in
treasure Treasure (from la, thesaurus from Greek language ''thēsauros'', "treasure store") is a concentration of wealth — often originating from ancient history — that is considered lost and/or forgotten until rediscovered. Some jurisdictions leg ...
cases. This role arose from the ancient duty of the coroner as a protector of the property of the Crown. It is now contained in the
Treasure Act 1996 The Treasure Act 1996 is a UK Act of Parliament, defining which objects are classified as treasure, legally obliging the finder to report their find. Provisions The Act is designed to deal with finds of treasure in England, Wales and Northern Ire ...
. This jurisdiction is no longer exercised by local coroners, but by specialist "coroners for treasure" appointed by the Chief Coroner.


Qualification

To become a coroner in
England and Wales England and Wales () is one of the three legal jurisdictions of the United Kingdom. It covers the constituent countries England and Wales and was formed by the Laws in Wales Acts 1535 and 1542. The substantive law of the jurisdiction is Eng ...
the applicant must be a qualified
solicitor A solicitor is a legal practitioner who traditionally deals with most of the legal matters in some jurisdictions. A person must have legally-defined qualifications, which vary from one jurisdiction to another, to be described as a solicitor and ...
,
barrister A barrister is a type of lawyer in common law jurisdictions. Barristers mostly specialise in courtroom advocacy and litigation. Their tasks include taking cases in superior courts and tribunals, drafting legal pleadings, researching law and ...
, or a Fellow of the Chartered Institute of Legal Executives (CILEx) with at least five years' qualified experience. This reflects the role of a coroner: to determine the cause of death of a deceased in cases where the death was sudden, unexpected, occurred abroad, was suspicious in any way, or happened while the person was under the control of central authority (e.g., in police custody). Until 2013 a qualified medical practitioner could be appointed, but that is no longer possible. Any medical coroner still in office will either have been appointed before 2013, or, exceptionally, will hold both medical and legal qualifications. Formerly, every justice of the High Court was, ''ex officio'', a coroner for every district in England and Wales. This is no longer so; there are now no ''ex officio'' coroners. A senior judge is sometimes appointed ''ad hoc'' as a deputy coroner to undertake a high-profile inquest, such as those into the deaths of
Diana, Princess of Wales Diana, Princess of Wales (born Diana Frances Spencer; 1 July 1961 – 31 August 1997) was a member of the British royal family. She was the first wife of King Charles III (then Prince of Wales) and mother of Princes William and Harry. Her ac ...
and the victims of the
2005 London bombings The 7 July 2005 London bombings, often referred to as 7/7, were a series of four coordinated suicide attacks carried out by Islamic terrorists in London that targeted commuters travelling on the city's public transport system during the mo ...
.


Inquest

The coroner's jurisdiction is limited to determining who the deceased was and how, when and where they came by their death. When the death is suspected to have been either sudden with unknown cause, violent, or unnatural, the coroner decides whether to hold a
post-mortem An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any dis ...
examination and, if necessary, an
inquest An inquest is a judicial inquiry in common law jurisdictions, particularly one held to determine the cause of a person's death. Conducted by a judge, jury, or government official, an inquest may or may not require an autopsy carried out by a coro ...
.


Conclusions (previously called verdicts)

The coroner's former power to name a suspect in the inquest conclusion and commit them for trial has been abolished. The coroner's conclusion sometimes is persuasive for the police and Crown Prosecution Service, but normally proceedings in the coroner's court are suspended until after the outcome of any criminal case is known. More usually, a coroner's conclusion is also relied upon in civil proceedings and
insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
claims Claim may refer to: * Claim (legal) * Claim of Right Act 1689 * Claims-based identity * Claim (philosophy) * Land claim * A ''main contention'', see conclusion of law * Patent claim * The assertion of a proposition; see Douglas N. Walton * A righ ...
. The coroner commonly tells the jury which conclusions are lawfully available in a particular case. The most common conclusions include: *
Natural causes In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinct ...
* Industrial disease * Alcohol or drug related *
Suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and s ...
* Accident/misadventure * Road traffic collision * Lawful killing * Open verdict *
Unlawful killing In English law, unlawful killing is a verdict that can be returned by an inquest in England and Wales when someone has been killed by one or more unknown persons. The verdict means that the killing was done without lawful excuse and in breach of ...
* Still birth Lawful killing includes lawful
self-defence Self-defense (self-defence primarily in Commonwealth English) is a countermeasure that involves defending the health and well-being of oneself from harm. The use of the right of self-defense as a legal justification for the use of force in ...
. There is no material difference between an accidental death conclusion and one of misadventure. Conclusions are arrived at on the balance of probabilities. Neglect cannot be a conclusion by itself. It must be part of another conclusion. A conclusion of neglect requires that there was a need for relevant care (such as nourishment, medical attention, shelter or warmth) identified, and there was an opportunity to offer or provide that care that was not taken. An open conclusion should only be used as a last resort and is given where the cause of death cannot be identified on the evidence available to the inquest. A coroner giving a narrative conclusion may choose to refer to the other conclusion. A narrative conclusion may also consist of answers to a set of questions posed by the coroner to himself or to the jury (as appropriate).


England and Wales

The coroner service in England and Wales is supervised by the Chief Coroner, a judge appointed by the Lord Chief Justice after consulting the Lord Chancellor. The Chief Coroner provides advice, guidance and training to coroners and aims to secure uniformity of practice throughout England and Wales. The post is currently part-time. The present Chief Coroner is Judge
Thomas Teague Thomas may refer to: People * List of people with given name Thomas * Thomas (name) * Thomas (surname) * Saint Thomas (disambiguation) * Thomas Aquinas (1225–1274) Italian Dominican friar, philosopher, and Doctor of the Church * Thomas the A ...
. England and Wales are divided into coroner districts by the Lord Chancellor, each district consisting of the area or areas of one or more local authorities. The relevant local authority, with the consent of the Chief Coroner and the Lord Chancellor, must appoint a senior coroner for the district. It must also appoint area coroners (in effect deputies to the senior coroner) and assistant coroners, to the number that the Lord Chancellor considers necessary in view of the physical character and population of the district. The cost of the coroner service for the district falls upon the local authority or authorities concerned, and thus ultimately upon the local inhabitants. There are 98 coroners in England and Wales, covering 109 local authority areas.


Northern Ireland

Coronial services in Northern Ireland are broadly similar to those in England and Wales, including dealing with treasure trove cases under the
Treasure Act 1996 The Treasure Act 1996 is a UK Act of Parliament, defining which objects are classified as treasure, legally obliging the finder to report their find. Provisions The Act is designed to deal with finds of treasure in England, Wales and Northern Ire ...
. Northern Ireland has three coroners, who oversee the province as a whole. They are assisted by coroners liaison officers and a medical officer.


Scotland

In Scotland, there are no longer coroners. Coroners existed in Scotland between about 1400 and 1800 when they ceased to be used. Now deaths requiring judicial examination are reported to the procurator fiscal and dealt with by
fatal accident inquiries A fatal accident inquiry is a Scottish judicial process which investigates and determines the circumstances of some deaths occurring in Scotland. Until 2009, they did not apply to any deaths occurring in other jurisdictions, when the Coroners and ...
conducted by the
sheriff A sheriff is a government official, with varying duties, existing in some countries with historical ties to England where the office originated. There is an analogous, although independently developed, office in Iceland that is commonly transla ...
for the area.


United States

, of the 2,342 death investigation offices in the United States, 1,590 were coroners' offices, 82 of which served jurisdictions of more than 250,000 people. Qualifications for coroners are set by individual states and counties in the U.S., and vary widely. In many jurisdictions, little or no training is required, even though a coroner may overrule a forensic pathologist in naming a cause of death. Some coroners are elected, and others appointed. Some coroners hold office by virtue of holding another office: in Nebraska, the county district attorney is the coroner; in many counties in Texas, the
justice of the peace A justice of the peace (JP) is a judicial officer of a lower or ''puisne'' court, elected or appointed by means of a commission ( letters patent) to keep the peace. In past centuries the term commissioner of the peace was often used with the sa ...
may be in charge of death investigation; in other places, the sheriff is the coroner. In different jurisdictions the terms "coroner" and " medical examiner" are defined differently. In some places, stringent rules require that the medical examiner be a forensic pathologist. In others, the medical examiner must be a physician, though not necessarily a forensic pathologist or even a pathologist; physicians with no experience in forensic medicine have become medical examiners. In others, such as Wisconsin, each county sets standards, and in some, the medical examiner does not need any medical or educational qualifications. Not all U.S. jurisdictions use a coroner system for medicolegal death investigation—some are on a medical examiner system, others are on a mixed coroner–medical examiner system. In the U.S., the terms "coroner" and "medical examiner" vary widely in meaning by jurisdiction, as do qualifications and duties for these offices. Advocates have promoted the medical examiner model as more accurate given the more stringent qualifications. Local laws define the deaths a coroner must investigate, but most often include those that are sudden, unexpected, and have no attending physician—and deaths that are suspicious or violent.National Academy of Sciences, ''Strengthening Forensic Science in the United States: A Path Forward'', (2009), pp. 241–253. In some places in the United States, a coroner has other special powers, such as the ability to arrest the county sheriff.


Duties

Duties always include determining the cause, time, and manner of death. This uses the same investigatory skills of a police detective in most cases, because the answers are available from the circumstances, scene, and recent medical records. In many American jurisdictions, any death not certified by the person's own physician must be referred to the medical examiner. If an individual dies outside of his/her state of residence, the coroner of the state in which the death took place issues the death certificate. Only a small percentage of deaths require an
autopsy An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
to determine the time, cause and manner of death. In some states, coroners have additional authority. * In
Louisiana Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...
, coroners are involved in the determination of mental illness of living persons. * In Georgia and
Colorado Colorado (, other variants) is a state in the Mountain West subregion of the Western United States. It encompasses most of the Southern Rocky Mountains, as well as the northeastern portion of the Colorado Plateau and the western edge of t ...
the coroner has the same powers as a county
sheriff A sheriff is a government official, with varying duties, existing in some countries with historical ties to England where the office originated. There is an analogous, although independently developed, office in Iceland that is commonly transla ...
to execute arrest warrants and to serve process, and is the only county official empowered to arrest the county sheriff; in certain situations where there is no sheriff, the coroner officially acts as sheriff for the county. * In
Kentucky Kentucky ( , ), officially the Commonwealth of Kentucky, is a state in the Southeastern region of the United States and one of the states of the Upper South. It borders Illinois, Indiana, and Ohio to the north; West Virginia and Virginia to ...
, section 72.415 of the Kentucky Revised Statutes gives coroners and their deputies the full power and authority of peace officers. This includes the power of arrest and the authority to carry
firearm A firearm is any type of gun designed to be readily carried and used by an individual. The term is legally defined further in different countries (see Legal definitions). The first firearms originated in 10th-century China, when bamboo tubes ...
s. * In
North Carolina North Carolina () is a state in the Southeastern region of the United States. The state is the 28th largest and 9th-most populous of the United States. It is bordered by Virginia to the north, the Atlantic Ocean to the east, Georgia and So ...
, the coroner exists by law in approximately 65 counties, but the office is active in only ten of them; in the counties that have coroners, they are set forth as common law peace officers, yet the coroner of the county also has judicial powers: to investigate cause and manner of death, as in other states, but also to conduct inquests, to issue court orders, to empanel a coroner's jury and to act as sheriff in certain cases or even arrest the sheriff for cause. Beginning in 2015, the NC Office of Chief Medical Examiner (OCME) began optional training for coroners to become special assistant medical examiner investigators (NC CH130A & 152). * In
Indiana Indiana () is a U.S. state in the Midwestern United States. It is the 38th-largest by area and the 17th-most populous of the 50 States. Its capital and largest city is Indianapolis. Indiana was admitted to the United States as the 19th s ...
, the coroner is the only law enforcement officer who has the authority to arrest and incarcerate the county sheriff and take command of the county jail. The coroner is also the only official who may serve the sheriff with civil process. * In
New York City New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
, the office of coroner was abolished in 1915, since before that time, having medical knowledge was not actually a requirement, leading to much abuse of position. * In
California California is a U.S. state, state in the Western United States, located along the West Coast of the United States, Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the List of states and territori ...
41 of the 58 counties have merged the county sheriff's office and the county coroner's office. In these counties, the sheriff also serves as the coroner.


Notable examples

*
Wynne Edwin Baxter Wynne Edwin Baxter FRMS FGS (1 May 1844 – 1 October 1920) was an English lawyer, translator, antiquarian and botanist, but is best known as the Coroner who conducted the inquests on most of the victims of the Whitechapel Murders of 1888 to ...
* Larry Campbell, former provincial coroner for British Columbia * Thomas Noguchi (born 1927), former Chief Medical Examiner-Coroner for the County of Los Angeles * Charles Norris *
Morton Shulman Morton Shulman (25 April 1925 – 18 August 2000) was a Canadian politician, businessman, broadcaster, columnist, coroner, and physician. He was born in Toronto, Ontario in 1925 to a Jewish family. He first came to fame as Ontario's Chief Coron ...
, former provincial coroner for Ontario *
William Wynn Westcott William Wynn Westcott (17 December 1848 – 30 July 1925) was a coroner, ceremonial magician, theosophist and Freemason born in Leamington, Warwickshire, England. He was a Supreme Magus (chief) of the S.R.I.A and went on to co-found t ...
* Athelstan Braxton Hicks, late 19th-century coroner in London and Surrey


Artistic depictions


Film

* In the song " Ding-Dong! The Witch Is Dead", from the classic 1939 film '' The Wizard of Oz'', the Coroner of Munchkinland confirms the death of the
Wicked Witch of the East The Wicked Witch of the East is a fictional character created by American author L. Frank Baum. She is a crucial character but appears only briefly in Baum's classic children's series of List of Oz books, ''Oz'' novels, most notably ''The Won ...
.


Literature

* M. R. Hall is a British crime novelist, who writes a series of best-selling novels featuring Bristol-based coroner, Jenny Cooper. * Novelist
Bernard Knight Bernard Henry Knight (born 3 May 1931) is a British forensic pathologist and writer. He became a Home Office pathologist in 1965 and was appointed Professor of Forensic Pathology, University of Wales College of Medicine, in 1980. Early life Kn ...
, a former Home Office
pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...
and a professor of forensic pathology at the
University of Wales College of Medicine The Cardiff University School of Medicine ( cy, Ysgol Feddygaeth Prifysgol Caerdydd) is the medical school of Cardiff University and is located in Cardiff, Wales, UK. Founded in 1893 as part of the University College of South Wales and Monmou ...
, is well known for his
Crowner John Mysteries The Crowner John Mysteries are a series of novels by Bernard Knight following the fictional life of Sir John de Wolfe, a former Crusading knight appointed to the office of Keeper of the Pleas of the King's Crown (''custos placitorum coronas''), i. ...
series set in 12th-century
Devon Devon ( , historically known as Devonshire , ) is a ceremonial and non-metropolitan county in South West England. The most populous settlement in Devon is the city of Plymouth, followed by Devon's county town, the city of Exeter. Devon is ...
, England. ("Crowner" is an archaic word for "coroner" and is based on the origins of the word. See the
History History (derived ) is the systematic study and the documentation of the human activity. The time period of event before the History of writing#Inventions of writing, invention of writing systems is considered prehistory. "History" is an umbr ...
section above.)


Television

Although coroners are often depicted in police dramas as a source of information for detectives, there are a number of fictional coroners who have taken particular focus on television. * Dr. Camille Saroyan is a federal coroner and the Head of the Forensic Division at Jeffersonian Institute in the TV series ''Bones''. * British television drama series ''
The Coroner ''The Coroner'' is a BBC Birmingham drama series starring Claire Goose as Jane Kennedy, a coroner based in a fictional South Devon coastal town. Matt Bardock stars as Detective Sergeant Davey Higgins. On 2 March 2017, the BBC announced that t ...
'' has as its main character a coroner based in a fictional Devon town. * '' Crossing Jordan'' features Jill Hennessy as Jordan Cavanaugh, M.D., a crime-solving forensic pathologist employed in the Massachusetts Office of the Chief Medical Examiner. * The coroner is a significant character and a main cast member on ''
CSI: Crime Scene Investigation ''CSI: Crime Scene Investigation'', also referred to as ''CSI'' and ''CSI: Las Vegas'', is an American procedural forensics crime drama television series that ran on CBS from October 6, 2000, to September 27, 2015, spanning 15 seasons. This wa ...
'' and its spin-offs ''
CSI: Miami ''CSI: Miami'' (''Crime Scene Investigation: Miami'') is an American police procedural drama television series that ran from September 23, 2002 until April 8, 2012 on CBS. Featuring David Caruso as Lieutenant Horatio Caine, Emily Procter as Dete ...
'' and ''
CSI: NY ''CSI: NY'' (''Crime Scene Investigation: New York'', stylized as ''CSI: NY/Crime Scene Investigation'') is an American police procedural television series that ran on CBS from September 22, 2004, to February 22, 2013, for a total of nine seaso ...
''. * The television series '' Da Vinci's Inquest'' has a coroner as its title character. * The American police procedural drama series ''
Hawaii Five-0 Hawaii Five-O or Hawaii Five-0 may refer to: * Hawaii Five-0 (2010 TV series), ''Hawaii Five-0'' (2010 TV series), an American action police procedural television series * Hawaii Five-O (1968 TV series), ''Hawaii Five-O'' (1968 TV series), an Ame ...
'' features a coroner named Dr. Max Bergman, played by Japanese-American actor
Masi Oka is a Japanese actor, producer, and digital effects artist who became widely known for starring in NBC's ''Heroes'' as Hiro Nakamura and in CBS's ''Hawaii Five-0'' as Doctor Max Bergman. Early life Oka was born in Tokyo, Japan, to Setsuko Oka. Hi ...
. * Kujo Kiriya from the 2016 Japanese TV series '' Kamen Rider Ex-Aid'' is a coroner. *
Kurt Fuller Kurt Fuller (born September 16, 1953) is an American character actor. He has appeared in a number of television, film, and stage projects. He is best known for his roles in the films ''No Holds Barred'' and ''Ghostbusters II'' (both 1989), ''Way ...
plays Woody, a coroner on the American detective comedy-drama ''
Psych ''Psych'' is an American detective comedy-drama television series created by Steve Franks for USA Network. The series stars James Roday as Shawn Spencer, a young crime consultant for the Santa Barbara Police Department whose "heightened observ ...
''. * The television series ''
Quincy, M.E. ''Quincy, M.E.'' (also called ''Quincy'') is an American mystery medical drama television series from Universal Studios that aired on NBC from October 3, 1976, to May 11, 1983. Jack Klugman starred in the title role as a Los Angeles County medic ...
'' has the title character (a medical examiner) under the authority of the county coroner. * The television series ''
Wojeck ''Wojeck'' is a Canadian dramatic television series, which aired on CBC Television from 1966 to 1968. It was arguably the first successful drama series on English Canadian television. Plot Steve Wojeck is a crusading big city coroner who regul ...
'' (the Canadian ancestor of ''
Quincy, M.E. ''Quincy, M.E.'' (also called ''Quincy'') is an American mystery medical drama television series from Universal Studios that aired on NBC from October 3, 1976, to May 11, 1983. Jack Klugman starred in the title role as a Los Angeles County medic ...
'') has a coroner as its title character, inspired by the coroner Dr.
Morton Shulman Morton Shulman (25 April 1925 – 18 August 2000) was a Canadian politician, businessman, broadcaster, columnist, coroner, and physician. He was born in Toronto, Ontario in 1925 to a Jewish family. He first came to fame as Ontario's Chief Coron ...
.CBC Television Series, 1952–1982: Wojeck
* In '' Law & Order: Special Victims Unit'', the detectives are regularly assisted by coroner Melinda Warner.


See also

* Ontario Centre of Forensic Sciences – home to the Coroner's Office for Ontario


References


Further reading

* * * See also the links at the bottom of the linked article.


External links


Dr. G Medical Examiner: Working with the Dead


by Prof.
Bernard Knight Bernard Henry Knight (born 3 May 1931) is a British forensic pathologist and writer. He became a Home Office pathologist in 1965 and was appointed Professor of Forensic Pathology, University of Wales College of Medicine, in 1980. Early life Kn ...


Coroners by country


Australia, New South Wales – Homepage of the New South Wales, Australian (NSW) Coroners Court



Australia, Western Australia – Homepage of West Australian (WA) Coroners Court

Australia, Victoria – Coroners Court of Victoria





New Zealand – Coronial Services of New Zealand

Northern Ireland – Coroners Service for Northern Ireland
{{Authority control Legal professions Health care occupations Forensic occupations Persons involved with death and dying