Autopsy question added to Minnesota death records to
Cause of death is the most
fundamental health statistic and autopsies assure an accurate cause of death
is determined. Many people have religious beliefs (e.g., American Indian
traditions, Orthodox Judaism, and Christian Catholic) that prohibit or
discourage autopsies. This was highlighted in February 2015 following the death
of an individual who had traditional American Indian beliefs. The family did
not want an autopsy, however the medical examiner believed an autopsy was
necessary. At the time, Minnesota law had no provision for objection to autopsy
on religious grounds.
The Minnesota Legislature amended Minnesota
Statutes 2014, section 390.11, by adding a subdivision, 2b, Religious
objections to autopsy (https://www.revisor.mn.gov/statutes/?id=390.11).
The subdivision, effective July 1, 2015, allows for a decedent’s representative
to object to an autopsy based on the religious beliefs of the decedent. The subdivision
also defines “compelling state interest” and lists the circumstances when an
autopsy may be performed despite the religious objection.
A workgroup at the Minnesota
Department of Health (MDH) was convened with members from the infectious disease, injury prevention and vital
records programs to assess the impact of
this change in the law and discuss opportunities to support Minnesota’s medical
examiners and coroners in protecting the public’s health.
At the request of the workgroup, the
Office of Vital Records modified the Minnesota Registration & Certification
(MR&C) system to include a data field for medical examiners and coroners to
indicate whether a religious objection to an autopsy had been requested. The data field has been available since
January 1, 2016 and includes three
response options for the religious objection to autopsy question: yes, no, and
unknown. Below is further clarification under which circumstances each response
should be selected:
religious objection occurs when the family or representative of the decedent
maintains the objection throughout the entire time period following the death, which
causes the medical examiner or coroner not to perform a complete or partial
autopsy (i.e., external examination, x-rays, specimens taken for toxicology or
other testing). Additionally, a religious objection occurs when the objection
is maintained, but an autopsy takes place because the case meets one of the
exceptions in the statute that constitute a compelling state interest.
religious objection to autopsy does NOT occur if no objection is raised by the
family or representative of a decedent. It also does NOT occur if originally
there is an objection, but the death investigators, medical examiners, or
coroners work with the family and come to a mutual decision that conducting an
autopsy is in the best interest of the family and the public’s health. The
autopsy process then moves forward with the support of the family.
Additionally, there is no religious objection if a religion other than the decedent’s
religion is used for the objection.
A religious objection to autopsy is unknown if the family or representative of
the decedent cannot be reached and the question cannot be answered.
Since the legislation took effect, there
have been seven religious objections through the end of February 2016; four
were reported to the Minnesota Department of Health via a survey in 2015, and three
have been reported in 2016 via the new data field in MR&C. Among the
religious objections in 2015, three were from families with traditional
American Indian beliefs and the fourth was a Christian Catholic family. Two of
the 2015 deaths resulted from motor vehicle crashes, one from natural causes,
and the final was a homicide. Despite the objections, external examinations of
the bodies occurred, x-rays and blood samples were collected for toxicology,
and in one case a full autopsy was performed. In 2016, all three religious
objections were for deaths from natural causes but the underlying cause of
death was undetermined. Further follow-up will occur to learn more about the
circumstances of each death.
MDH can provide assistance and support for medical examiners and coroners. Medical examiners or coroners who
have questions or concerns about a specific religious
objection and think a compelling public health interest may
exist to conduct an autopsy can contact the MDH Infectious Disease
Epidemiology, Prevention and Control Program at 651-201-5414 or 1-877-676-5414.
The final decision about performing an autopsy must be made by a medical
examiner or coroner; MDH does not have the legal authority to make that decision.
Paternity education materials updated
Legislative changes effective March 1, 2016, required the
Minnesota Department of Human Services (DHS), Child Support Division to clarify
the effects of signing and filing Recognitions of Parentage (ROPs) and to update
all of their paternity education materials.
Child support team members updated information and emphasized important points with larger, bolder font and graphic layout in the booklet, Being a
Legal Father: Parentage information for mothers and fathers, and the Minnesota Voluntary Recognition of
Parentage form. Later this year, the ROP signature page will be updated when the Office of Vital
Records completes its technical project to update the imaging software that is
required for ROP filing. DHS is translating both of these documents into
non-English languages. The paternity forms available from MR&C are updated. Make sure any printed handbooks and forms in use at your facility are the most recent versions from January 2016. Parentage forms are available from a county child support office or the Minnesota Department of Human Services website.
Work is already underway at the Child Support Division to
replace the video, Power of Two, with updated information to comply with the mandate. DHS expects to release
the video later this year. Contact Kristi Phetdara, DHS Paternity Program
Administrator at 651-431-4435 or Kristi.firstname.lastname@example.org
for more information.
Engaging the community to serve families better
Hibbing training brings new approach to birth registration
Registering a birth record correctly is important because the data we collect is used by many programs. Sometimes a community approach fosters an environment that supports collaboration and cooperation.
Last month, Judy Strumbell’s efforts to host a conversation about improving birth registration and paternity establishment, brought professionals together in a new way. Strumbell, a social worker at Fairview Range Medical Center in Hibbing, invited staff from the Office of Vital Records and the Minnesota Department of Human Services, Child Support program to lead a birth registration and paternity establishment training open to staff from other hospitals.
The training was unique in that social workers, child support officers, birth registrars, and personnel from the St. Louis County Attorney’s office attended. Each attendee had a different level of knowledge and perspective on the subject of paternity and birth registration. All had something to contribute to the conversation, learned something from the training and other attendees, and found new ways to help each other and serve families.
The Hibbing event is an example of a creative approach and a way to strengthen collaborative efforts in paternity education and birth registration. Kristi Phetdara, DHS Paternity Program Administrator who presented at the event commented “Inclusive trainings such as this provide an opportunity to bring together many stakeholders and perspectives. By bringing the community together, we can provide a comprehensive approach to addressing complex issues. We are better together!”
Other vital events such as fetal deaths and deaths similarly impact hospitals and other agencies and offices. These events must be registered; the resulting records and the families involved can benefit from professionals involved in the process reaching out to the community. No matter your role in vital records, OVR supports a teamwork approach to registering the birth accurately and in a timely manner, and supporting parents and their children right from the very beginning—at the hospital at the time of the birth.
Birth Registration 101 - March 29 and 31, 2016
OVR recommends that those who are new to registering births or have never been formally trained attend Birth Registration 101. The class incorporates presentations from subject-matter experts with MR&C hands-on practice and discussion. More information about the class is on the MDH Birth Registration Information page.
The Five R’s of Death Registration: Rules, Requirements, and Resources for Recording and Registering Minnesota Deaths - May 23, 2016
The Minnesota Funeral Directors Association (MFDA) invited the Office of Vital Records to provide the Five R's class as an optional learning opportunity on May 23, 2016, for funeral professionals who attend the MFDA 126th Annual Convention. The class provides an overview of death registration, interactive dialogue, and tips to maximize use of the Minnesota Registration & Certification (MR&C) system. Licensees can earn 3 hours of continuing education in Regulation and Ethics. For registration information please see the MFDA convention information online. OVR will offer the class in November for others who do not attend the event or who are new to the industry. OVR will also exhibit at the MFDA convention.