Breaking the Myths: Knowledge, Awareness, and Public Perceptions Regarding Medicolegal Postmortem Examination (Autopsy) among the General Population of Haryana, India.

Medicolegal postmortem examination (autopsy) is a cornerstone of forensic medicine and the criminal justice system. It is a scientific examination of a deceased individual conducted under legal authority to determine the cause, manner, and mechanism of death, document injuries, collect forensic evidence, and assist law enforcement and courts in the investigation of unnatural, suspicious, or unexplained deaths. Beyond its legal role, Medicolegal autopsies contribute significantly to public health surveillance, injury prevention, disease monitoring, and disaster victim identification.1,2

 

Despite its importance, medicolegal autopsy remains one of the most misunderstood procedures among the general public. It is frequently associated with myths and misconceptions, including unnecessary body mutilation, organ removal, delayed funeral rites, and religious or cultural objections. Such beliefs often arise from inadequate public awareness, misinformation, and inaccurate media portrayals, leading to fear, anxiety, and mistrust toward forensic and healthcare services.3-5

 

Public understanding of medicolegal autopsy is influenced by education, socioeconomic status, cultural beliefs, previous exposure to medicolegal cases, and access to health information. Although studies from various countries have reported inadequate knowledge and persistent misconceptions regarding autopsy, community-based evidence from India remains limited. Most available research has focused on healthcare professionals or medical students, with little emphasis on the perceptions of the general population.6-11

 

Haryana, with its unique geographical terrain, diverse cultural practices, and increasing burden of accidental and unnatural deaths, provides an important setting to evaluate public awareness regarding medicolegal autopsy. Understanding existing knowledge gaps and misconceptions is essential for improving forensic literacy, strengthening public confidence in medicolegal services, and facilitating effective communication between healthcare professionals, forensic experts, law enforcement agencies, and the community.

 

Therefore, the present study was undertaken to assess the knowledge, awareness, and public perceptions regarding medicolegal postmortem examination among the general population of Haryana and to identify socio-demographic factors associated with these perceptions. The findings are expected to support the development of targeted awareness programmes and evidence-based interventions aimed at dispelling myths and promoting informed public understanding of medicolegal autopsy.

Study Design and Setting

A community-based, cross-sectional study was conducted between January and April 2025 among the general population of Haryana, India, to assess knowledge, awareness, and public perceptions regarding medicolegal postmortem examination (autopsy).

 

Study Population

The studies included adults aged 18 years and above who had been residing in Haryana for at least five years and were willing to participate voluntarily in the study. Individuals unable to comprehend the questionnaire or unwilling to provide informed consent were excluded.

 

Sample Size

The sample size was calculated using the single population proportion formula, assuming a 50% expected awareness level, 95% confidence interval, and 5% absolute precision:

N=Z2×p(1−p)/d2

The minimum required sample size was 384. Considering possible incomplete responses, a total of 420 participants were included in the study.

 

Sampling Technique and Data Collection

Data were collected using a structured questionnaire form, which was disseminated physically across different districts of Haryana. Participation was voluntary and informed consent was also obtained before commencement of the study.

 

Study Instrument

The questionnaire was developed following an extensive review of forensic medicine literature and existing legal guidelines. It consisted of four sections:

1.       Socio-demographic characteristics (age, gender, education, occupation, residence, income, religion, and previous exposure to medicolegal cases).

2.       Knowledge regarding medicolegal autopsy (definition, purpose, indications, legal aspects, and procedure).

3.       Awareness of medicolegal and forensic issues (authority for conducting autopsy, consent, evidence collection, identification, and role in criminal investigation).

4.       Public perceptions and myths regarding medicolegal autopsy, including attitudes towards body handling, religious beliefs, organ removal, funeral delays, and acceptance of the procedure.

 

Each correct knowledge response was awarded one mark, while incorrect or "Don't Know" responses zero marks. Based on the cumulative score, overall knowledge was categorized as:

•          Excellent: ≥75%

•          Good: 50–74%

•          Fair: 25–49%

•          Poor: <25%

 

Validation and Reliability

The questionnaire underwent content and face validation by experts from the Departments of Forensic Medicine, Community Medicine, and Public Health. A pilot study involving 40 participants (excluded from the final analysis) was conducted to assess clarity and comprehensibility. The questionnaire demonstrated good internal consistency with a Cronbach's alpha coefficient of 0.86.

 

Statistical Analysis

Data were exported from Google Forms into Microsoft Excel 2021 and analyzed using Epi Info version 7. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the data. Associations between socio-demographic variables and levels of knowledge, awareness, and public perception were evaluated using the Chi-square test. A p-value <0.05 was considered statistically significant.

A total of 420 participants from different districts of Haryana were included in the study.

 

Table 1. Socio-demographic Characteristics of the Study Participants (n = 420)

The majority belonged to the 26–35 years age group (29.0%), with females (52.4%) slightly outnumbering males (47.6%). Nearly three-fourths of the participants were graduates or postgraduates (73.3%), and the largest occupational group comprised service/professional employees (35.7%). Most participants belonged to the middle-income category (25,001–75,000 INR; 61.9%), resided in rural areas (64.3%), and had no previous exposure to medicolegal autopsy (74.8%).

 

Table 2. Knowledge Regarding Medicolegal Postmortem Examination (Autopsy) Among the General Population of Haryana (n = 420)

Overall knowledge regarding medicolegal postmortem examination was moderate to good, with participants demonstrating satisfactory understanding of its purpose and legal significance. More than three-fourths correctly recognized that autopsies help determine the cause of death (81.4%), assist criminal investigations (80.0%), and serve as evidence in courts (78.6%). However, important knowledge gaps persisted regarding replacement of organs after autopsy (50.0%), the public health role of autopsy (59.0%), and the legal authority responsible for ordering medicolegal autopsies (63.3%), indicating the need for greater public education on forensic medicine and medicolegal procedures.

 

Table 3. Awareness Regarding Legal and Procedural Aspects of Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

Participants demonstrated moderate awareness regarding the legal and procedural aspects of medicolegal autopsy. Most respondents recognized that autopsies help determine the cause of death (83.3%), preserve forensic evidence (80.5%), differentiate natural from unnatural deaths (79.5%), and contribute to judicial proceedings (79.0%). However, awareness was comparatively lower regarding the legal requirement for family consent (55.7%), the public health role of autopsy (56.7%), and the fact that not all hospital deaths require medicolegal autopsy (59.0%), highlighting persistent gaps in legal and procedural understanding among the general population.

 

Table 4. Public Perceptions and Myths Regarding Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

Overall, participants exhibited a positive perception toward medicolegal postmortem examination despite the persistence of several misconceptions. More than three-fourths acknowledged that autopsy is important for determining the true cause of death (81.4%), ensuring justice (77.6%), and improving transparency in death investigations (74.3%). A large majority also supported family counselling (83.8%), public awareness programmes (84.8%), and forensic education in schools and colleges (77.1%). Nevertheless, misconceptions persisted, with 32.9% believing that autopsy unnecessarily mutilates the body, 36.7% perceiving that it significantly delays funeral rites, and 29.5% assuming that organs are permanently removed during every autopsy, indicating the continued need for targeted public education and myth-dispelling initiatives.

 

Table 5. Overall Knowledge, Awareness, and Public Perception Scores Regarding Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

Overall, participants demonstrated moderate to good knowledge and awareness regarding medicolegal postmortem examination. Approximately 66.2% exhibited good to excellent knowledge, while 66.6% showed good to excellent awareness of its legal and procedural aspects. Public perception was largely favorable, with 65.7% demonstrating a positive attitude towards medicolegal autopsy and only 3.8% expressing negative perceptions. The mean scores for knowledge (13.9 ± 3.3), awareness (13.6 ± 3.1), and public perception (15.2 ± 3.4) indicate satisfactory overall understanding; however, the presence of nearly one-third of participants with fair or poor scores highlights the need for targeted community awareness initiatives to improve forensic literacy and dispel persistent misconceptions.

 

Table 6. Association Between Socio-demographic Variables and Overall Knowledge Regarding Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

* Significant at p <0.05; Highly Significant at p <0.001; NS = Not Significant

Overall knowledge regarding medicolegal postmortem examination was significantly associated with age (p=0.009), educational status (p<0.001), occupation (p=0.004), monthly household income (p=0.011), and place of residence (p=0.036). Participants who were postgraduates, service/professionals, urban residents, and those belonging to higher-income groups demonstrated significantly better knowledge than their counterparts. Gender was not significantly associated with knowledge levels (p=0.607). These findings suggest that educational attainment and socioeconomic factors play a pivotal role in shaping public understanding of medicolegal autopsy.

 

Table 7. Association Between Socio-demographic Variables and Awareness Regarding Legal and Procedural Aspects of Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

* Significant at p <0.05; Highly Significant at p <0.001; NS = Not Significant

Awareness regarding the legal and procedural aspects of medicolegal postmortem examination was significantly associated with age (p=0.012), educational status (p<0.001), occupation (p=0.007), monthly household income (p=0.018), and place of residence (p=0.031). Participants with higher educational qualifications, professional occupations, urban residence, and higher household income demonstrated significantly better awareness of medicolegal procedures and legal provisions. Gender was not significantly associated with awareness levels (p=0.556), indicating comparable understanding among male and female participants. These findings emphasize the influence of education and socioeconomic status on awareness regarding medicolegal autopsy.

 

Table 8. Association Between Socio-demographic Variables and Public Perceptions Regarding Medicolegal Postmortem Examination Among the General Population of Haryana (n = 420)

* Significant at p <0.05; Highly Significant at p <0.001; NS = Not Significant

Public perception towards medicolegal postmortem examination was significantly associated with age (p=0.019), educational status (p<0.001), occupation (p=0.008), monthly household income (p=0.010), and place of residence (p=0.029). Participants with higher educational qualifications, professional occupations, higher household income, and urban residence demonstrated significantly more positive perceptions towards medicolegal autopsy. Gender showed no significant association with public perception (p=0.481). Overall, these findings indicate that education and socioeconomic status are key determinants of public acceptance and positive attitudes toward medicolegal postmortem examination.

The present study provides a comprehensive assessment of the knowledge, awareness, and public perceptions regarding medicolegal postmortem examination among the general population of Haryana. The findings demonstrate that although the majority of participants possessed moderate to good knowledge and generally positive perceptions towards medicolegal autopsy, important misconceptions and deficiencies in legal and procedural understanding continue to exist. These findings emphasize that while the concept of autopsy is familiar to many individuals, comprehensive forensic literacy remains inadequate among the general public.

 

Overall, approximately two-thirds of the participants demonstrated good to excellent knowledge regarding medicolegal autopsy. Most respondents correctly recognized that medicolegal postmortem examination is performed to determine the cause of death, assist criminal investigations, and provide scientific evidence for judicial proceedings. These findings suggest an encouraging level of awareness regarding the primary objectives of medicolegal autopsy, which may be attributed to increasing educational attainment, wider access to healthcare information, and growing exposure through electronic and social media. Similar observations have been reported in studies, where respondents exhibited satisfactory understanding of the general purpose of autopsy but demonstrated limited knowledge regarding its procedural and legal aspects.8,9 Although direct comparisons with Indian community-based studies remain difficult due to the paucity of published literature, the present findings indicate that public understanding in Haryana is gradually improving but remains incomplete.10-13

 

Despite satisfactory overall knowledge, several important misconceptions persisted. Only half of the respondents were aware that organs examined during routine medicolegal autopsy are generally replaced before the body is handed over to the relatives, while awareness regarding the contribution of autopsy to public health surveillance and epidemiological research was comparatively lower. Similarly, understanding of the legal authority responsible for ordering medicolegal autopsy remained suboptimal. These findings indicate that the public possesses greater awareness regarding the purpose of autopsy than its scientific methodology and legal framework. Such misconceptions may contribute to fear, anxiety, and resistance among bereaved families during medicolegal investigations and highlight the need for better public education regarding standard forensic practices.7-9

 

Awareness regarding the legal and procedural aspects of medicolegal autopsy also showed a similar trend. Most participants correctly recognized that autopsy findings contribute to criminal investigations, establish the cause of death, preserve forensic evidence, and assist courts of law. However, awareness regarding statutory provisions and consent requirements remained relatively poor, with a considerable proportion of respondents incorrectly believing that family consent is mandatory before every medicolegal autopsy. Under Indian legal provisions, medicolegal autopsies are performed under statutory authority in specified circumstances and generally do not require consent from relatives.14 This lack of awareness may partly explain the misunderstanding and occasional conflict observed between investigating authorities and family members during medicolegal procedures. Increasing public knowledge regarding the legal framework governing medicolegal autopsy could therefore improve cooperation and strengthen public confidence in forensic services.

 

One of the most significant findings of the present study was the persistence of myths surrounding medicolegal autopsy. Nearly one-third of the participants believed that autopsy unnecessarily mutilates the body, more than one-third perceived that it substantially delays funeral rites, and approximately one-third assumed that internal organs are permanently removed during every autopsy. Similar misconceptions have been documented internationally, where concerns regarding body disfigurement, organ retention, religious beliefs, and delayed burial continue to influence public acceptance of autopsy. These misconceptions are often reinforced through hearsay, cultural traditions, sensationalized media portrayals, and limited interaction with forensic medicine professionals. Addressing these myths through scientifically accurate community education is therefore essential for improving public acceptance of medicolegal procedures.11-13

 

Despite these misconceptions, participants generally exhibited positive attitudes towards medicolegal autopsy. Nearly two-thirds demonstrated positive perceptions, and the majority acknowledged that medicolegal autopsy plays an important role in determining the true cause of death, ensuring justice, maintaining transparency in death investigations, and supporting the criminal justice system. Most respondents also supported public awareness programmes, counselling of bereaved families, and inclusion of forensic medicine awareness in educational institutions. These findings are encouraging, suggesting that although misconceptions persist, the public remains receptive to scientifically accurate information and recognizes the societal importance of medicolegal autopsy. Similar positive attitudes have been reported in awareness studies conducted among the general population in several countries, where respondents expressed willingness to support educational initiatives aimed at improving understanding of forensic medicine.5,6,9,15

 

The present study further demonstrated that educational status emerged as the strongest predictor of knowledge, awareness, and public perception. Participants with postgraduate education consistently demonstrated significantly higher levels of understanding and more positive attitudes than those with lower educational qualifications. Similar associations have been reported in numerous public health studies, where higher educational attainment is closely linked with improved health literacy, greater access to reliable information, and enhanced scientific understanding.6,9,10 Occupation and household income also showed significant associations, with service professionals and higher-income groups exhibiting superior knowledge and awareness. These findings suggest that socioeconomic empowerment plays an important role in shaping public understanding of medicolegal procedures and acceptance of forensic practices.7.9

 

Urban participants demonstrated significantly better knowledge, awareness, and positive perceptions compared with rural residents. This difference is likely attributable to improved educational opportunities, greater access to tertiary healthcare facilities, wider exposure to digital media, and better availability of health information in urban settings. Considering that a large proportion of Haryana's population resides in rural and geographically remote areas, targeted awareness programmes should prioritize rural communities through primary healthcare institutions, community health workers, educational institutions, and local media platforms. Such interventions may substantially reduce existing disparities in forensic literacy across different population groups.

 

Interestingly, gender was not significantly associated with knowledge, awareness, or public perception regarding medicolegal autopsy. Male and female participants demonstrated comparable levels of understanding across all study domains, indicating that educational attainment and socioeconomic status exert a greater influence on forensic literacy than gender alone. Similar observations have been reported in several public awareness studies where gender differences disappeared after adjustment for education and occupation.6,7,11 This finding suggests that awareness programmes should be designed for the general community rather than targeting one gender specifically.

 

The findings of the present study have important implications for forensic medicine, public health, and policy. Improving community awareness regarding medicolegal autopsy has the potential to reduce misconceptions, strengthen public trust in forensic services, facilitate communication between healthcare professionals and bereaved families, and improve cooperation during legally mandated death investigations. Public education initiatives should specifically address misconceptions related to body mutilation, organ removal, consent requirements, and funeral delays while emphasizing the scientific, legal, and humanitarian importance of medicolegal autopsy. Community awareness campaigns, digital health education, school- and college-based forensic literacy programmes, and collaboration between forensic departments, healthcare institutions, law enforcement agencies, and media organizations may significantly enhance public understanding and acceptance of medicolegal postmortem examination. Such evidence-based interventions will not only improve forensic literacy but also strengthen the interface between forensic medicine, public health, and the administration of justice.

 

Strengths and Limitations

The present study is among the few community-based investigations from India assessing knowledge, awareness, myths, and public perceptions regarding medicolegal postmortem examination among the general population. Its strengths include a relatively large sample size, representation from diverse socio-demographic groups across Haryana, use of a validated and reliable questionnaire, and comprehensive assessment of multiple domains related to medicolegal autopsy. The online survey facilitated wide community participation while minimizing interviewer bias. However, the study has certain limitations. Being a cross-sectional, self-reported online survey, causal relationships cannot be established, and the findings may be influenced by recall, reporting, and social desirability biases. Individuals without internet access or adequate digital literacy may have been underrepresented, thereby limiting the generalizability of the findings to the entire population of Haryana.

The present study demonstrates that the general population of Haryana possesses moderate to good knowledge and awareness regarding medicolegal postmortem examination, with an overall positive perception of its role in determining the cause of death and supporting the administration of justice. Nevertheless, important misconceptions regarding body mutilation, organ removal, consent requirements, and procedural aspects continue to persist, resulting in significant knowledge gaps. Educational status, occupation, income, and place of residence were important determinants of knowledge and public perception, while gender showed no significant influence. The findings highlight the need to strengthen forensic literacy among the general population to improve acceptance of medicolegal autopsy and foster greater public confidence in forensic medicine and the criminal justice system.

 

Recommendations

Based on the study findings, comprehensive public awareness initiatives should be undertaken to improve understanding of the scientific, legal, and public health importance of medicolegal postmortem examination. Community-based education campaigns, digital media initiatives, and information, education, and communication (IEC) activities should focus on dispelling common myths related to body disfigurement, organ removal, funeral delays, and consent requirements. Basic concepts of forensic medicine and medicolegal autopsy may be incorporated into school, college, and community health education programmes to enhance forensic literacy. Healthcare professionals, forensic experts, and law enforcement agencies should provide appropriate counselling to bereaved families during medicolegal investigations to improve transparency and public trust. Future multicentric studies involving larger and more diverse populations, including qualitative assessments, are recommended to better understand sociocultural factors influencing public perceptions and acceptance of medicolegal autopsy.

1.       Vedha Geethan RN. Medico-legal significance of injuries and the death investigation process. Indian J Leg Rev. 2026;6(9):1049-1063.

2.       Nahar K, Ali SMY, Hossain MI, Islam MS, Ahmad MR. Medicolegal autopsy in forensic practice: determining cause and manner of death. Front Health Inform. 2024;13(8):7820-7826.

3.       Nadesan K. The importance of the medico-legal autopsy. Malays J Pathol. 1997;19(2):105-109.

4.       Yadwad BS. Medicolegal autopsy: what, why and how. J Indian Med Assoc. 2002;100(12):703-705,707.

5.       Pawar MN, Suryawanshi DM, Kumar JP. Myths and misconceptions about medico-legal autopsies among the people of Tamilnadu, India. J Forensic Leg Med. 2015;34:159-163.

6.       Babu B, Varghese AM, Joseph A, Neeraja B, Nallathamby R. Public awareness and perceptions of medicolegal autopsies in Kerala. Med Leg Update. 2025;25(1):22-29.

7.       Kumar S, Mundri S, Shubhendu K, Kumar A. Analysis of autopsy justifications by medical boards in relation to the manner and cause of death. Cureus. 2025;17(5):e83432.

8.       Subedi N, Paudel IS, Kandel D, Chudal A. Knowledge and perception of public towards medico legal autopsy in Nepal. J Lumbini Med Coll. 2018;6(1):6-10.

9.       Parmar P, Rathod GB. Study of knowledge, attitude and perception regarding medico-legal autopsy in general population. Int J Med Pharm Sci. 2013;3(6):1-6.

10.    Kasulkar AA, Wakde SD, Hajare S, Bhagwat DL, Khan S. Awareness of medico-legal autopsies among population visiting tertiary care hospital of central India: a cross-sectional study. Indian J Forensic Community Med. 2025;12(4):261-266.

11.    Chawla H, Tyagi A, Kumar R, Malhotra R, Kumar N, Shankar S. A study evaluating knowledge, attitude and perception of undergraduate medical students towards medico-legal autopsy. Indian J Forensic Community Med. 2019;6(3):138-143.

12.    Gurung S, Manandhar B, Bhakta S. Knowledge and attitude of medical students towards autopsy. Janaki Med Coll J Med Sci. 2025;13(2):66-74.

13.    Vignesh S, Channabasappa SR. Knowledge and attitude of medical students towards medico-legal autopsy: a questionnaire-based study. Indian J Forensic Med Toxicol. 2021;15(2):1789-1792.

14.    Mahanta P, Gogoi K. Knowledge, attitude and perception of family members on medico-legal autopsy: a critical review. Int J Health Res Med Leg Pract. 2022;8(1):14.

15.    Barot D, Shaikh MM, Trivedi J, Bhise RS. Knowledge and perception of general population on forensic autopsy in Ahmedabad city. Indian J Forensic Med Toxicol. 2020;14(3):1870-1872.