Cremation is the most common type of burial in Germany. Evidence is lost when cremating the body. A second postmortem external examination (postmortem external examination at the crematory) is required by law in almost all German federal states prior to cremation. This duty is often performed by a legal medical specialist.This article provides an overview of different, mostly legal, medical assessments of the postmortem examination at the crematory and reports on personal experience in postmortem external examinations at crematories.The second postmortem medical examiner detects formal, content-related, and in some cases serious errors on medical death certificates on a regular basis. In cases with indications for a non-natural death or uncertain identity of the body, the cremation is stopped and some cases are reported to the investigative authority. Indications of death caused by physical trauma or malpractice are the most common reasons for delaying a cremation during the postmortem medical examination at the crematory. The percentage of delayed cremations is minimal (up to 5%). The second postmortem examiner reports approximately 0.5-2% of cases to the investigating authorities. The number of court-ordered autopsies of decedents that had been reported as being conspicuous has always been low (approximately 1%).Currently, the postmortem external examination by a specialist postmortem medical examiner at the crematory remains a vital prerequisite for identifying non-natural cases of death. Only a high number of autopsy orders can significantly improve the cause-of-death statistics of the postmortem external examinations at the crematory.
Keywords: Cause of death; Cremation; Death certificate; Postmortem external examination.