AN ELDERLY WHITE woman died in the care of a male friend who was her caretaker for the past year. She was found in her bed, unresponsive, and the police were notified. Upon arrival, the police found her in the bed on top of dirty, soiled linens. Fecal material and areas of urine staining were present, each in excess of what would be expected from agonal defecation and urination. Her physician refused to sign the death certificate because he had not seen her in 2 years, and previously she had been doing well. He could not think of a clear cause of death since her medical history was significant only for senile dementia and osteoporosis during the past 4 years. The male friend was considered the next of kin, and he desperately wanted to complete the paperwork for burial and insurance purposes. The physician agreed to sign the death certificate if a complete autopsy was performed. The body was taken from the home to the autopsy room.
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