Abstract / Summary
Fatal neck compression (most commonly due to hanging and ligature strangulation) remains a frequent and high-stakes category in medico-legal autopsy practice. Although classical external and internal autopsy findings that support differentiation are widely taught and described in standard forensic literature, a recurring and problematic pattern in some autopsy opinions is the use of non-committal statements such as “compression of the neck,” “ligature mark present,” or “ligature compression of the neck,” without clarifying whether the findings are more consistent with hanging or with strangulation, and without articulating the basis of any uncertainty. This review revisits the pathophysiology, morphological hallmarks, and interpretative limitations in neck compression deaths and then critically examines the medico-legal culture that incentivizes ambiguous reporting: Fear of litigation, adversarial cross-examination, institutional pressures, inadequate training, heavy caseloads, and the perceived need to “wait” for police investigation. The central argument of this review is that routinely using vague terminology is both unscientific and unethical when autopsy findings reasonably support a specific and qualified opinion, as it withholds necessary interpretation and may ultimately compromise the interests of justice. Practical recommendations are proposed for documentation, standardized neck dissection, structured reporting, transparent expression of uncertainty, and improved courtroom communication.