The purpose of the postmortem external examination is to ascertain death and authorize burial. Requirements regarding external postmortem examinations and the tasks of physicians having this specific duty, vary in different regions of Italy. In this study, we analyzed the rationale and role of physicians performing post mortem external examinations. The role of physicians ascertaining death should be enhanced and they should play a bigger role in the identification and verification of the cause of death. A reorganization of post-mortem procedures also appears necessary.