LGBTQ+ characters in Scarpetta receive affirming treatment through complex arcs that emphasize dignity and resilience. Lucy's storyline validates queer love and grief via her interaction with an AI version of her late wife, while the queer cop contributes capably to the narrative without mockery or reduction to tropes.

The series alters Lucy Farinelli's background from white in Patricia Cornwell's novels to mixed-race with half Cuban heritage, portrayed by Black Latina actress Ariana DeBose, resulting in a race swap. Pete Marino, originally a white Italian-American, is played by Latino actor Bobby Cannavale.

The series portrays an extended family living arrangement as strained and emotionally messy, incorporating progressive elements such as same-sex marriage and AI-recreated bonds while highlighting tensions in traditional sibling and marital roles. This framing questions conventional family norms through dysfunction and alternative structures.