Autopsy Consent Practice at US Teaching Hospitals

Rosenbaum, Glen; Burns, Jeffrey P.; Johnson, Judy; Mitchell, Christine; Robinson, Mary; Truog, Robert D.

doi:10.1001/archinte.160.3.374

Cited by 56 publications

(44 citation statements)

References 40 publications

(42 reference statements)

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“…Most relevant literature cites only autopsy rates, not the percentage of patients or families who were approached and counseled, even though permission for an autopsy must be granted, except where required by a medical examiner [10]. While some studies cite reasons families might decline an autopsy, arguably the more important statistic is how often they were actually asked and accepted and perhaps even how they were asked [14,16]. A recent study by Combes and colleagues suggests that, when asked, a high percentage of families actually agree to autopsies [17].…”

Section: Discussionmentioning

confidence: 99%

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

Hsin¹

2013

J Palliative Care Med

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Section: Discussionmentioning

confidence: 99%

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

Hsin¹

2013

J Palliative Care Med

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“…4,5 Residents, medical students, and nurses need better education on the rationale for performing autopsies and on the appropriate consent process. 6 What we have had, instead, is a lot of finger-pointing. Clinicians are not alone in suggesting that today's pathologists prefer the more lucrative and less onerous diagnostic patient-care services; such a complaint has also been issued from within the pathologists' own ranks.…”

Section: Discussionmentioning

confidence: 99%

Keeping the autopsy alive

Vlietstra

2004

Clinical Cardiology

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Summary:The recent decline in autopsy rates has many causes and has been the subject of vigorous debate amongst clinicians, pathologists, and investigators. For cardiologists, the lack of direct information on the vessel wall may impede the ability to develop and interpret new imaging methods and to understand the effects of the newest interventions.Key words: autopsy, pathology, vessel wall, imaging, interventions These days, autopsy rates nationally are at an all-time low, with less than 5% of people dying in hospital undergoing autopsies. 1 The arguments for and against performing more autopsies have been well rehearsed.Those in favor argue that many significant abnormalities are missed when autopsies are neglected. Shojania et al. estimate that major diagnoses are missed in 8.4% of individuals dying in U.S. hospitals, and nearly half of these patients might have survived to discharge had the misdiagnosis not occurred. 2 A second argument for more autopsies is that without pathologic calibration, significant uncertainty will attach to the diagnoses in the medical record, a disadvantage not only for conscientious clinicians but also for databases and clinical trials. The relatives of the deceased also miss out on the chance for complete disclosure when events surrounding the death are unclear.The opponents of performing more autopsies point to the widespread use of imaging methods that virtually reproduce the same findings, and busy pathologists point to a lack of payment for any autopsy service they render. In today's adversarial environment, clinicians also fear the risk of a malpractice suit if undiagnosed problems are uncovered. On this last point, a study from the University of Pittsburgh Medical Center found that only one malpractice claim arose from 176 autopsies, and in that particular case the intent to litigate preceded the patient's death. 3 Even so, it is easy to understand the hesitation on the part of the sometimes already put-upon physician.Whatever their view, neither side can justify inordinate delays in the reporting of autopsy findings. Often many months pass before the full report is available to the clinician and family. It is similarly disappointing that there has been a lack of progress in the techniques applied, with apparently little advance in necropsy investigative methods during the last 50 years, in spite of the revolution in molecular pathology surrounding us. Scandalous stories in the international press serve to remind us that proper consent procedures and respect for all parts of the deceased are mandatory. 4,5 Residents, medical students, and nurses need better education on the rationale for performing autopsies and on the appropriate consent process. 6 What we have had, instead, is a lot of finger-pointing. Clinicians are not alone in suggesting that today's pathologists prefer the more lucrative and less onerous diagnostic patient-care services; such a complaint has also been issued from within the pathologists' own ranks. 7 To be fair, it must be discouraging that physician...

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“…The public interest, not the private interest of the family, should control the decision here, where the public interest is very strong. Families often initially, while their grieving is fresh, express their desire that an autopsy not be performed, only to later wish an autopsy had been done to answer their questions [36][37][38][39][40].…”

Section: The Rationale For Not Conducting the Autopsy Was Insuffi Cientmentioning

confidence: 99%

Untitled

2017

J Forensic Sci Res

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Coroner and medical examiner offi ces are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profi le case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities.Medico legal death investigation offi ces, including both medical examiner and coroner offi ces, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d'être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the nextof-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the offi ce resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offi ces. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offi ces. Specifi cally, we believe the recent case of Otto Warmbier is such a case.

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Autopsy Consent Practice at US Teaching Hospitals

Cited by 56 publications

References 40 publications

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

Keeping the autopsy alive

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