The autopsy: complete or not complete?

Abstract

Less invasive or non-invasive alternatives to the complete autopsy have been sought for some time, and a range of methods, ranging from needle sampling to endoscopy to magnetic resonance imaging, have been considered. Evaluations of these methods are few and far between, but generally confirm the predictable conclusion that incomplete autopsies provide incomplete information. It is not difficult to envisage a situation whereby pressure for non-invasive autopsies will allow them to become prevalent, whether properly evaluated or not. However, used appropriately, non-invasive or less invasive autopsies may be valuable tools capable of answering specific questions in situations where it is not possible to perform a complete autopsy.

Limited post-mortem examination. An alternative and viable way to avoid full examination?

“…Among the indications for limited postmortem examination in hospital cases are limited consent by the next-of-kin, area of interest, or infectious reasons [8,9]. It is argued that the limited approach may result in a higher number of cases.…”

The slow death of the clinical post-mortem examination: implications for clinical audit, diagnostics and medical education

“…It has long been recognised that the clinical (consented) PM is in decline 1,5,[8][9][10][11][12] and, if not dead, then terminally ill. 13 In Britain, this decline appeared to start in the 1950s 8,12,14 and has continued ever since. There are, however, few recent data to support this contention, and the effects of the publicity following events in Bristol and Liverpool have not been explored.…”

“…8,12,14 Consenting relatives have recently become increasingly likely to limit the extent of examination allowed. This change followed the introduction in 2000 of a new local consent form, which made explicit the option of a limited examination.…”

“…One family allowed a complete examination except for the heart, which had to be left intact and in situ for religious reasons. Special methods of PM examination, such as needle autopsy and radiological methods, 12 were not undertaken.…”

“…[4][5][6] Moreover, the greater understanding following PM may also be beneficial for the family, 7 something that should not be overlooked when the recently bereaved are counselled by clinicians. This is particularly the case in pregnancy loss and possible inheritable disease, where there may be important implications for other family members.It has long been recognised that the clinical (consented) PM is in decline 1,5,[8][9][10][11][12] and, if not dead, then terminally ill. 13 In Britain, this decline appeared to start in the 1950s 8,12,14 and has continued ever since. There are, however, few recent data to support this contention, and the effects of the publicity following events in Bristol and Liverpool have not been explored.…”