Do You Want to be Autopsied?

Routine hospital autopsies, performed by pathologists, in the past was a not an uncommon result after a patent died in the hospital.  Families were routinely asked for permission for the autopsy.  In recent years, routine autopsies far less frequent.  According to a recent report by the CDC (United State Center for Disease Control) written by  Donna L. Hoyert the key findings were as follows:

• The percentage of deaths for which an autopsy was performed declined more than 50 percent from 1972 through 2007, from 19.3 percent to 8.5 percent.
• External causes accounted for 9 of the 10 most frequently autopsied causes of death.
• The percentage autopsied declined with age after ages 15–24: from 60 percent at 15–24, to 11 percent at 55–64, to less than 5 percent at 65–74.
• In 1972, 79 percent of autopsies were performed for deaths due to disease conditions and 19 percent for deaths due to external causes. By 2007, the respective percentages were 46 percent and 50 percent.
• While the age distribution of deaths shifted to older ages from 1972 through 2007, autopsied deaths were increasingly concentrated in the age groups 1–34 and 35–64.

An autopsy, the medical examination of a deceased person, may confirm clinical findings, provide more complete information to describe cause of death, or uncover conditions not recognized clinically prior to death (1). Two types are performed in the United States: a) hospital or clinical autopsies, which family or physicians request to clarify cause of death or assess care, and b) medicolegal autopsies, which legal officials order to further investigate the circumstances surrounding a death (2). The autopsy rate, or percentage of deaths that received this final assessment, was stable from the 1950s until the beginning of the 1970s, when the autopsy rate began to decrease (3). This report uses mortality data from the National Vital Statistics System (NVSS) over a 35-year period to examine changes in the autopsy rate and in the distribution of those autopsied by age and cause. Variation in autopsy patterns has implications for which deaths may have a more complete and conclusive cause-of-death determination.

Read the full study.  To answer the question, why are autopsies not as popular now as it had been in th past, George Lundberg, M.D. writing in KevinMD suggest the following from the view of each participant except, of course, the deceased patient:

1. Pathologists don’t like autopsies because they can be unpleasant, smelly, time-consuming, unappreciated, often not specifically paid for, and they take time away from other tasks viewed as more important, appreciated, pleasant, and lucrative.
2. Clinicians do not like autopsies because it is uncomfortable to face a family that has lost a loved one. The physician must confront a level of failure because of the death, a tarnishing of the doctor-as-god image. Autopsy surprises might lead to an unhappy family, quality assurance committee concerns, possible litigation, and even a report to the state medical board.
3. Hospital administrators do not like autopsies because they prefer not to dwell on unfavorable results of hospitalization. They claim difficulty finding the money to pay for them and can never make a profit from autopsies. They often have little medical or scientific background that would encourage curiosity and they tend to do mostly what licensing and accrediting agencies require; these remain strangely silent.
4. Third-party payers do not like autopsies because they are an expense, and are performed on people who are already dead.
5. Families of patients do not like autopsies because they are ill-informed about their value, afraid that it might cost them money, and some feel that the deceased person has already been through too much of an ordeal in dying.

The value of any professionally carried out autopsy might reveal not only some unexpected or unknown cause of death but also could provide the medical profession and future generations with knowledge of disease never previously described. In these days of modern technology from MRIs to genetic analysis, there is always room for the old fashioned but information-yielding autopsies. Permitting  an autopsy could be looked upon as a altruistic action for the future living even though, unfortunately, the patients themselves will no longer be benefited. 

So  the question for this thread: "Do you want to be autopsied?" And the answer is:____________. 

(You might also explain your answer.)  ..Maurice.


Graphic: From Wikimedia Commons: "The Anatomy Lesson of Dr. Nicolaes Tulp"  Rembrandt, 1632