We searched Medline (January, 1966–January, 2006). We used the search terms “autopsy”, “necropsy”, and “post-mortem examination”, in combination with the terms “attitudes”, “consent”, “education”, “endoscopic autopsy”, “histology”, “history”, “needle autopsy”, “pathologist”, “rates”, “regulation”, “training”, “trends”, “undergraduate”, and “verbal autopsy”. The search was limited to articles relating to work in people. We concentrated on publications in the past 5 years, but did not exclude
ReviewClinical, educational, and epidemiological value of autopsy
Section snippets
Trends in autopsy rates
Until the 1960s, the autopsy was regarded as central to medical research, education, and professional development.1 However, many studies2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 have shown the decline of autopsy in adults in most developed countries in the latter half of the 20th century and beyond (table 1).
The fall in autopsy rates is not universal and can be reversed.10 In Nova Scotia, Canada, although the clinically indicated autopsy rate fell in the 13 years before
Attitudes to autopsy
The reasons for the fall in autopsy rates are multifactorial and complex. The general public, medical professionals, and pathologists all have a vested interest in the autopsy, and knowledge of the attitudes of these interested parties is essential to understand the present status of the procedure.
Legal aspects
Autopsies can be undertaken only with appropriate consent or other authorisation, which defines the limits of the procedure. In most cases nowadays, authorisation comes from the relevant medicolegal officer, and is restricted to an examination that allows that officer to establish the cause and circumstances of death.
Authorisation for tissue retention at autopsy
Tissue is retained from autopsies most often for histological confirmation or refinement of the macroscopic findings. Such is the value of histology that routine sampling of major organs and lesions is regarded as an integral part of the autopsy in protocols issued by many professional pathology organisations. The subsequently archived tissue can be re-examined for clinical reasons to reinterpret the findings and perhaps revise the cause of death in view of new information. Archived tissue is
Minimally invasive autopsies
Minimally invasive and non-invasive autopsies are considered when there are strong emotional, cultural, or religious objections to a complete autopsy, or where there are serious risks to the health and safety of the pathologist and mortuary staff. Minimally invasive autopsies include those in which only blind or targeted percutaneous needle biopsies are taken (needle autopsies), and examinations that use an endoscope or laparoscope (endoscopic autopsies). Non-invasive autopsies, also referred
Verbal autopsy
The so-called verbal autopsy has emerged as an indirect retrospective method to identify the probable cause of death. This approach has largely been confined to developing countries where resources are restricted and to countries where there are strong religious objections to human dissection.76 No examination of the body is undertaken in this method. Indeed, we contend that the term verbal autopsy is an oxymoron, and suggest that post-mortem clinical case review is more appropriate. The
Role of autopsies in medical education
Autopsy epitomises problem-based learning for students. Despite curricular reform, a decline in autopsy rates, and adverse media attention to autopsy, medical educators regard this technique as valuable but underused in medical education.42, 43 Provided that adequate consent has been obtained,51 students can either be invited to the mortuary to witness autopsies, from external examination to reconstruction of the body, or they can be called once the examination has been completed to discuss the
Conclusions
We cannot support the assertion, published in The Lancet, that “the autopsy has lost much of its authority and now has a marginal role in contemporary medical practice”.98 Despite intensive modern clinical investigations, autopsies continue to reveal major ante mortem diagnostic errors in around 30% of cases;99 thus, autopsies improve the completeness and reliability of national mortality data on which health-care strategies are based. Autopsy is also a decisive factor in the discovery of
Search strategy and selection criteria
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Necropsies in African children: consent dilemmas for parents and guardians
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Consent to autopsy for neonates
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Family members' experience of autopsy
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Next of kin clinics: a new role for the pathologist
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The value of the autopsy from a clinical point of view: a survey of 250 general practitioners and hospital clinicians in the county of Sor-Trondelag, Norway
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The autopsy: lessons from the National Confidential Enquiry into Perioperative Deaths
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The role of the autopsy in medical malpractice cases, II: Controversy related to autopsy performance and reporting
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Pathologists in a teaching institution assess the value of the autopsy
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Attitudes of senior pathologists towards the autopsy
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The attitudes of junior pathologists towards the autopsy
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Autopsy consent practice at US teaching hospitals: result of a national survey
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