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May 2, 1990

DNR and Autopsy: A Linked Bayesian System

Author Affiliations

Chippenham Hospital Richmond, Va

Chippenham Hospital Richmond, Va

JAMA. 1990;263(17):2298. doi:10.1001/jama.1990.03440170020013

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To the Editor.—  The development of modern diagnostic techniques is perhaps the most important of several factors that have changed medical practice so that realistic and compassionate donot-resuscitate (DNR) orders are now commonplace. The careful evaluation that must precede a DNR decision anticipates the function of the autopsy and is, in fact, a form of autopsy (seeing for oneself). Thus, the autopsy approach to DNR patients begins with the use of diagnostic probes to secure aliquots and images of organs and tissues that provide more timely information than postmortem specimens.Information leading to a DNR decision coupled with postmortem data forms a linked Bayesian system in which the final posterior probability (P≈100%) of the primary disease is established before death. Because the postmortem part of the linked diagnostic system is limited to refining the principal diagnosis and turning up secondary diagnoses—pulmonary embolism, pneumonia, gallstones, and the like— that were not