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June 16, 1999

Autopsy Rates and Diagnosis

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;281(23):2181. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-23-jac90005

To the Editor: Despite diminishing numbers of autopsies, the need for this crucial procedure, "a fundamental principle of all clinical research,"1 remains irrefutable.2 One element of current autopsy practice is undermining the goals of autopsy: limitations placed on autopsy consent by next-of-kin. At our institution such consent limitations are placed on approximately 1 in 5 autopsies.3 The most common consent limitation (about 40% of all restricted cases) is placed on the examination of the brain owing to the mistaken assumption that such an examination would preclude an open-casket funeral. Of course, some religious or spiritual beliefs may preclude examination of certain organs. In all other cases, perhaps, the placement of consent limitations makes the performance of an autopsy more acceptable to the next-of-kin. However, it ought to be realized that consent limitations inhibit pathological evaluation of effects of fatal disease and of cause of death. At our hospital, pathological evaluation may be significantly hampered in approximately 18% of cases that are autopsied with consent limitations (eg, cases of stroke or suspected encephalitis with the head as the limitation).