POST-MORTEMS are on the wane around the world. As in Britain, doctors are now
less likely to assume that relatives will consent to the procedure, and more
families are asserting their rights to say no.
Fear is also playing a part. In the US, doctors are increasingly nervous
about litigation and malpractice lawsuits, and many avoid carrying out a
post-mortem as a result. That鈥檚 despite no evidence that doctors are more likely
to be sued because of an autopsy.
A more insidious explanation, however, is that doctors are growing
complacent, feeling they no longer need to subject their diagnoses to a 鈥渟econd
opinion鈥� after death. 鈥淚n general, the international trend is for the rates to
decrease,鈥� says Elizabeth Burton, director of post-mortem services at the Baylor
College of Medicine in Dallas, Texas. 鈥淚n the US there鈥檚 an illusion that our
technology is so good we don鈥檛 need post-mortems any more.鈥�
Advertisement
But this perception is false, she says. The discrepancy rate between what is
written on a death certificate and the true cause of death hasn鈥檛 changed in
decades. Post-mortems still reveal surprises in 30 to 40 per cent of
cases鈥�10 per cent are serious errors which would have changed the
treatment and outcome for the patient, says Burton. 鈥淚f you have a 10 per cent
error to improve on, that鈥檚 significant.鈥�
There is however, one scheme that is working. Post-mortems remain
routine鈥攁lmost obligatory鈥攊n some European countries. According to
Burton, countries such as Austria, Sweden and Switzerland operate opt-out
systems whereby post-mortems follow all deaths unless individuals 鈥渙pt out鈥�
before they die. These countries report post-mortem rates as high as 98 per
cent. Germany also has high rates, although they are dropping. In contrast,
voluntary autopsies follow only 5 per cent of deaths in the US.
