Autopsy Consenting Procedures

[b&ierstiefel]

OK folks, this has always been a curiosity of mine. Usually, this comes up in my mind when I'm on like autopsy call or something (i.e., and not wanting to be paged). I would rather be sitting at home reading Sternberg or Rosai to buff up my diagnostic skillz and increase my fund of knowledge...maybe even start studying for boards.

I was wondering what clinicians say to the deceased patient's family to get them to agree to allow an autopsy?

Do they go into detail as to what an autopsy actually entails?

And for what percentage of deaths, at your institution, do the clinicians even bring up the topic of autopsy to the family?

I wonder because for me personally, if a loved one of mine died, I would be inclined to not agree to an autopsy. I mean, I know that autopsies can reveal information that can be helpful for the care of other patients. But my loved one is dead and nothing is bringing him/her back. And yes, a lot of my sentiment maybe due to the fact that I know what actually happens during an autopsy and can visualize it. So apart from medicolegal cases where the family is itching to find some reason to sue, I can imagine that the clinicians have to do quite a bit of convincing and advertising to get the family to consent.

So what happens during the dialogue? What is actually said? Anyone witness this first hand how the clinicians can magically pull off this jedi mind trick?

*waves hand* .... "you will consent to autopsy"

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[stormjen]

I would imagine it's presented as a learning experience: "we would like to explore what happened to your dear grandmother in order to save future grandmothers".

I for one have already told my husband that I do not want an autopsy. I will donate all my organs, then I wish to be incinerated and tossed into the ocean.

 

[pathstudent]

^Even when patients have cancer, chronic organ failure, auto-immune diseases, or are immune-compromised, the family still has hopes and doesn't understand how the patient was stable and "OK" a week ago or a month ago and now is dead. So they agree to the post in order to learn what happened.

The other common scenario is the present at the hopsital and drop dead shortly thereafter scenario. Families are often very willing to agree to the post.

In terms of agreeing to a post so we can learn, I don't think that is that common except in cases where the patient has a chronic guarnteed fatal illness such as ALS, Huntingtons, etc...

 

[b&ierstiefel]

^Even when patients have cancer, chronic organ failure, auto-immune diseases, or are immune-compromised, the family still has hopes and doesn't understand how the patient was stable and "OK" a week ago or a month ago and now is dead. So they agree to the post in order to learn what happened.

The other common scenario is the present at the hopsital and drop dead shortly thereafter scenario. Families are often very willing to agree to the post.

In terms of agreeing to a post so we can learn, I don't think that is that common except in cases where the patient has a chronic guarnteed fatal illness such as ALS, Huntingtons, etc...

Good points. With regards to your last point and ruminating a bit over my autopsy experiences, it makes sense. I think I have only had 3 cases where the family consented to the autopsy to aid in research or something...a noble gesture indeed.

When I made the "so we can learn" point, I was also alluding to the fact that in some cases, I suspect that the clinicians may want the autopsy more than the family. Sure, the family may be disinclined to consent initially but after some "negotiations", they may give into the clinician who are trying to get the green light. Again, this is all speculation because for one, I don't directly care for patients anymore so I don't know what goes on during these discussions.

Oh here's a random question...let's say a patient is pronounced dead at 4 pm. Is the family approached with the autopsy topic immediately or if not, what is the average length of time before the clinician broaches the subject?

Yes, I realize these questions and this thread are kinda stupid but just indulge my curiosities here

 

[yaah]

I think it depends on the institution to some extent. As you probably know, here they are required to fill out some paperwork at death and one thing they have to check off is whether an autopsy is requested or refused. Either way, the patient's family has to check it off and sign it. So it forces the discussion. I think the way a lot of people present it is as an "examination after death," which can be directed to answer specific questions or concerns. A lot of people have family histories or concerns which may impact the rest of the family.

I always wonder though, whether people are saying yes because they expect or hope to find something that will lead to a lawsuit. I would imagine they have to present it carefully though. They have to avoid sounding like there is something they (the clinicians) are trying to hide, and they have to avoid sounding like they want to cut grandma up. A lot of people have misconceptions of autopsies (like if you have a full autopsy there is no way you can have an open casket).