Despite the clinical advantages of the information gained, autopsy rates have continued to decline in the United States. This decline is primarily the responsibility of physicians. Physicians may believe they already know everything about the case, and not want to stress the family further. Medical students are not taught the importance of the autopsy. Finally, the Joint Commission on Accreditation of Hospitals eliminated its minimum autopsy rate of 20 percent in 1971. 20

Advantages of the autopsy include improvement in medical care nearly half the time, frequently by clarifying the diagnosis. 21 Diagnosis of new diseases is aided by the autopsy. Autopsies can assist in the grieving process by demonstrating to the family that they did not contribute to the death. Despite physicians' fear that the autopsy will lead to increased liability exposure, postmortem examinations are more often used as a defense. 22

Public misperceptions concerning autopsy abound. Some of the misperceptions are that diagnostic tests are infallible; autopsy disturbs the patient's "peace"; bodily mutilation occurs; funeral arrangements will be delayed; it's too late to accomplish anything positive; religious prohibitions are present; the family never gets the results; and if an autopsy is necessary, one will be requested.23

The most senior physician involved with the case should approach the family with the request for autopsy. Specific points to be discussed include that the autopsy is done by specialists in pathology (an analogy to surgery may be helpful); specific determination of cause of death may help to dispel any doubt the family has; funeral arrangements will not be disturbed; and no mutilation occurs.11 If the family is concerned about religious prohibitions, they can be reassured that autopsy is not prohibited by most of the major religions,24 and can be encouraged to consult with the chaplain. The physician requesting the autopsy must be aware of local and institutional policies regarding billing and payment for autopsies. Many teaching institutions consider the autopsy as part of comprehensive care and do not submit a charge. However, there is great variation on policies in community, state, and municipal hospitals, and the patient's family should be so informed when they make their decision about an autopsy.

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