Elaine Souder, Phd, RN; Tanya Laws Terry, MS; Robert E. Mrak, MD, PhD

Disclosures

Geriatr Nurs 

In This Article

The Autopsy Procedure

Physicians and nurses need to understand the process and procedures of an autopsy to be able to answer patients' and family members' questions. A family confronted with a difficult decision, such as whether to have an autopsy performed on their loved one, is very likely to ask what will happen. Therefore, we briefly describe the procedure here.

Before asking consent from a family member, the physician must first determine whether or not the death of the patient falls under the jurisdiction of the medical examiner. Cases that typically fall under this jurisdiction are those in which the cause of death is uncertain, is suspicious, or involves a crime. The medical examiner may also have jurisdiction for performing an autopsy if the deceased is unidentifiable in any other way (eg, the person was involved in a car accident, house fire, etc). If physicians are at all uncertain whether a case falls under the medical examiner's jurisdiction, they should consult the medical examiner. Consent from the family is not required for autopsies that fall under the medical examiner's jurisdiction.[18] Therefore, physicians should ask for permission from the family only when they are certain that the autopsy is not legally required. The family may be caused undue stress if they are asked and decline permission and then the autopsy has to be performed anyway.

Consent for an autopsy not required by the medical examiner must be obtained from the next of kin. The spouse of the deceased is considered by most states to be the next of kin. However, when the spouse is also deceased or the deceased was not married, the definition of next of kin varies from state to state.[19]

The autopsy is performed by a pathologist or a pathologist's assistant under the supervision of a pathologist. A full autopsy typically includes the removal and examination of all internal organs, including the organs of the central nervous system, pelvis, and abdomen.[20] This is done according to long-established techniques that do not involve disfigurement of the face or limbs and are entirely compatible with modern mortuary practices and open-casket funerals.[19,21] Examination of individual organs includes subsequent microscopic examination of tissues.

A complete autopsy is most desirable because it permits complete inspection of all organs and recording of all diseases present. However, in cases in which the next of kin has misgivings about a full autopsy, there is the option to consent to a restricted autopsy, with examination of only certain organs designated by the next of kin. Restricted autopsies, with removal and examination of only specified organs or examination of organs in situ with only small biopsy samples taken for microscopic examination, can still yield important information. For example, the physician of a patient with suspected AD may request that only the brain be examined, or the family of an individual with pancreatic cancer may consent only to autopsy of the abdominal area. Restricted autopsies, however, carry the risk of missing undiagnosed, clinically significant conditions, thus limiting the value of the autopsy to family, physicians, quality assurance, medical statistics, and science.[22] It goes without saying that autopsy is the final chance to conclusively identify the patient's disease or diseases. The complete autopsy ensures that all occurrence of disease is documented on the death certificate and conveyed both to the family and to the National Center for Health Statistics.

A preliminary report of the major gross autopsy findings is available within 2 working days; and according to the guidelines set by Joint Commission for Accreditation of Health Organizations (JCAHO), the preliminary report should be recorded in the medical record and available to the clinical physician within 3 working days.[20] It is possible that the clinical physician may be able to discuss the results with the family within a week of the patient's death. However, certain diseases (AD, for example) require microscopic examination of tissues and further special studies. In these cases, final results may not be available for several weeks.

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