Autopsy (Encyclopedia of Nursing & Allied Health)

Definition

An autopsy is a postmortem assessment or examination of a body to determine the cause of death. An autopsy is performed by a physician educated in pathology. Often this physician also has forensic training.

Purpose

Most autopsies advance medical knowledge or provide evidence for legal action. Medically, autopsies may determine the exact cause and circumstances of death, discover the pathway of a disease, and/or provide valuable information to be used in the care of the living. When foul play is suspected, a government coroner or medical examiner performs an autopsy to collect data for legal investigation. This branch of medical study is called forensic medicine. Forensic specialists investigate deaths resulting from violence or occurring under suspicious circumstances.

Benefits of research from autopsies include the discovery of new medical information on diseases such as toxic shock syndrome, acquired immunodeficiency syndrome (AIDS), and Alzheimer's disease.

Precautions

When performed for medical reasons, autopsies require formal permission (written consent), from family members or a legal guardian. Autopsies required for legal reasons when foul play is suspected require authorization from a coroner or medical examiner. Such autopsies do not need the consent of next of kin. During the autopsy, very concise notes and documentation must be made for both medical and legal reasons. Some religious groups prohibit autopsies, although special waivers apply where suspicious death occurs.

Description

An autopsy is the examination of a deceased human body with a detailed investigation of the person's remains. This procedure dates back to the Roman era when few human dissections were performed. Autopsies were utilized, however, to determine the cause of death in criminal cases.

A pathologist fills out an autopsy report during an autopsy. (Photograph by Glauberman. Science Source/Photo Researchers. Reproduced by permission.)

At the beginning of the procedure, the exterior body is examined and the internal organs are removed and studied. Some pathologists argue that more autopsies are performed than necessary. However, recent studies show that autopsies can detect major findings about a person's condition which were not suspected when the person was alive. The growing awareness of the influence of genetic factors in disease has also emphasized the importance of autopsies.

Despite the usefulness of autopsies, fewer autopsies have been performed in the United States during the past 10 to 20 years. A possible reason for this decline is concern about malpractice suits on the part of the attending physician, although there are other reasons. Hospitals are performing fewer autopsies because of the expense. Modern technology, such as CT scans and magnetic resonance imaging (MRI), can often provide sufficient diagnostic information. Nonetheless, federal regulators and pathology groups have begun to establish new guidelines designed to increase the number and quality of autopsies being performed.

Many experts are concerned that if the number of autopsies increases, hospitals may be forced to charge families a fee for the procedure as autopsies are not normally covered by insurance companies or Medicare. However, according to several pathologists, the benefits of the procedure for families and doctors justify the cost. In medical autopsies, physicians remain cautious, examining only as much of the body as necessary, taking into account the wishes of the family. It is important to note that in certain circumstances, autopsies can provide peace of mind for a bereaved family.

Preparation

If a medical autopsy is being performed, written permission is secured from the family member of record of the deceased.

Aftercare

After an autopsy has been completed, the body is prepared for final arrangements according to the family's wishes, or the funeral director's instructions.

Complications

There is some risk of disease transmission from the deceased. In fact, some physicians may refuse to do autopsies on specific persons because of a fear of contracting diseases such as AIDS, hepatitis, or Creutzfeld-Jakob disease.

Results

In most situations, the cause of death is determined from the autopsy without any transmission of disease. Results of tests performed on samples of tissue and bodily fluids provide information about the cause and mechanism of death.

Abnormal results include inconclusive results from the autopsy and transmission of infectious disease during the autopsy. By following proper procedures, these are both highly unusual.

Health care team roles

Bodies of persons dying in a hospital are taken to the morgue by hospital attendants. Bodies of persons from any other location are transported by funeral home personnel, coroners, or their assistants. An autopsy is conducted by a physician, usually by one trained in pathology or forensic science. In some states, a coroner can legally carry out an autopsy. Laboratory personnel process any specimens or samples obtained during an autopsy. Once completed, funeral home personnel transport the remains to another location for burial preparation.

KEY TERMS

Acquired immunodeficiency syndrome (AIDS) group of diseases resulting from infection with the human immunodeficiency virus (HIV). A person infected with HIV gradually loses immune function, becoming less able to resist immune-related diseases and cancers, resulting in death.

Computed tomography scan (CT scan)he technique used in diagnostic studies of internal bodily structures in the detection of tumors or dysfunction. This diagnostic test consists of a computer analysis of a series of cross-sectional scans made along a single axis of a bodily structure or tissue that is used to construct a three-dimensional digital image of that structure.

Creutzfeld-Jakob disease rare, often fatal disease of the brain, characterized by gradual dementia and loss of muscle control that occurs most often in middle age and is caused by a slow-acting virus.

Hepatitisnflammation of the liver, caused by infectious or toxic agents and characterized by jaundice, fever, liver enlargement, and abdominal pain, with abnormal blood chemistry readings.

Magnetic resonance imaging (MRI) diagnostic tool that utilizes nuclear magnetic energy in the production of digital images of specific atoms and molecular structures in solids, especially human cells, tissues, and organs.

Postmortemfter death.

L. Fleming Fallon, Jr., MD, DrPH