Liability concerns are reflected in nation’s low autopsy rate

Regarding: “Declining autopsy rates affect medicine and public health” (Article, Feb. 20):

The fact that only 9% of all deaths in the U.S. were autopsied in 2007 is highly disturbing, especially since a large study in 2005 revealed that approximately 50% of autopsies revealed findings that were unsuspected prior to the patient’s demise.

The reasons for this continuing downward trend and the significant adverse consequences have been repeatedly commented upon. From medicolegal and forensic scientific perspectives, the likelihood of serious consequences and grave injustice in both civil and criminal matters is quite apparent. Educated, intelligent, sensitive people like experienced physicians should be fully aware of these tragic ramifications.

As both a hospital and forensic pathologist, I have been amazed by the frequency of cases in which the attending physician literally attempts to dissuade a family from having an autopsy performed. “It’s not necessary. We know everything already” to “Why should you want to have your loved one cut open?” are among the kinds of comments I have encountered personally.

I believe that the principal factor responsible for this unacceptable decline of autopsies was not referred to in this otherwise informative article. Fear of a malpractice lawsuit — that is the primary reason that doctors do not want autopsies to be done.

In the absence of a thorough postsmortem examination by an experienced pathologist, the cause of death will be officially designated by the diagnosis set forth by the treating physician. This is the regrettable and harsh explanation for this scientifically deplorable and societally unacceptable philosophy.

Cyril H. Wecht, MD, JD, Pittsburgh

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/03/19/edlt0319.htm.