The European Critical Care Foundation is sufficiently concerned about this to have organised a one-day meeting on the subject, hosted by the Nuffield Council on Bioethics in London on 6th March. It was a fascinating meeting, with lots of unexpected conclusions.
Although medico-legal post-mortems for the coroner continue to be performed in large numbers, the number of post-mortem examinations carried out with the consent of relatives has shown a progressive decline across Europe. The UK is leading the way; less than 0.1% of deaths in the UK are now followed by a consented post-mortem.
Many would be surprised that critical care doctors are bothered about this; aren’t their patients investigated enough during life to be sure what caused death? Not so, and the European Critical Care Foundation recognises this. Different studies produce different numbers, but a post-mortem typically identifies something that, if known during life, would have altered the care given in about 20% of intensive care unit deaths.
Many would think that modern scanning techniques will make conventional autopsies redundant. Not so; such scans can certainly help in unexpected sudden deaths, but it was pointed out that patients in intensive care have usually had all the scans that modern medicine can provide; yet post-mortem examinations still generate numerous unexpected findings.
Many would think that the decline is because society has changed and relatives are less willing to give consent. Not so; there is actually little evidence of such a change in attitudes, but there is abundant evidence that doctors have stopped asking for consent for post-mortem examinations.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.