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ISITNECESSARYTOGETCONSENTFORANAUTOPSY

IsItNecessaryToGetConsentForAnAutopsy?
RobertGordon
SaltLakeCommunityCollege

ISITNECESSARYTOGETCONSENTFORANAUTOPSY

Introduction
Ifapatientdiesunexpectedly,adoctorusuallywonderswhytheunexpecteddeath.Especiallyif
theyrecentlyperformedtreatmentonthepatientthatseemedlikeasuccess.Anautopsyis
usuallyperformedinordertomoreclearlyseewhatcausedthedeathofthepatient,andhowthe
doctorcanimprovetheircareforpatients.Alotofinformationcanbegainedfromobservingthe
deadpatientsremains.Thedoctorcanthendeterminewhatwentwrong,andcantryandfixitfor
futurepatients.Butinsomecases,thegrievingfamilyofthedeceasedrefusesconsentforan
autopsy,keepingthedoctorfromlearningmorefromthedeceased'sbody,andpotentially
helpingfuturepatientsfrommeetingthesameunexpectedend.
Onesuchcaseisfromacardiacsurgeon,Dr.Zinker.Dr.Zinkerspatient,Ms.Foster,
unexpectedlydiedwhilemakingacomplicationfreerecoveryfromsurgery.Ms.Fosterhad
complainedofhavingashortnessofbreath,andexcessfluidaroundoneofherlungswas
drained.Thenshedevelopedunstablebloodpressure,anddespitetreatment,shepassedon.Dr.
ZinkerwantstoperformanautopsytoseeifsomethinghedidduringMs.Fosterssurgery
contributedtoherdeath.HemeetswithMs.Fostershusband,Jim,anddaughter,Alta,inorder
toobtainconsentfortheautopsyhewantstoperform.Afterexplainingwhattheautopsywould
entail,howlongitwouldtake,andwhenthepreliminaryandfinalresultswouldbein,both
fatheranddaughterarereluctanttogiveconsent.Theyareworriedaboutdelayingthefuneral
alongwithunwillingnesstoputMs.Fostersbodythroughmorethanitalreadyhasbeen.Jim
andAltaalsoexpressconfusiononwhytheautopsyshouldtakeplace.Now,Dr.Zinkeris
confusedonwhattodonext,andcontactsthehospitalspathologistforhelp.
Thesis

ISITNECESSARYTOGETCONSENTFORANAUTOPSY

Thebestwaytoapproachthisistorespectthewishesofthefamily.Performinganautopsyto
determinethecauseofdeathisthebestchoiceofaction,especiallyiftheexactcauseofdeath
isntknown.Thisisthenumberonecourseofactionthatshouldbetaken,butnumerousfactors
suchascultureandreligioncouldupsetthefamily.Asthefamilyaretheonesthatcommunicate
whatthedeceasedpatientwouldwant,itisnecessarytokeepthemhappywithwhatoccurs.By
takingprecautions,andexplainingbothwhatthedoctorintendstodoandwhytheywanttodoit,
itallowsformoreunderstandingofthesituationonthesideofthefamily,andallowsfora
greaterchancetogetconsent.
MedicalIndications
Inageneralsense,theproblemofadeceasedpatientisthattheydiedunexpectedly,andthe
doctorwantstofigureoutexactlywhythispatientdied.Familyofthedeceasedrefusestogive
consentfortheautopsy,causingadilemmaforthedoctor.Thegoalofthisautopsyistoseethe
exactcauseofdeath,andtoseehowthetreatmentcouldbeimprovedforfuturepatients.Only
futurepatientswouldbenefitfromtheautopsy,otherthanfindingoutthecauseofdeath,butif
thereisnoautopsy,thewishesofthefamilyarerespected.
InthecaseofMs.Foster,thefamilyisreluctanttogiveconsentforanautopsy,whichwould
providehelpfulinformationaboutthedeathofMs.Foster.Dr.Zinkersgoalistoseeifanything
hedidduringsurgerycontributedtoMs.Fostersdeath,andifhecanimprovehissurgeryto
avoidanotherpatientsdeath.Futurepatientsaredefinitelyabletobenefitfromtheautopsy,but
JimandAltaswishesneedtoberespectedastheyarethenextofkin,andhaveownershipofthe
bodyduetoquasiproperty.
PatientPreferences

ISITNECESSARYTOGETCONSENTFORANAUTOPSY

Forthegeneralcase,thepatientisdead,andcantgivetheiropiniononbeingautopsiedornot.
Theresponsibilitythenfallstothenextofkin,whoisapparentlyfullycapableofmakingan
informeddecision.Nextofkinhasnotgivenconsentfortheautopsy,andhasallthenecessary
informationabouttheprocedure.Usuallythereasonforrefusingtogiveconsentisareligiousor
aculturalproblem,butmayalsobebecausetheydontwanttoseetheirlovedonesufferany
more.Eventhoughthepatientisalreadygone,thedeadbodystillrepresentsthemintheeyesof
theirfamily.
Ms.Fosterisalsodeceasedandcannotgiveherownopinion.Dr.Zinkerhasmetwithher
husbandanddaughter,makingsuretheyknowwhatwillhappenifanautopsytakesplace.Jim
andAlta,thefamily,haventgivenorrefusedtogiveconsent,butfeelreluctantastheydont
wanttoseeMs.Fostersbodytosufferanymore.Theyalsoexpresseddesiretoknowwhythe
needforanautopsyispresent.ItseemslikeDr.Zinkerdidnttellthemwhyhewantedto
performoneinthefirstplace.
QualityofLife
Generally,thedeceasedpatientwonthaveabetterqualityoflifeifanautopsyisperformedor
not.Thenextofkinwontreallyhaveabetterqualityoflifeeither.Theymayfeelalittlebetter
atknowingexactlywhytheirlovedonedied,butnotnecessarilyenoughtodrasticallychange
howtheywillcontinuewiththeirlives.Onlythosepatientsthatmaybeunderthefuturecareof
thedeceasedsdoctorcouldhaveabigchangeintheirlifequality.Ifthedoctorfindssomething
theycanchangewhileperforminganautopsy,theycanimprovetheirtreatmentandcarefor
futurepatients.

ISITNECESSARYTOGETCONSENTFORANAUTOPSY

Aswithageneralcase,bothMs.Fosterandherfamilywonthaveabetterqualityoflifeno
matteriftheautopsyisperformedornot.Ms.Fosterisofcoursedead,meaningthereisno
changingherqualityoflife.Herfamily,asstatedbefore,willnothavetheirqualityoflife
affectedmuchwhethertheautopsyisdoneornot.Alsostatedearlier,futurepatientsofDr.
Zinkerwillexperiencethemostchangeinqualityoflife.Ifitturnsoutthatsomepartofthe
surgerycontributedtoMs.Fostersdeath,Dr.Zinkerwillbeabletochangehispracticeto
benefithisfuturepatients.Dr.Zinkerhimselfwillprobablyexperiencethemostdrasticchange
inhisqualityoflifeiftheautopsygoesthrough.Hewilleitherlearnhowtoimprovehis
procedure,orgettheweightofapatient'sdeathoffhisshoulders,ashemayfindouthissurgery
didntcontributetoherdeath.
ContextualFeatures
Anyrelationsthatwouldaffectmostcasesdealingwithconsenttoperformautopsywouldmost
likelybereligiousorculturalissues.Someculturesfeelthatthebodyofthosethatpassonis
sacred,andshouldntbetouchedforanyreason.Othersthinkthatthereisstillaconnection
betweenthespiritandthebody,soanytamperingwiththebodyleadstodamagetothesoul.
Religionsalsohaveahardtimewithautopsyasmanybelievethedeadtobesacred.Anyother
operationotherthanpreparationforburialiswrong.Anotherissueisthefuturepatientsthat
couldbeaffectedpositivelybyanyinformationthatisdiscoveredthroughanautopsy.
JimandAltaareonlyreluctanttogiveconsentastheyfeelMs.Fosterhasgonethroughenough,
andcantbeartohaveherbodygothroughanymore.Thisleadstoaninferenceoftheirreligion,
culture,orpersonalbeliefsthataffectstheirdecision.Dr.Zinkerfeelsthatbyperformingan
autopsyhecanimprovehissurgeryandhelpthosewhomaycometohiminthefuture.One

ISITNECESSARYTOGETCONSENTFORANAUTOPSY

thingthatseemsoddwhileDr.Zinkertriedtogetconsentisthathedidntsaywhyhewantedto
performanautopsy.JimandAltaexpressedadesiretoknowwhy,andDr.Zinkerdidntgive
themone.Perhapshefeelsguiltyforassumingthathissurgerymayhavecontributedtothedeath
ofMs.Foster,anddoesntwantthefamilytoknow.
Conclusion
Asstatedinthethesis,thebestwaytoapproachthesituationistogivethefamilybothwhatwill
happeninanautopsyandwhyitshouldbedone.Thisallowsforthegreatestchanceof
understandingfromthefamilyandallowsthemtoseethereasonsforallowinganautopsytotake
place.Dr.ZinkerdidntgiveJimandAltaareasonwhyanautopsywasneeded,sotheywere
unabletoseehowtheautopsywouldbenefitfuturepatientsandDr.Zinkerssurgeryskills.For
futurecases,makingsurethefamilyunderstandsthewholereasonforanautopsyandhowitmay
benefitpeoplecanmakethedifferencebetweengettingconsentornot.Oncethefamilymembers
knowwhatinformationanautopsymayprovide,theymaybemorepronetogivingtheirconsent.
Bibliography
http://journalofethics.amaassn.org/2016/08/ecas21608.html
(Icouldonlyfindonesource).(ThesourceIfoundonlyhadMs.FosterasMs.eventhoughshe
wasmarried.Ileftitasistokeepfrommakingamistake,thoughIthinkitshouldbeMrs.
Foster).