Asking relatives for permission for a post mortem examination

Abstract

SummaryThis article discusses the possible aims, benefits, and also the content, format and timing of training in one specific aspect of clinical practice; how to request permission for post mortems. There is increasing concern regarding the current world-wide decline in clinical or hospital post mortem rates.' The reason for this concern is that the post mortem is still ofbenefit to both medical practice and to society. The decline is believed to be due to a number of complex factors.' Clinicians, particularly junior clinicians, are usually responsible for approaching relatives for their permission2 although in some cases specially trained decedent affairs staff may undertake this task.3 These individuals therefore have a key role in determining hospital post mortem rates. This is particularly true in those countries which are now changing from a system whereby patients or relatives had to opt out of clinical post mortems to a system in which relatives' consent must be obtained.A major factor in the decline in hospital post mortem rates is that fewer requests are being made.4 This may be due to a number of reasons including a fear of confronting the relatives,' personal discomfort,5'6 an inability to explain adequately the value of the post mortem,7 a belief that relatives are becoming more reluctant to give permission,8 or a desire not to upset the relatives.69The outcome of an autopsy request is highly dependent on the manner in which it is made.'0 Thus, the process would be easier for all concerned if those involved in making the requests had received appropriate training and if the requesting procedures were well-established.3Training in requesting permission for a hospital post mortem A large number of clinicians appear to have never received any formal training or advice in how to approach relatives for permission for a post mortem.2'5"1"2 Most clinicians learn through personal experience or by accompanying senior colleagues who have had no training themselves.5"2 Initial experiences could have long-term effects on clinicians' motivation and expectations regarding future requests, particularly if these experiences are negative. This is one reason why preparation via the provision of relevant training is important.Many junior clinicians feel that there is a need for training in how to request post mortems.8" Support for this proposal has come from a wide range of clinical and non-clinical sources.479"' It has been suggested that most basic skills required for medical practice should be acquired during the pre-registration year when supervisors have a responsibility to ensure that adequate training is provided. 14 Content of training

Parental decision making around perinatal autopsy: a qualitative investigation

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The attitudes of relatives to autopsy: a misconception

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Audit study of next of kin's satisfaction with clinical necropsy service

“…The high number of relatives distressed by necropsy requests points to a need to train all grades of doctors in communication skills for dealing with death and dying 3. Trained bereavement officers can help doctors.…”