Dead in the water – are we killing the hospital autopsy with poor consent practices?

Abstract

It is now a recognized fact that the practice of conducting a consent (or hospital) post-mortem examination is in decline. There have been many reasons put forth to explain this demise, but the quality of the consenting process is frequently cited as having a high impact. This article focuses on consent practices for post-mortem examinations in England and Wales, and considers if our consent techniques are adversely affecting post-mortem examination uptake. We examine the regulatory compliance of trusts with their statutory obligations by analyzing the Human Tissue Authority's compliance and inspection reports. We further analyze 21 publicly available NHS Trust policies on post-mortem examination consent procedures, and consider whether these are fit for the purpose of meeting the dual needs of clinicians and the bereaved. Despite more Human Tissue Authority inspections, there is a disproportionate rise in enforcement actions, with up to 48% of sampled Trusts exhibiting shortcomings in their legal duties. Additionally, only 52.4% of sampled trusts follow the Human Tissue Authority best-practice model, with 23.8% having no documented procedures. Despite the well founded evidence base for best-practice models, consent practices for post-mortem examinations remains poor and is likely to have a gross adverse effect on the rate of post-mortem examinations. We recommend that NHS Trusts rigorously review their protocols and introduce a team-approach between clinicians and trained bereavement staff in core-consent teams, as the Human Tissue Authority suggests, whilst at the same time placing a strong emphasis on education for junior and senior colleagues alike.

Bereaved relatives’ experiences in relation to post mortem: a qualitative exploration in North East Scotland

“…However, the recognised decline in the numbers of hospital post mortem examinations carried out (Henry & Nicholas, 2012) is concerning and may have been exacerbated by the so called 'organ retention scandal' in the late 1990s (Redfern, Keeling & Powell, 2001). Poor adherence to authorisation procedures in England and Wales may also mean relatives are less likely to provide consent (Henry & Nicholas, 2012).…”

“…However, the recognised decline in the numbers of hospital post mortem examinations carried out (Henry & Nicholas, 2012) is concerning and may have been exacerbated by the so called 'organ retention scandal' in the late 1990s (Redfern, Keeling & Powell, 2001). Poor adherence to authorisation procedures in England and Wales may also mean relatives are less likely to provide consent (Henry & Nicholas, 2012). In addition, the results of post mortem can be inconclusive, often controversial and may be contested (Timmermans, 2005), and along with the increasing popularity of post mortem sampling, or minimally invasive autopsy of easily accessible organs and tissues, may influence reduced numbers of traditional invasive post mortem procedures (Rigaud et al, 2011).…”

Computerized Tomography Scanning and Magnetic Resonance Imaging Will Terminate the Era of the Autopsy - A Hypothesis

“…Religion has been for long periods at the top of the list, ever since the Bull by Pope Bonifacius VIII (1299) and his ban of the human dissection 8 .…”

“…But, five hours should elapse between the death notification to the family and the start of the autopsy, to allow for a possible retraction. Practically, this law has made the rejection of the request by families much easier 8 .…”

“…However, more recently, several Islamic organizations have initialized the re-examination of the official position on this issue. But fetuses and newborn babies dying around the time of birth are autopsied, as the health of future children in the family is at stake 8 .…”