Is Consent to Autopsy Necessary? Cartesian Dualism in Medicine and Its Limitations

Abstract

When a hospitalization ends in death, a request for an autopsy can lead to an emotionally charged encounter between a physician and the deceased patient's family. A case is presented in which a cardiac surgeon, believing he might have made a mistake, requests an autopsy, but members of the deceased patient's family believe that she would not have wanted an autopsy performed. A central question discussed in this commentary is whether and when consent for autopsy is necessary. We discuss two theoretical frameworks that support differing views on this question. Beyond engaging this philosophical discussion, we also highlight a practical approach to discussing an autopsy with a grieving family by using the case presented. CaseDr. Zinker, a cardiac surgeon, is surprised by the rapid and unexpected death of his patient, Ms. Foster, whose postsurgery recovery had appeared complication-free. Prior to her death, she complained of shortness of breath and was found to have a pleural effusion, an abnormal volume of fluid around one of her lungs. The pleural effusion was drained, but she developed unstable blood pressure, which required increasing administration of vasopressors. Despite these supports, Ms. Foster died. Dr. Zinker wants to order an autopsy to determine the exact cause of Ms. Foster's death. Specifically, he wants to discover whether something he did during the surgery contributed to her unexpected death.Dr. Zinker meets with Ms. Foster's husband, Jim, and adult daughter, Alta, to obtain consent for an autopsy. He explains to them what's involved in an autopsy and how long it might take. The normal protocol for autopsy includes examining both the head and the body, but Dr. Zinker explains that the family may limit autopsy to the body if so desired. He also explains that the autopsy should take a few hours and that preliminary results would be available shortly after the procedure was complete. He tells the family that final results might not be available for several weeks because academic autopsies often involve microscopic evaluation of tissues, which requires additional histologic processing. Jim and Alta are reluctant to consent to the autopsy of Ms. Foster, stating, "She's already

Impacts of Forensic Outcomes on Cadaveric Organ Donations in Malaysia

“…Thus, the element of respect for autonomy in this sense must be deliberately explored in assessing the impacts of forensic outcomes on cadaveric organ donations. 17 The autonomy of those who are legally in possession of the body needs to be respected as well. In this regard, for them to be fully autonomous, clinicians play a central role in giving them the whole picture of what is going on and what are the implications of any of the decisions are going to be in their specific cases.…”