“We might get a lot more families who will agree”: Muslim and Jewish perspectives on less invasive perinatal and paediatric autopsy

Abstract

BackgroundPerinatal and paediatric autopsy rates are at historically low levels with declining uptake due to dislike of the invasiveness of the procedure, and religious objections particularly amongst Muslim and Jewish parents. Less invasive methods of autopsy including imaging with and without tissue sampling have been shown to be feasible alternatives. We sought to investigate attitudes including religious permissibility and potential uptake amongst members of the Muslim and Jewish communities in the United Kingdom.MethodsSemi-structured interviews with religious and faith-based authorities (n = 16) and bereaved parents from the Jewish community (n = 3) as well as 10 focus groups with community members (60 Muslim participants and 16 Jewish participants) were conducted. Data were analysed using thematic analysis to identify key themes.FindingsMuslim and Jewish religious and faith-based authorities agreed that non-invasive autopsy with imaging was religiously permissible because it did not require incisions or interference with the body. A minimally invasive approach was less acceptable as it still required incisions to the body, although in those circumstances where it was required by law it was more acceptable than a full autopsy. During focus group discussions with community members, the majority of participants indicated they would potentially consent to a non-invasive autopsy if the body could be returned for burial within 24 hours, or if a family had experienced multiple fetal/pregnancy losses and the information gained might be useful in future pregnancies. Minimally invasive autopsy was less acceptable but around half of participants might consent if a non-invasive autopsy was not suitable, with the exception of the Jewish Haredi community who unanimously stated they would decline this alternative.ConclusionsOur research suggests less invasive autopsy offers a viable alternative to many Muslim and Jewish parents in the UK who currently decline a full autopsy. The findings may be of importance to other countries with significant Muslim and/or Jewish communities as well as to other religious communities where concerns around autopsy exist. Awareness-raising amongst religious leaders and community members will be important if these methods become routinely available.

Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure

“…Our findings suggest that the MinImAL procedure has a performance similar to that of standard autopsy in terms of the proportion of IUFD/stillbirth cases in which a cause of death is determined. Given that recent data indicate that LIA techniques are well accepted by parents and religious communities, these findings have implications for perinatal autopsy practice globally, as acceptability of standard autopsy continues to decline.…”

Availability of less invasive prenatal, perinatal and paediatric autopsy will improve uptake rates: a mixed‐methods study with bereaved parents

“…This is likely to be because of the small number of Muslim and Jewish responders. However, qualitative research with parents and religious leaders from these two religious groups has shown that the invasiveness of standard autopsy is a key reason why Muslim and Jewish families decline, along with the requirement to bury the body quickly, and that non‐invasive approaches in particular, would be considered religiously permissible and much preferred …”

Ultrasound examination: The key to maximising the benefits of advances in molecular diagnostic technologies

“…However, in this issue we hope to persuade you otherwise, as the contents of this special issue on ultrasound and genetic syndromes demonstrate how expert sonography and other fetal imaging is key to maximising the benefits of the technological advances we are seeing in molecular diagnosis. While largely focused on prenatal imaging, we also show how combined prenatal ultrasound and postnatal MRI examinations may be able to replace traditional post‐mortem examination, an approach welcomed by both the public and patients …”