Sir, - The current controversy on the practice and procedures surrounding autopsies has been marked by much confusion. The extent of the information provided to relatives of the deceased to facilitate and inform consent has clearly been inadequate in some cases. There is a potential conflict between the medical desire to minimise the trauma of bereavement and the recent demands for explicitness demanded by some traumatised relatives. Where should the balance lie between a brutally explicit description of a full autopsy and the minimal information that had often been the norm heretofore? Information demanded by one family may upset and repel another. Cultural norms change over time and the context will define "informed" consent.
For pathologists, the development of a codified standard operating procedure for post-mortem examinations whether full or limited should be done by the faculty of pathology and posted on the Internet. This would allow access to full information on procedures to those members of the public who wished to know.
In 1990, the College of American Pathologists published a document which defined the purpose of autopsies as being "to establish with all possible accuracy the cause of death and to determine the nature and cause of those disease processes or other conditions that contributed to death or contributed to other illnesses present at the time of death". New unsuspected findings are found in 5-40 per cent of autopsy series.
Their suggested authorisation form to be signed by relatives states: "I understand that it is standard procedure . . . to remove certain organs and tissues and retain them for educational, research, potential future therapies and other scientific purposes even though such organs and tissues may not show changes directly related to the cause of death, and that they may be disposed of by the hospital through its department of pathology at the discretion of the department".
To examine the brain it is standard procedure to suspend the entire brain in four litres of formalin for two to four weeks. The pituitary is dissected as a routine procedure. The Americans suggest that "in infants and young children, it may be advisable to remove the heart and lungs as a single block." Retention times for tissues may be five to 20 years, depending on the case.
Hospital autopsy rates have fallen to around five per cent. Most are now coroners' cases where consent by relatives is not required. Many factors have lead to this decline including lack of support by clinicians and the public, fear of malpractice litigation and reluctance of relatives. Some of those involved in the current autopsy campaign in the media have not had to give consent as the coroner was involved. Perhaps the coroners could agree to supply an information booklet to the public regarding their procedures. Finally to underpin public confidence, there should be an independent report group in each hospital to review all deaths in hospital that do not come into the current remit of the coroner. - Yours, etc.,
Dr Bill Tormey, Glasnevin Avenue, Dublin 11.