The Autopsy

Autopsies at death are not really routine here in the United States unless the death is suspicious, in which case one will probably be ordered. The state of death investigation here is complex and depending on where you are you may be subject to a coroner system, a medical examiner, or a hybrid system. Sometimes a hospital may request permission to perform an autopsy if a patient died in an unusual way and they want to learn more. Family members can also specifically ask for one even if it is not indicated if they’re curious and want to know more.

When an autopsy is ordered for legal reasons, the family doesn’t get a say in the matter, but in situations where it is optional, people should think carefully before responding. There can be some definite advantages to approving or requesting an autopsy, even if it may seem like an unpleasant thing to think about at the time. While the thought of callously hacking apart a loved one after death might not be high on the list of things you want to do, autopsies are not necessarily invasive, you can specify the level of death investigation you want, and you may learn some things of interest. It’s also possible that the autopsy will provide information that could be important for someone else.

On the one hand, someone is definitively dead, no matter what, so asking for an autopsy might not really seem necessary or productive, but it can also answer lingering questions. Dementia, for example, is often just recorded as that, without any further explanation, and when an older adult with dementia dies, an autopsy is not usual. But it might have been Alzheimer’s disease, a spongiform encephalitis, or any number of other things that you can’t identify until you look at the brain in an autopsy. You might want to know if a close relative died of a condition with a genetic link, or not, because that might be of interest to you in the future.

Or you might just want to know; how far spread was the cancer? Was there an underlying medical issue that didn’t get caught? Did the surgeon actually follow generally accepted standards and practices? Is there a chance that someone you’re related to has markers of a genetic condition that you could have too? You may find answers to all of these things in an autopsy. It might even provide some degree of peace, too. A pathologist may be able to tell you that yes, the growth really was invasive, it really was caught as early as possible, and there really wasn’t anything else that could have been done.

In the immediate wake of a death, it’s hard to imagine the things that may wrack your conscience or trouble you later. An autopsy might answer some questions you will have in the future. You don’t have to look at the report right away if you don’t want to. You don’t even have to think about it. But, someday, maybe in a few months or a few years, you might be glad you have that information to refer to. Or you might be glad that you can show other family members. You might not, too. It’s possible that the autopsy report will never be looked at, and that’s ok.

Autopsies can also be really helpful for care providers. A lot of the things we’ve learned about the human body have come from death investigations. And a lot of the things that we keep learning come from autopsies. Surgeons might want to see how their work held up. Autopsies might show that a given surgical technique or medical device is not safe, and should be reevaluated by government regulators and possibly pulled from the market. Conversely, it could show that something experimental did work and should be made more widely available.

If a patient had an acute reaction to a drug, the autopsy could show why, and it might help doctors avoid that reaction in other patients. For those in a giving mood, it’s possible to keep giving after death by letting your body serve as a canary in a coal mine. The only way we can pull drugs and medical devices from the market is through reports on when they don’t work, and a patient death is a very, very bad outcome that tends to trigger a warning to watch a situation more carefully. To miss the cause of death by writing it off as something else may mean it takes that much longer to identify the pattern in a set of deaths related to a treatment that isn’t working.

This is not an attempt to guilt you into autopsy, mind you! Autopsies are really helpful and the more the better, but they’re certainly not the end of the line. If you are really opposed to any kind of death investigation on Auntie Mabel, it’s not like you’re personally responsible for injuries and mortalities from defective medications and medical devices, ok? It’s just something to think about when considering an autopsy.

Autopsy reports on suspicious deaths are usually available to next of kin, a somewhat nebulous term that may vary by jurisdiction, and may be made public in some situations. In others, people who want to review the report will need permission from next of kin. This is something to think about as well; I have looked at autopsy reports for people I’ve lost and I found them helpful. A lot of them were clarifying, or added to my understanding, or put my mind at rest. The same may not be true for you, but it’s good to know that this information is available when and if you want it. You just need to contact the medical examiner or coroner and ask about what you need to do to get it released, if you want to see.

Looking at an autopsy report doesn’t have to be frightening, and the ME may be happy to go over it with you or answer questions, to boot.