Number of postmortems in England and Wales should be cut
The number of postmortem examinations carried out in England and Wales is unjustifiably high and could be cut by 80,000 a year, researchers say.
Currently, more than one in five of all deaths leads to a postmortem – more than double the rate in Scotland, Ireland, Canada, New Zealand and Australia.
An automatic recourse to postmortem is “inappropriate” and coroners should instead look to requesting more external examinations, experts said.
While some postmortems are essential for establishing cause of death and investigating possible crimes, many are unnecessary and intrusive.
The researchers, from the centre for forensic and legal medicine at the University of Dundee, said “Just as the option to perform an autopsy is a necessary element in modern scientific death investigation, so too the option to perform an external examination is a necessary element in the death investigative system of any society which aspires to respect human rights.”
In England and Wales, the “overwhelming majority” of bodies dissected have died of natural causes, according to the article in the Journal of the Royal Society of Medicine. “Yet there is no evidence of a proportionate benefit to justify a policy of high autopsy rates in natural deaths.”
In parts of Scotland, pathologists are given power to perform either an external examination of the body or a dissection.
An external examination includes a “head-to-toe” recording of all identifying features, old and recent injuries, clothing, and recent medical procedures. Small samples can also be removed for toxicology tests, the authors said.
If the system running in Tayside in Scotland was adopted (autopsy rate of 6%) then the number of dissections in England and Wales could drop from 110,000 to 30,000 per year, they added.
This is not only cost-effective but is “an appropriate balance between intrusion by the state and the rights of the bereaved”.
Some campaigners support the use of MRI scans to examine the body, including some from Jewish and Muslim communities.
Many object to postmortems on religious and cultural grounds, wishing to avoid their relative undergoing such an invasive procedure.
Prof Peter Furness, president of the Royal College of Pathologists, said: “We have long expressed the view that we want to be doing fewer overall coroners’ postmortems and doing those that do need doing to a higher standard.”
“However, what coroners do is not really under our control – pathologists do postmortems when asked to do so by the coroner.
“If you do a post-mortem you are more likely to get an accurate cause of death than if you examine the body externally, but most of the time it is a natural cause of death.
“The question is what is the coroners’ postmortem trying to achieve? If it is to exclude an unnatural cause of death, such as foul play, then we are doing more postmortems than is necessary.”
“If we want a system of identifying an accurate natural cause of death then that’s what postmortems are (currently) doing.”
Furness said rules likely to come into force at the end of 2011 or early 2012 would lead to some of the changes suggested by the researchers.
This includes double-checking of death certificates, and all bodies to be externally examined by a doctor.
Prof Furness said MRI and CT scans had long been used to provide extra information for postmortems, but the cost of scans was much higher than for post-mortems.
Lead author Prof Derrick Pounder, an internationally renowned pathologist, said: “We need fewer autopsies in which we invest more time to perform them better.
“We need to change our approach and be much more thoughtful in selecting which deaths we autopsy, rather than carrying out autopsies automatically in large numbers of deaths, and running a production line system.”
Pounder said there were simply not enough pathologists to perform such large numbers of autopsies well.
“The inevitable result is a lowering of autopsy standards, and a false sense of security that we have properly investigated the death.”
A statement from the Coroners’ Society of England and Wales said death certification was different to that in Scotland.
It added: “It would be helpful if the model described could be subject to research in order to ascertain whether or not it is a reliable method of determining causes of death.”
“Coroners in England and Wales would welcome a reduction in the numbers of autopsies provided that alternative methods are shown to be reliable and accurate in order to comply with current statutory provisions.”
In 2009, 500,100 deaths were registered in England and Wales and 46% were referred to coroners. Of those deaths referred, 108,360 (46%) resulted in autopsy.
Tags: National Health Service, NHS, NHS Deaths, red tape