The Autopsy: Rest in Peace

By Jerry Shine

Please don't take this personally, but let's imagine for a moment that you have just died. Perhaps your car ran off a cliff or you were shot in a hunting accident. In any case, the manner of your demise is somewhat suspicious, and foul play can't be ruled out. You are about to join the ranks of an ever smaller, ever more select group -you will be autopsied.

Consider that in 1945 half of all deaths were routinely autopsied: today, that number is closer to 10 percent. This morbid art --practiced by humans since 300 B.C. and modernized by German scientists in the mid-1800s--is itself dying. "A lot of doctors believe that technologies like CAT scans and MRIs give them all the information they need while their patients are living, making autopsies later on unnecessary," says Dr. Kevin Bove, chairman of the autopsy committee at the College of American Pathologists. "The evidence, however, doesn't back them up." Indeed, in one recent study, 40 percent of the autopsies performed turned up at least one major undiagnosed disease that had contributed to the patient's death.

Doctors may also hesitate to order autopsies because "surprise" findings raise the risk of malpractice suits. And because hospitals are not reimbursed for the cost of autopsies, the procedure is an easy target for cost-conscious administrators. These financial and legal disincentives have converged with what Dr. George Lundberg, former editor of the Journal of the American Medical Association, has termed "a vast cultural delusion of denial"-our unspoken desire for a reassuringly simple explanation as to why the sickest patents die.

There are reasons to mourn this passing. Historically, autopsies have helped doctors judge the effectiveness of new therapies, uncover hospital-acquired infections, identify new or changing diseases, and evaluation diagnostic accuracy. But as autopsy numbers decrease, so does the possibility of providing a representative sample large enough to fulfill any of these functions. Postmortems have also played a crucial role in the education of medical students, allowing would-be doctors to stare directly into the face of disease and death. (The word autopsy means "to see with one's own eyes.") Although med students were once required to view dozens of autopsies, today many learn through CD-ROMS and slides--an approach whose effectiveness is unproven.

Meanwhile, the decline of the "official" autopsy has spawned a new industry: freelance autopsies performed by private companies for a fee, to provide objective answers to families about the death of a loved ones. The purpose, more often than not, is to gather information for potential lawsuits. Vidal Herrera of Autopsy/Post Services, Inc. (1-800-Autopsy) , one of several such companies, has watched his business grow by 30 percent each year since he founded it in 1989. "We have bodies flown to us from all over the world," he says, "and we hope to be franchising later this year."