Autopsies Provide Important Clues for Family Health
Maintaining Your Health on Mackinac
By Yvan Silva, M.D.

The post-mortem examination of a body by a pathologist, an autopsy, provides the most accurate information on the state of health or ill-health of the deceased. And, indeed, the information obtained can be very valuable, in most cases, for the health of relatives and usable practically, for them and for generations to come.

Admittedly, this is a morbid subject and the decision whether to subject the body to autopsy comes at the most difficult of times. Wrought by the emotional effects of the loss, the next of kin are asked to sign a consent form for an autopsy. The request seems gruesome, and more often than not it is denied, often arising from a conflict of opinions between family members. And unknowingly, many believe that the procedure violates the body and disfigurement may result.

Indeed, autopsies are done following a long-standing protocol and the cosmetic results are so good that open-casket viewing is commonplace. Partial or complete autopsies are also possible in that there can be a mutual decision not to have certain body cavities opened and examined.

The technique sounds macabre, yet the opening of the chest, abdomen, and head for the removal and examination of the contained organs can yield the most accurate information of the state of health of the deceased, the definitive cause of death, and also importantly, reliable information for the relatives regarding genetic linkages to cardiovascular disease, chronic brain conditions like Alzheimer’s disease, cancer, and many other conditions. While the medical sciences continue to provide huge advances in familial and genetic patterns, enhancing the importance of autopsies for valuable health-related information, nowadays only about 10 percent of corpses in the United States are autopsied.

Not too long ago, more than half of all corpses in the United States were autopsied. Indeed, the percentage of autopsies in hospital deaths were an important criterion for accreditation, especially for teaching hospitals.

In the ever-present quest for cost containment, hospitals have discontinued their efforts in this direction. Doctors have become increasingly reluctant to encourage it, especially because of the conflict that can arise in their clinical diagnoses and the subsequent diagnoses made by the pathologist. And then also, there is concern that litigation can ensue on allegations of medical malpractice. For example, the cause of death cited in a death certificate may be broad, congestive heart failure is one example, and that is non-specific; for the living relatives, it may well be important to know if it was a heart attack, pulmonary embolus - a blood clot in the lung arising from a clot in the leg veins, or a rupture of an aneurysm - a blowout of a major artery, since these are known to have strong genetic links.

When the actual causes of death are defined by autopsy, preventive measures and diagnostic tests can be outlined for the health of relatives. Critical screening tests for cancer risks and appropriate changes in lifestyles can be effectively identified.

A recent federal publication revealed that of deaths in U.S. hospitals, in about 23 percent of cases, the official cause of death was overturned by autopsy.

Research in molecular biology, genetic mapping and engineering, and chromosomal studies is flourishing with everincreasing applicability to health maintenance and disease prevention for families. And so, while the importance of the autopsy is increasing in value, unfortunately, the frequency is declining.

Autopsies are regularly done in cases where foul play is suspected or evident. Even when the cause of death may be apparent, an autopsy can provide critical information. An individual who dies from a heart attack may also be harboring a cancer that is known to occur in families. There are several private companies that provide autopsy services. Pathologists, some in conjunction with funeral homes, also offer this service privately. All rights to the body belong to the next of kin, except when the county medical examiner demands an autopsy, and then payment is made by the taxpayer.

In privately done autopsies, costs run from $1,000 to about $3,000 and insurers do not cover costs.

The issue is perhaps best discussed by the family prior to the death of an individual. Rationale in favor of autopsy before death prevails in a better setting than when the death has already occurred. Many times, when an autopsy is denied, family members later regret it.

Performance of an autopsy may be indicated when an apparently healthy individual dies suddenly, regardless of the age. When death occurs in the hospital, hospital authorities should be requested to do the autopsy without charge - the family should be provided the opportunity to know definitively why the patient died. When there is doubt regarding the care received, an autopsy done by an outside pathologist will avoid a potential conflict of interest. A second autopsy can be done after exhumation should the need arise, after the corpse is buried. Clearly, cremation removes that option. The final results of an autopsy take time. A preliminary report is usually issued and then, when microscopic examinations of all tissues are completed and all the evidence is correlated, a full report becomes available. This describes all the disease processes evident in the deceased that might not have been known.

The death of a family member is always a sad occasion. Whether it occurs suddenly or after a prolonged illness, there is always information to be obtained that can be used by the rest of the family, contemporaneously or by future generations.

An autopsy is the most practical and valuable method to obtain that information.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.