1. Skelley, Billie Holladay MS, RN


It's time to say 'yes' to this valuable teaching tool and source of information.


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"What do you think? Should we do it?"

Figure. Billie Holla... - Click to enlarge in new window Billie Holladay Skelley

These two questions are often posed to nurses by family members of patients who have died. They're asking about an autopsy. Many times, these questions are asked after other medical personnel have left the room and the nurse is alone with the family. Upset and grieving, they are looking for guidance. It can be difficult to know how to respond.


The benefits of an autopsy far outweigh any drawbacks. One major advantage of having an autopsy performed is that it can provide a definitive answer about why a patient died. Certain diseases, such as Alzheimer's disease, can only be diagnosed and confirmed by autopsy. Knowing the precise cause and manner of death can give a family much needed closure.


An autopsy can also relieve guilt and anguish if the results reveal that nothing more could have been done to save the patient. Families often wonder if they should have done something sooner or if more could have been done to save their loved one. An autopsy may confirm that earlier or different treatment would not have made a difference.


The molecular autopsy is a newer type of postmortem exam available in some areas that can reveal undiagnosed genetic conditions and hereditary issues. In these autopsies, DNA tests are used to help determine the cause of death, potentially providing family members with information that can affect their lifestyle choices and the frequency with which they seek medical care and monitoring.


Autopsies are also excellent teaching tools for physicians, nurses, and students. They allow for firsthand observations of human anatomy and disease processes. In addition, they enable clinicians to compare premortem and postmortem findings, allowing them to determine if the clinical diagnosis was correct-and if the care they provided to the patient was appropriate and effective.


These exams are useful for monitoring public health, revealing disease trends and patterns, for example. They also help to improve our understanding of diseases and foster advances in treatment. Autopsies of people with cancer, for instance, may reveal how the disease spreads and add to our overall knowledge of the condition. There is also the potential to use tumor samples taken during an autopsy to grow new cancer cells. Researchers can then use these cells to test new therapies.


Of course, autopsies are not beneficial all the time, and families may express legitimate reasons for not having an autopsy performed. Some may recoil at the idea of having their loved one traumatized further. In these cases, virtual autopsies using imaging techniques or minimally invasive autopsies, in which only one organ is examined, may be acceptable alternatives. Religious concerns need to be addressed individually, but it's not uncommon for families to withdraw their objection to an autopsy when they are assured their religious practices and protocols will be followed.


Perhaps the biggest worry for many families is cost. Autopsies can be expensive-typically $2,000 to $4,000. Health insurance, Medicare, and Medicaid do not normally cover this cost. However, if the patient is in a hospital at the time of death and the medical staff requests the autopsy, there is often no cost to the family. In addition, some institutions will perform an autopsy, even if requested by the family, at no charge. The facility's patient services staff may be able to assist families with any fees they encounter.


The number of autopsies performed each year in the United States is difficult to determine, but there is general agreement that autopsy rates began to significantly decline after the 1970s. According to a 2011 National Center for Health Statistics brief, The Changing Profile of Autopsied Deaths in the United States, one out of every five deaths resulted in an autopsy in 1972, whereas an autopsy was performed in just one out of every 10 deaths in 2007. A valuable tool for nurses and other clinicians is being lost.


Death may be a negative event, but something positive can come out of it if nurses answer "yes" when families ask if an autopsy should be performed.