15283-B-Blokker

37 Autopsy considerations in the consent process 3 INTRODUCTION Background Autopsies on in-hospital deceased patients are performed to confirm, revise or identify the cause of death and relevant pathology, in order to provide clinicians with appropriate feedback on diagnosis and treatment. Despite the use of advanced diagnostic technologies in modern medicine, autopsies still reveal major diagnostic errors. 10,13 Although the clinical autopsy thus remains an important healthcare quality control measure, the last 30 – 40 years have witnessed a worldwide decline of clinical autopsies. 22,23,32 Particularly in developed countries, with traditionally high autopsy rates, where financial and technical resources are available. For a clinical autopsy, consent from next-of-kin is compulsory in most countries. The reluctance of next-of-kin to consent to autopsy, for example due to fear of mutilation of the body or concerns about organ retention of their loved ones, 24,38,40 may be one explanation for low autopsy rates. Moreover, there seems to be a declining interest in autopsies among both clinicians and pathologists. 43 Although many clinicians still recognize the importance and benefits of autopsies, 41,81 in practice they find it difficult to request consent for autopsy, and often do not ask for it. 30,81 In such circumstances, the next-of-kin will rarely consider the possibility of an autopsy. 22 Purpose The aim of this prospective observational study is to examine how often and why clinicians do not request an autopsy, and how often and for what reasons the next-of- kin allow or refuse it. We investigate the correlations between autopsy rate and certain patient characteristics and clinical aspects. MATERIALS AND METHODS Study population and study design For this prospective observational study, a survey was carried out at the Erasmus University Medical Centre, the tertiary referral centre, with around 1200 beds, for 3 to 4 million people in the Southwestern part of the Netherlands. Clinicians were asked to fill in a questionnaire about the consent process in their conversation with the next-of-kin subsequent to the death of an adult patient. According to the policy at Erasmus MC they should always offer the next-of-kin the possibility of an autopsy. For the purpose of our study, we had them ask the next-of-kin about their reasons for either giving or refusing consent to an autopsy in the ensuing conversation. It was deemed unethical to confront