15283-B-Blokker

41 Autopsy considerations in the consent process 3 In 12 (7.2%) cases, which were not victims of traffic accidents, the conversation with next-of-kin was done by forensic doctors, who had been consulted for legal reasons. Being externally employed, they did not know about the autopsy policy in our institute and therefore did not ask permission for clinical autopsy. As motives for not requesting autopsy in these cases, we scored ‘other’ and ‘not the right person to ask permission’ for autopsy. The two main motives of next-of-kin to not give consent for autopsy were similar to those of the clinicians (Fig 3-B). A ‘ supposed known cause of death ’ was mentioned in 327 of the 641 (51.0%) cases, and ‘ a long illness whereby the deceased had suffered enough’ was mentioned in 189 (29.5%) cases. A combination of these two motives (with or without another motive) was reported in 70 cases (10.9%). Their third motive, ‘ fear of mutilation of the deceased’s body’ , was mentioned in 103 cases (16.1%). The combination of ‘ fear of mutilation ’ and a ‘s upposed known cause of death ’ was reported in 42 (6.6%) cases, and the combination of ‘ a long illness ’ and ‘ fear of mutilation ’ in 32 (5.0%) cases. ‘ To find out about the cause of death ’ was the most important motive for next-of-kin to give consent for autopsy (Fig 3-C). It was reported in 124 of the 150 cases (82.7%), followed by 42 (28.0%) cases in which next-of-kin wanted ‘ to find out if the deceased had any other disease’ . In 35 (23.3%) cases both of these motives were reported. In 40 (26.7%) cases the next-of-kin had decided to give consent for autopsy, because the clinician had requested it and/ or advised to have an autopsy performed. DISCUSSION Main findings Autopsy rates were the highest among patients who had died suddenly and/or unexpectedly, were on an intensive care unit, 30 to 39 years, European, or a donor. The main motive for clinicians to not request an autopsy, and for next-of-kin to not consent to it, was the assumption that ‘ the cause of death was known’ . Their second motive was ‘ a long illness’ , whereby clinicians found an autopsy too much to request and next-of- kin found that the patient had suffered enough. A third concern for next-of-kin was ‘ fear of mutilation of the deceased’s body’ . Limitations of this study The study was conducted in a single academic institution where autopsies are encouraged to the extent that physicians should always offer the next-of-kin the possibility of an autopsy, and where there are no financial restraints for clinicians to