15283-B-Blokker

43 Autopsy considerations in the consent process 3 observed for surgical wards and ICUs, resulting in rates below 10%, whereas autopsy rates for neurosciences remained above 20%. 30 Apparently, attitudes and approaches of clinicians toward autopsy differ per specialty and hospital. Several patient variables seem to influence the chance of an autopsy being requested and performed. Comparable to other studies 77,83 autopsy rates were higher in younger patients, lowest in the age group of 80-99, and similar between the sexes. In contrast to another study 32 autopsy rates appeared not to be different depending on marital status or religion. Religious objections and concerns about mutilation have been described in several studies. 38,40,41,81 Especially in Islam, removal of organs or disfigurement of the deceased’s body is generally forbidden. 84 In our cohort, not a single autopsy was performed on a deceased patient who was known to be a Muslim. In 48.7% of these cases next-of-kin had religious motives for refusing autopsy, and in 2.6% they feared of mutilation, compared to 4.8% and 13.8%, respectively, among known Christians. Some of the considerations to not request or consent to autopsy should be addressed in order to improve autopsy rates. In this study ‘ inadequate knowledge about the autopsy procedure keeping clinicians from requesting consen t’ 81 was mentioned in only a single case, complex consent forms were not mentioned as discouraging, neither were a decreased quality of the autopsy procedure or delay of the final autopsy report. 24,30,75,81 In several cases both next-of-kin and clinicians mentioned that ‘ the deceased had suffered enough’ 38,41,85 which correlates to the lower autopsy rate we found among patients who died after a long illness. Perhaps fear of the discovery of misdiagnoses or treatment errors 30,38,75,81 and the risk of malpractice suits 39 kept clinicians from requesting an autopsy in such cases. Or, more likely, both clinicians and next-of-kin had fewer unanswered questions than in cases of sudden death. In general, clinicians tend to overestimate the reliability of advanced diagnostic technologies and therefore underestimate the value of autopsy. 22,30 ,32,44 They assume that ‘ the cause of death is known’ , and may be unaware of the fact that there are still discrepancies found between premortem diagnoses and diagnoses found at autopsy. 7-10,13,86 If clinicians, when discussing the possibility of autopsy, tell the next-of- kin that the cause of death is already known and do not explain how or why an autopsy could still be of value, the next-of-kin will probably not consent to autopsy. 87 Improved knowledge and confidence will enable clinicians to ignore their ‘ expectation not to get consent from next-of-kin ’ and to always request consent for autopsy properly, or even motivate next-of-kin to have an autopsy performed. As a result, the next-of-kin are probably more willing to give consent. 82,83