J R Soc Med 2002;95:547-548
doi:10.1258/jrsm.95.11.547
© 2002 Royal Society of Medicine
Pathologists' views on consent for autopsy
A T Williams PhD MRCPath
D Morris MA 1
N K Patel MB MRCPath
Department of Histopathology, Royal Sussex County Hospital, Eastern Road,
Brighton BN2 5BE, UK
1 Department of Clinical Audit, Royal Sussex County Hospital, Eastern Road,
Brighton BN2 5BE, UK
Correspondence to: Dr N K Patel E-mail:
Neera.patel{at}bsuh.nhs.uk
 |
SUMMARY
|
|---|
Consent to autopsy is usually obtained by a doctor other than
the one who
will perform the procedure. There is an argument
that, for proper informed
consent, a pathologist should participate.
We ascertained the views of
consultant pathologists in south-east
England.
53 (87%) of 61 consultants responded, of whom 50 currently do autopsies.
Only 2 at present participate directly in obtaining consent, and 10 of the
remaining 48 expressed willingness to do so. The general view was that consent
is best obtained by a senior clinician from the team that has looked after the
patient.
Pathologists see their primary role as to provide guidance to clinicians.
Few see it as their function to obtain consent for autopsy.
|
INTRODUCTION
|
|---|
Public and professional confidence in the autopsy service has
been
undermined by recent events, many of which have reflected
poor communication
between pathologists, clinicians, the coronial
service and patients'
families
1. In the
medical press there
have been repeated suggestions from clinicians that
pathologists
should participate actively in gaining consent for
autopsies
2,3.
The
autopsy is unusual in medical practice in that, customarily,
consent is
obtained by a doctor who will
not perform the
procedure
4.
We have
surveyed practising histopathologists in south-east
England to determine the
extent to which they participate in
gaining consent for hospital autopsy and
how they would feel
about increasing their involvement. At present, direct
consent
from the family is not required for a coronial autopsy.
|
METHODS AND RESULTS
|
|---|
A postal questionnaire was sent to all 61 consultant pathologists
working
at sixteen hospitals within the South Eastern region,
including two teaching
and fourteen district general hospitals.
Replies were received from 53 (87%),
50 of whom currently perform
autopsies. Only 2 respondents participate
directly in obtaining
informed consent from next of kin whilst 13 are
indirectly involved
(by offering advice to clinicians who will be seeking
consent).
Of the 48 not directly involved, only 10 indicated that they
would
be willing to become directly involved in the consent
process. Further
questions sought to establish the pathologists'
attitudes towards consent,
both as it is now obtained and with
regard to the possibility of direct
contact with patients' families
(
Table
1).
Space was provided for specific comments (received from 25 respondents) and
these expanded on the reasons for pathologists' reluctance to participate in
gaining consent. Among these respondents the majority view was that consent is
best obtained through the clinical team who have been looking after the
patient, since the family will know the doctors and they will be able to
explain most clearly the clinical reasons for an autopsy. One added that, in
the aftermath of Alder Hey, direct participation in the consent process would
be regarded by the relatives as ‘distasteful eagerness on my
part’. Several suggested that the most appropriate time for the
pathologists to meet the family would be in a next-of-kin clinic in which
relatives could meet clinicians and pathologists to discuss autopsy findings
and their implications. Many mentioned the explicit autopsy consent forms that
have been widely adopted in response to guidelines from the Royal College of
Pathologists5,
although not all clinicians like the candour of these
forms3. The
importance of continuing education of clinicians concerning the nature and
value of the autopsy was stressed by several respondents. When asked which
grades of clinicians were appropriate for seeking informal consent only 1 of
the 50 said preregistration house officer and 4 said senior house officer; 15
thought a staff grade or registrar was appropriate and all 50 a
consultant.
|
COMMENT
|
|---|
The majority view among our respondents is that responsibility
for gaining
consent should rest with the consulting clinician,
and that the discussion is
best conducted without the pathologist
in attendance. Pathologists see their
primary role as providing
guidance to clinicians. Few believe either families
or clinicians
wish them to be present. Nevertheless, respondents did share
the
concern of some clinicians that, without the participation
of a pathologist,
consent is not fully informed. The introduction
of more explicit consent forms
has not been welcomed by all
clinicians. The preferences of the families in
this process
are paramount and clearly neither clinicians nor pathologists
wish
to increase their distress. Public expectations are likely to
have been
changed by the widespread media coverage of autopsy
practice, and in future
pathologists and clinicans will need
to be responsive to family preferences,
after local discussions
including all interested parties.
|
REFERENCES
|
|---|
- Burton JL, Wells M. The Alder Hey affair: implications for
pathology practice. J Clin Pathol2001; 54:820
-3[Free Full Text]
- Barlow P. Pathologists must take responsibility for autopsy
consent. Hosp Doctor2001; 5:4
- Sayers GM, Mair J. Getting consent for autopsies: who should ask
what and why? BMJ2001; 323:521[Free Full Text]
- Department of Health. Reference Guide to Consent for
Examination or Treatment. London: Department of Health,2001
- Royal College of Pathologists. Guidelines for the
Retention of Tissue and Organs at Post Mortem Examination.
London: Royal College of Pathologists, 2001
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
R. Khiani, S. Shingler, and P. Hasleton
Consent for autopsy
J R Soc Med,
January 1, 2003;
96(1):
53 - 53.
[Full Text]
[PDF]
|
|
|
TOP
SUMMARY
INTRODUCTION
