It’s one of our oldest medical procedures. Over the centuries, its techniques have modified and its applications have expanded into medical anatomy and education, medico-legal inquiry and beyond. Now, it is integral to public health, medical education and quality health care.
In addition to fulfilling these purposes, an autopsy also gives a decedent a final opportunity to make a meaningful contribution to society, said Alex Kent Williamson, MD, chief of the North Shore-LIJ Health System’s autopsy services.
“An autopsy lets someone engage in the education of tomorrow’s physicians,” Dr. Williamson said. “Findings from the procedure may help to advance understanding of diseases like cancer or Alzheimer disease.” Dr. Williamson leads 12 other doctors with practice and research interests across the spectrum of pathology specialties. They perform about 225 autopsies annually for decedents of all ages, most at LIJ Medical Center and some at North Shore University Hospital. Each site’s autopsy suite is adjacent to the morgue. It resembles an operating room, with similar tables, lights and instruments. Pathologists wear the same operating attire as surgeons, since a postmortem exam is essentially a surgical procedure.
For suspicious, unusual or violent deaths, a local Medical Examiner’s Office or coroner usually performs an autopsy. But a relative or other legally authorized person can request the procedure for a loved one who has died of natural causes.
Like other medical procedures, an autopsy requires a valid consent. The person giving consent can specify certain restrictions, but Dr. Williamson advises that “a limited autopsy gives limited answers.” The procedure can follow organ donation, does not delay funeral arrangements more than 48 hours, and never prevents an open-casket wake.
Reinstating an Avenue of Insight
Autopsies follow less than one in 10 US hospital deaths today — a steep decline from nearly half of hospital deaths in the 1940s.
The decline is due to many causes, said Dr. Williamson, citing as a large factor the common mistaken belief that modern medicine makes the procedure unnecessary. Yet while various technologies and testing methods have improved over the past decades, discrepancies still arise, he said, adding: “An autopsy remains the only way to know for sure what diseases and co-existing conditions were present in someone who has died.” Furthermore, medical schools rarely give their students exposure to the procedure.
When the students go on to practice medicine, this deficit may leave them uncomfortable or unsure about how to request permission for an autopsy on their patient, Dr. Williamson said. As an associate professor of pathology at Hofstra North Shore-LIJ School of Medicine, he is countering this trend by working to ensure at least one autopsy in each student’s curriculum.
Even after performing nearly 700 postmortem examinations, Dr. Williamson remains excited and feels privileged to be the last physician to care for a patient.
“I take this responsibility very seriously,” he said. “It’s a humbling experience.”