Getting consent for necropsies

Editor—Sayers and Mair highlight the reasons for which hospital (consent) necropsies are performed and for which clinicians are now faced with the task of seeking informed consent—to confirm the cause of death, to answer diagnostic queries, and to obtain and retain material for research and teaching.1 Another key use of a necropsy, not mentioned on the consent form, is in undergraduate teaching. Many medical students will encounter the necropsy during their training, either witnessing the whole procedure or as a demonstration of the pathological findings of the procedure in which organs and tissues are displayed (perhaps with the patient's body in the background) before their return to the body. Should explicit informed consent be obtained to use necropsy in this way? The short report by Westberg et al in the same issue serves to highlight the importance of obtaining consent for students to witness invasive procedures such as a vaginal examination, even though most patients do not object.2 Necropsy is no less invasive. Whether patients and relatives would object to a group of students viewing the body after death is not known. It is established, however, that “an important precondition for good education of medical students is that patients are prepared to participate in training.”3 Failure to obtain consent denies the autonomy of both the patient and the relatives. Some people argue that, once death has occurred and the decision to allow a necropsy has been taken, the worst is over and therefore the presence of students at the necropsy is of no consequence and does not require consent. This denies relatives the opportunity to be altruistic and know of the benefits that come to students from the procedure. We should be as concerned that consent is adequate as we are with who obtains it.