Case Study 12 : AUTOPSY WITHOUT CONSENT
Challenges
A 45-year old female diagnosed with Infiltrating Ductal Carcinoma of the left breast underwent a left-modified radical mastectomy. On the 5th post-operative day her condition deteriorated rapidly; she expired the following day.
Because of the patient’s totally unexpected and sudden demise, the service residents requested an autopsy from the relatives, who vehemently refused. But to document the problem, the residents contemplated on doing a needle biopsy of the liver without the relatives’ knowledge.
Question
Is it morally and legally permissible to extract tissue from a cadaver for diagnostic purposes without the proxy’s consent?
Solutions
Those who refuse an autopsy normally consider it an added burden emotionally (considering as well the disgust and stress after the patient’s death), financially (fear of an autopsy fee; besides, many funeral parlors charge more for an autopsied body, claiming it is more difficult to embalm) and logistically (delay of a few hours or even days in taking the body out; for this reason, many technicians and funeral parlors discourage the relatives from consenting). Furthermore, the media frequently present a negative image of autopsies – disfigured bodies, organs not returned, autopsies done primarily on charity patients, etc.
Performing an autopsy without the relatives’ knowledge is legally risky. First, the act might be considered as stealing some tissues from a cadaver. Second, there could be hemorrhage, which others might interpret as a result of negligence.
Legally speaking, however, whenever the cause of death is unknown, the case automatically becomes medico-legal. An autopsy becomes mandatory, and thus no consent is necessary. The ideal approach however is to make the relatives understand the nature of an autopsy and its advantages to medical knowledge, and ultimately to society as a whole. An existing doctor-patient (and family) relationship based on trust greatly facilitates – or is even necessary for – obtaining their consent.
