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Referral for autopsies
  1. R CHARLTON
  1. Centre for Primary Health Care Studies
  2. University of Warwick, Coventry CV4 7AL, UK
  3. rodger.charlton{at}warwick.ac.uk

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    Editor,—With reference to the paper by Khunti last July,1 the aim should not be to increase the number of autopsies, but rather to increase their specificity as a research tool to be of benefit in three ways where the cause of death is unclear: educating the profession, ascertaining where death is unnatural, and most importantly facilitating the grieving process of relatives. In all three situations feedback should be given to the relatives as the author suggests because knowledge of the cause of death is important. Indeed this information may assist in confirming the inevitability of death and help to dispel feelings of doubt, guilt, and anger.2 However, this does not always happen and in the case of autopsies conducted at the request of the coroner, doctors may be inhibited by the standard admonition regarding a coroner's report that the content should not be disclosed to a third party without consent.3

    This is an area which, with appropriate guidelines, the number of autopsies could be reduced, particularly in the elderly as in many cases death is beyond reasonable doubt from natural causes, but a person has not been attended by a doctor in the required 14 days. The production of guidelines could standardise communication where there is considerable variation between doctor and the coroner, in particular, coroners' officers.4 This will help to ensure that a coroner's postmortem examination is conducted when a death is likely to be due to unnatural causes or is without doubt, unknown. In this way clinical effectiveness will be improved using the autopsy as both a useful education and research tool. This will facilitate clinical governance through improved health care for grieving relatives and on going medical education.

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