Carpenter Belinda, Tait Gordon, Jonsson Linda, Peschl Heiko, Naylor Charles, Bermudez-Ortega Aurora
School of Justice, Faculty of Law, Queensland University of Technology, Queensland, Australia.
J Law Med. 2010 Dec;18(2):402-12.
This article scrutinises the argument that decreasing hospital autopsy rates are outside the control of medical personnel, based as they are on families' unwillingness to consent to autopsy procedures, and that, as a consequence, the coronial autopsy is the appropriate alternative to the important medical and educational role of the autopsy It makes three points which are well supported by the research. First, that while hospital autopsy rates are decreasing, they have been doing so for more than 60 years, and issues beyond the simple notion of consent, like funding formulae in hospitals, increased technology and fear of litigation by doctors are all playing their part in this decline. Secondly, the issue of consent has as much to do with families not being approached as with families declining to give consent. This is well supported by recent changes in hospital policy and procedures which include senior medical personnel and detailed consent forms, both of which have been linked to rising consent rates in recent years. Finally, the perception that coronial autopsies are beyond familial consent has been challenged recently by legislative changes in both Australia and the United States of America which allow objections based on religion and culture to be heard by coroners. For these reasons, it is argued that medical personnel need to focus on increasing hospital autopsy rates, while also addressing the complex ethical issues associated with conducting medical research within the context of the coronial autopsy.
本文审视了这样一种观点，即医院尸检率的下降超出了医务人员的控制范围，其原因是家属不愿意同意尸检程序，因此，死因裁判官尸检是替代尸检重要医学和教育作用的合适选择。文章提出了三点，这些观点得到了研究的有力支持。第一，虽然医院尸检率在下降，但这种情况已经持续了60多年，除了简单的同意概念之外，医院的资金分配方案、技术进步以及医生对诉讼的担忧等问题都在导致尸检率下降方面起到了作用。第二，同意问题既与家属拒绝同意有关，也与未与家属沟通有关。医院政策和程序的近期变化对此提供了有力支持，这些变化包括高级医务人员参与以及详细的同意书，这两者都与近年来同意率的上升有关。最后，澳大利亚和美国最近的立法变化对死因裁判官尸检无需家属同意这一观念提出了挑战，这些变化允许验尸官听取基于宗教和文化的反对意见。出于这些原因，有人认为医务人员需要专注于提高医院尸检率，同时还要解决在死因裁判官尸检背景下进行医学研究相关的复杂伦理问题。
