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    AUTOPSY
    Understanding life, after death

    Fewer autopsies

    Today, more than 80 percent of Americans die in hospitals, nursing homes, or other health care institutions. Nevertheless, the percentage of autopsies being done in the United States has declined from more than 50 percent in the 1950s to less than 10 percent now. Many hospitals, especially small or rural facilities, don't provide for autopsies.

    Autopsy rates at medical teaching and research institutions tend to run higher, about 10 percent to 15 percent. Performs autopsies on about a third of the people who die at its hospitals.

    Bjornsson, think that diagnostic measures done during the life of the patient establish the cause of death so well that an autopsy is unnecessary. Others think that sophisticated technology has replaced autopsy as a method to teach young physicians how a disease or condition affects the body.

    In fact, however, autopsies uncover important undetected conditions in about 20 percent of patients - a rate that has not changed substantially in the past 75 years

    In many cases, families are reluctant to ask for or permit an autopsy. Some consider the procedure degrading or feel the deceased has "suffered enough." Others may worry - incorrectly - that an autopsy will delay or otherwise adversely affect funeral plans.

    Worries about the cost of an autopsy also may have contributed to the decline. If a death occurs at a hospital, especially at a teaching facility, there is usually no charge for an autopsy. If a family wants to learn the cause of death of someone who has died in another setting - perhaps at home - the cost could range from $1,000 to about $2,500

    Autopsies usually are required by state or local laws if a death results from an accident, is unexpected, has no clear cause, or if the death is a suspected homicide or suicide. A medical examiner or coroner usually orders or performs this type of autopsy, called a forensic autopsy. Forensic autopsies seek only to determine the cause of death, and may not assess other medical aspects of the deceased.

    In some areas, organ donor cards include a request that an autopsy to be done. Individuals who make such requests should ensure that members of their family are aware of their wishes

    How are autopsies done?

    A large Y-shaped incision is made from the shoulders to just below the navel. Then the organs are removed from the chest and abdomen, examined and samples taken for further evaluation. Organs not used for additional study are returned to the body for burial. If the brain is to be examined, an incision is made along the back of the head and the skull is opened and the brain removed. After the entire procedure is completed, the body is stitched closed.

    The procedure, which takes anywhere from 1 to 3 hours, doesn't disfigure the face and in no way interferes with embalming or an open-casket funeral.

    Family members may request a copy of the pathology report. The report may not be completed for about a month due to the time it takes for some tests to be completed.

    Benefits

    Historically, human tissue samples removed during autopsy have helped advance medical knowledge. For example, pathologic observations helped confirm the link between cigarette smoking and lung cancer, and the nature of diseases like heart disease and viral hepatitis. Autopsy studies also contributed to an early medical understanding of Legionnaire's disease and toxic shock syndrome.

    Researchers also have learned a great deal from autopsies about the effects of toxic chemicals and industrial hazards on the body.

    Besides quality assurance, autopsy contributes to the development of vital statistics and an understanding of trends in mortality, from both disease and degenerative illness. Death statistics influence spending for health care, safety standards, and the design of medical equipment.



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