• autopsy
• clinical trial
• consent

Despite continued advances in clinical and laboratory medicine and diagnostic imaging, there remains a significant divergence between clinical diagnosis and autopsy findings. Even in the intensive care unit, where some of the most advanced medical technology is to be found, diagnostic error rates of 6–40% are reported, with postmortem examinations regularly identifying previously unrecognised pathological processes.¹ Although these published figures may overestimate the current scale of the problem, it is beyond dispute that postmortem examinations sometimes reveal unsuspected pathological processes which may result in a change in death certification. Despite this, autopsy rates continue to fall, prompting concern about their diminished role in disease surveillance and medical audit.²

In this issue, Snowdon et al publish a series of articles in which they survey the attitudes of parents and medical professionals to perinatal autopsy.^3–5 Although the articles deal with the specific circumstances of an autopsy in a randomised control trial, the responses provide considerable insight into at least some of the reasons why the autopsy is in decline.

It is clear from a review of the articles that many of the neonatologists quoted are unfavourably disposed towards the autopsy. They find discussion of the procedure distasteful and distressing to relatives. Furthermore, it is apparent that recent recommendations about providing more detailed anatomical information and more explicit consent forms (see below) have added further to their discomfort. Many also feel that the examination is of limited value. With autopsy rates declining and physician attendance at the autopsy increasingly rare, clinical staff have less and less familiarity with the procedure they are describing and “advocating”.^6,7 As O’Grady⁶ has succinctly observed, doctors cannot explain the purpose and benefits of the procedure if they do …