A bite into the history of the autopsy : From ancient roots to modern decay

How to conceive the dignity of the dead? A dispositional account

In dealing with human corpses, notions of dignity play a decisive role, especially within legal texts that regulate a corpse's handling. However, it is quite unclear how the claim "Treat human corpses with dignity!" should be understood and justified. Drawing upon examples and problems from forensic medicine, this paper explores three possible lines of interpreting such demands: (a) positions that closely link the dignity of the human corpse to the dignity of the former living persons and (b) accounts that derive the dignity of the dead from consequentialist considerations. We argue that both lines heavily rely on contestable metaphysical claims and therefore propose an alternative account for the dignity of the dead. Our proposal (c) focuses on action-guiding attitudes and the symbolic value of the dead. Such a conception allows for a variety of morally appropriate groundings of individual attitudes. It avoids metaphysically troublesome premises and, at the same time, allows to classify certain actions and manners of acting as clearly inappropriate and blameworthy.

Applicability and usefulness of the Declaration of Helsinki for forensic research with human cadavers and remains

Bodies of deceased persons and human remains and their specimens (i.e., organs, bones, tissues, or biological samples) are essential in forensic research but ad hoc worldwide-recognized ethical standards for their use are still lacking. Such standards are needed both to avoid possible unethical practices and to sustain research in the forensic field. Pending consensus within the forensic science community regarding this topic, with this article we aim to stimulate a debate as to the applicability and usefulness of the Declaration of Helsinki in the field of forensic research involving human cadavers and remains. Considering the fundamental differences compared to clinical research involving human beings and the different moral obligations involved, we focus on the risks, burdens, and benefits of research, ethics committee approval, and informed consent requirements. The Declaration of Helsinki framework allows forensic researchers to focus on substantial ethical principles promoting the consistency, integrity, and quality of research. Consensus regarding ethical standards and the adoption of national and supranational laws that clearly regulate the use of human cadavers and remains, including those from autopsies, continues to be of primary importance for the forensic science community.

Undergraduate medical student perspectives on the role of autopsy in medical education

Medical autopsy has historically been considered a valued experience in undergraduate medical education; however, student participation has declined in recent years. Medical education literature from the educator point of view supports autopsy as an educational tool, but more data are needed on undergraduate medical students' (UMS) perspectives on autopsy. This study aims to assess UMS opinions on the role of autopsy in undergraduate medical education. A 5-point Likert scale survey concerning autopsy and medical education was offered to all UMS at Sidney Kimmel Medical College. In addition, 28 senior students were assigned a 500 word essay on hospital autopsy and its role in medical education. Senior students were given the opportunity to view an autopsy prior to completing their essays. UMS (n = 87) reported that witnessing an autopsy can improve anatomic knowledge (μ = 4.3), observational skills (μ = 4.1), and clinicopathologic correlation (μ = 4.3) but were neutral in their perceived importance of viewing an autopsy in their pathology education (μ = 3.7). Senior students (n = 27) responding to the essay prompt reported that autopsy is essential in medical education (85.2%) and increases clinical and anatomical understanding (63.0%). This study suggests that many UMS acknowledge the importance and applicability of autopsy in their education. This concurrence of UMS opinion with the medical education literature supports making autopsy participation a widely available component of undergraduate medical education.

Reviving the Autopsy for Modern Cancer Evolution Research

Outstanding questions plaguing oncologists, centred around tumour evolution and heterogeneity, include the development of treatment resistance, immune evasion, and optimal drug targeting strategies. Such questions are difficult to study in limited cancer tissues collected during a patient's routine clinical care, and may be better investigated in the breadth of cancer tissues that may be permissible to collect during autopsies. We are starting to better understand key tumour evolution challenges based on advances facilitated by autopsy studies completed to date. This review article explores the great progress in understanding that cancer tissues collected at autopsy have already enabled, including the shared origin of metastatic cells, the importance of early whole-genome doubling events for amplifying genes needed for tumour survival, and the creation of a wealth of tissue resources powered to answer future questions, including patient-derived xenografts, cell lines, and a wide range of banked tissues. We also highlight the future role of these programmes in advancing our understanding of cancer evolution. The research autopsy provides a special opportunity for cancer patients to give the ultimate gift-to selflessly donate their tissues towards better cancer care.

Ethics in clinical autopsy

This manuscript concerns the ethical aspects of the clinical autopsy procedure. Much of the literature on this topic addresses some of the multifaceted issues potentially involved: religious beliefs and/or cultural traditions coming to bear on the management of autopsies, relations between families and healthcare personnel (physicians and technicians) involved in conducting an autopsy, ethical implications of regulations to follow and procedures for obtaining biological samples for further diagnostics or research. All these issues have ethical implications, particularly in today's globalised cultural domain. To preserve for future generations the teaching and scientific value of the clinical autopsy, scientific societies and academic institutions should endorse educational efforts to promote the ethical management of autopsy procedures.

Apoplexy, cerebrovascular disease, and stroke: Historical evolution of terms and definitions

The long-standing concept of “apoplexy' can be followed from Antiquity, passing through the Middle Ages and Renaissance, and reaching the Modern era and the present day, with the new designation of “stroke”. The definition of “apoplexy” can be divided, by the history of autopsy, into a period predating this practice, which spanned from Antiquity until the Renaissance, with a relatively stable clinically-based umbrella concept, and an autopsy period of the Modern era, when the condition was subdivided into several subtypes. Thus, it took about 2,500 years assembling the numerous pieces of information to achieve a fairly well-defined picture. The “stroke” concept inherited the information developed for “apoplexy”, incorporating all historical acquisitions to form the current state of this knowledge.

Back to the Future - Part 1. The medico-legal autopsy from ancient civilization to the post-genomic era

Part 1 of the review "Back to the Future" examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section focusing on "The Past", the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on "The Present", the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in "The Future" section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.

Computerized Tomography Scanning and Magnetic Resonance Imaging Will Terminate the Era of the Autopsy - A Hypothesis

Background: Reports on a marked reduction of the number of autopsies performed worldwide to less than 5% of hospital deaths remain without a satisfactory explanation. The premature disappearance of the autopsy might represent a medical tragedy of a major order. One of the causes for the decrease in autopsies is poorly documented: we suspect that the attending physician might show some reluctance when requesting a consent for an autopsy from the bereaved family. Moreover, this officer might consider that the post mortem will add little information to that already obtained from the computerized tomography scanner or the magnetic resonance imaging.

Methods: In order to confirm our hypothesis, we carried out a review of 300 articles indexed as "radiologic-histologic correlation", 118 of which were selected for a significant correlation. From the abstracts, we retrieved the type of the article, the degree of correlation as assessed by the authors and the form of imaging employed, and we computed them.

Results & conclusions: The most striking correlation was observed in the small prospective series. An additional search for the "radiologic-autopsy correlation" supported a marked reduction in the number of post-mortems, especially those related with prospective studies. Based on the present study, we cannot determine precisely the role of the house officer in this tragedy. We may have demonstrated, however, that the modern radiologic methods have not yet reached a high enough performance quality to achieve the status of a candidate substitute for the autopsy.

Resuscitating the Dying Autopsy

Clara Menéndez and colleagues consider the importance of conducting autopsies and possible alternative methods for determining cause of death in resource-limited settings.

Medical student attitudes to the autopsy and its utility in medical education: a brief qualitative study at one UK medical school

Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the "emerging patient"-an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy-based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho-social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy-based teaching represents a low-cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact.

Introducing gross pathology to undergraduate medical students in the dissecting room

Pathology and anatomy are both sciences that contribute to the foundations of a successful medical career. In the past decade, medical education has undergone profound changes with the development of a core curriculum combined with student selected components. There has been a shift from discipline-based teaching towards problem-based learning. Both anatomy and pathology are perceived to have suffered from this educational shift. The challenge is to introduce methods of learning for these subjects into an integrated student-centered curriculum. The purpose of this study was to determine the prevalence of pathology in 12 donor cadavers in the dissecting room of the Bute Medical School, University of St Andrews. All of the cadavers had multiple pathologies (between three to four conditions) ranging from common to rare disorders. A number of prostheses and surgical interventions were also noted. This small study confirms that cadaveric dissection provides an excellent opportunity for the integration of anatomy, pathology, and clinical medicine into the early clinical training of undergraduate medical students. The identification of disease in a cadaver provides an excellent introduction to the gross features of a disease process, but does not substitute for the detailed study of a process later in the curriculum.

Human experimentation: historical perspective of breaches of ethics in US health care

Health care supervisors and managers may participate in ethical discussions and serve on ethics committees in their health care organizations. To aid them in their participation and service, this article expands upon the knowledge of ethics that they obtained in their academic training. The article provides readers with a common language based on frequently cited cases and key documents. The article traces a brief history of human experimentation, describes ethical breaches in the United States, and summarizes key documents guiding current thought on informed and voluntary consent. The article concludes with 3 common misconceptions that health care supervisors and managers will want to avoid in ethical discussions and ethical decision making. Health care supervisors and managers will be prepared to meaningfully contribute to the discussion of ethical issues and to the resolution of ethical problems in their health care organizations.

The dead continue to teach the living: examining the role of computed tomography and magnetic resonance imaging in the setting of postmortem examinations

High-resolution imaging methods are used more frequently in the setting of postmortem investigation. Used for some time in forensics, computed tomography (CT) and magnetic resonance imaging (MRI) are now being evaluated as complementary or even as alternative means of postmortem examination. We review briefly the history of autopsy and the reasons for the gradual decrease in autopsy rates. An overview of advantages and limitations of modern imaging autopsy techniques is then presented, which includes a discussion of the potential role of imaging autopsy in medical and surgical education. Potential future applications of this technology in postmortem analysis, which includes the incorporation of ultrasound technology, are then discussed.