An unintentional irony: the autopsy in modern medicine and society

Autopsy rates continue to decline despite abundant evidence of the autopsy's value. Such an extraordinary contradiction requires that we look beyond issues of education to consider our basic moral and political commitments; to consider, in other words, the kind of society in which we live, and the kind of people we are. In a heterogeneous culture, we should not be surprised to find that even our most basic obligations may be in conflict. This essay draws on social and ethical perspectives to examine a peculiar phenomenon: the reluctance of physicians to have autopsies performed on themselves or their family members. Such behavior reflects an unintentional irony, a conflict between our societal commitments to treat dead persons properly and our professional commitments to remain self-critical. The resources needed to resolve medicine's unintentional irony are to be found in our traditional language of medicine as a moral praxis, an uncertain but honorable craft devoted to the care of those who suffer. Autopsies remain the best way to learn whether or not clinical judgments are made correctly. Therefore, the autopsy is not an option; it is a professional obligation. We simply cannot hope to maintain our professional integrity as long as we proclaim the value of autopsies for our patients, but deny for ourselves and our families the same privilege.