The changing role of the autopsy: a social environmental perspective

Over the past decade, the declining autopsy rate has been the subject of much debate. Many articles in professional journals have explored both the cause of the decline as well as its desirability. Explanations for the declining rate of autopsies have typically been of two types, specifically "professional" and "technical." The former implicate declining professional standards, while the latter point to the emergence of new diagnostic technologies as the cause of the lower autopsy rate. This paper argues that both of these explanations are better understood as two components of a larger explanation known as the "social environmental perspective." Applied to the autopsy debate, the environmental perspective focuses on social, political, and economic forces that influence research hospitals and the different groups of people practicing within them. By placing the debate in a larger social framework, a more complete understanding of the declining autopsy rate may be reached. More important, it is hoped that the illumination of social processes affecting the work of medical professionals will encourage explicit discussions of those forces and possible ways of dealing with them.