Autopsies Consent - Crozer-Keystone Health System - PA

Autopsies...Who's Really Responsible to Get Consent?

November 2010

Autopsies can be a very controversial issue to bring up at a very sensitive time. However, it is a subject that should be addressed by the physician with the family members prior to or at the time of a patient’s death. There are two conditions under which an autopsy can be performed: written consent by the appropriate party or if the state requires an autopsy. 

Physicians have an obligation to obtain the appropriate authorization before an autopsy is actually performed. Authorization is obtained per the same criteria established for obtaining informed consent - for example, we look towards the surviving spouse, adult children, parents, brothers/sisters, etc., if the patient has not provided advance directions. If there is no kin available, then the person who assumes custody of the body for burial can give written authorization.

Although written authorization is preferred, it may be given by fax, telegram or telephone as long as it is done per hospital policy. 

Any autopsy performed without appropriate authorization can give rise to legal action by the surviving spouse or next of kin. A special consent form specific to an autopsy is available and should be used when a patient dies in the hospital. Please note that when obtaining consent for an autopsy there should be discussion and consent obtained for the body and/or brain of the deceased. Follow your hospital’s policy as to form and procedures required.

In certain cases, the circumstances of death may necessitate the medical examiner's being called and an autopsy being done. The medical examiner should be called immediately by the physician most familiar with the case, preferably the attending physician. The medical examiner’s office will determine if they want to accept or decline the case and give direction regarding disposition of the body, effects, and medical records. The medical examiner or coroner does not need to obtain consent prior to conducting an autopsy; however, he has a responsibility to notify the next of kin. The medical examiner’s objective is to determine if the death may have resulted from criminal acts or criminal neglect.

The following are reportable deaths to the medical examiner:

  • Trauma or poisoning if suspected or known to be a factor in the causation of death.  This includes homicidal, suicidal, accidental, or therapeutic deaths.
  • Any death occurring outside the medical institution including deaths at home in the ED or DOA. Jurisdiction may be declined when an attending physician is found who can issue a certificate stating the individual died of natural causes.
  • Any still birth of 16 or more weeks gestation where there was no attending physician.
  • Any death in which certification of death by natural causes cannot legitimately e made on the basis of clinical presentation or medical history - deaths which were sudden, violent, or suspicious in nature.
  • Any death occurring during or in association with a surgical or medical procedure.
  • Death resulting from an adverse reaction to medication.
  • Any death in which the reporting physician is unclear as to its status.
  • Any case where suspicion regarding cause of death arises during the course of an autopsy - the autopsy should be stopped immediately and the medical examiner called.

** less than 24 hour hospitalization is not a reason in and of itself for reporting a death to the medical examiner if other criteria are not met.

For those cases where the medical examiner accepts jurisdiction he will issue the death certificate. The body may not be released to anyone other than the medical examiner or his designee. No postmortem examination, photographing, removal of clothing/prostheses, or effects, stuffing, tying, handling or transport of the body in any manner whatsoever shall be done except by specific authorization of the medical examiner.

Risk Management should be notified of all deaths reported to the medical examiner. Risk Management can be contacted at 610-447-2764 or 610-284-8156.

Questions and Answers

Autopsies...Who's Really Responsible to Get Consent? November 2010 Questions

Autopsies...Who's Really Responsible to Get Consent? November 2010 Answers

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