A popular ingredient in stories of crime in movies and television programs is the defining moment when a detective and the pathologist are able to solve a puzzling death based on autopsy findings. In contrast to forensic autopsies mandated by law, clinical autopsies are performed to clarify diagnoses. Rates of the latter procedure have declined from a high of 19% (1950s-1970s) to 8% (2007). This decrease is related to financial, legal, and administrative disincentives, along with perceptions that diagnostic improvements render autopsies obsolete. Patient and caregiver factors also may be related to declining rates. Across all conditions, black individuals had a significantly higher rate of autopsies compared with white individuals (difference between races: 0.9% in cancer and 5.6% in cardiovascular disease). According to an item published on June 29, 2020 in the journal JAMA Internal Medicine, it is hypothesized that the higher rate of autopsies in black decedents may reflect health disparities. Less-aggressive diagnostic workups in black patients may translate into less-established diagnoses before death, possibly associated with the rates of autopsies. The higher rate also could reflect altruism, obtaining autopsies for the promotion of science, and perhaps even may represent caregivers wanting to know the “real cause of death,” suggesting mistrust of the health care system.
Another element that may be of some interest is that pathologists likely will incorporate genetic testing into routine autopsies. An article published in the June 2020 issue of the Archives of Pathology & Laboratory Medicine poses the question, should specific consent for genetic autopsy testing be required? An individual consenting to an autopsy should know that genetic testing will be performed and may lead to information that directly will have an impact on the decedent’s family, e.g., an increased risk of untreatable neurodegenerative disease. The author indicates that the person giving informed consent for the autopsy needs to know, understand the benefits, limitations, and alternatives of genetic testing and be able to refuse genetic testing in a private autopsy. Clearly, details of how best to obtain consent for genetic testing in autopsies is a needed area for future discussion and clarification.
More July-August 2020 TRENDS Articles
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PRESIDENT’S CORNER
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contains information about steps taken by the Trump Administration in response to Congressional deadlock in reaching agreement on a new coronavirus relief package. Read More
HEALTH REFORM DEVELOPMENTS
Points out how disparities can result from housing policies outside the health domain that entail historic redlining and its effects on birth outcomes. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Describes financial aspects related to closing schools because of COVID-19, mental health services for students, and a new grant program aimed at enabling higher education institutions to emerge from the current pandemic better able to expand educational opportunities for students. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
The COVID-19 Pandemic And Exacerbation Of Intimate Partner Violence
Mental Health, Substance Use, And Suicidal Ideation During The Coronavirus Pandemic
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Using Smartphone Accelerometers To Sense Gait Impairments Due To Alcohol Intoxication Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
Sharing Clinical Trial Data: Challenges And A Way Forward
National Inpatient Hospital Costs: The Most Expensive Conditions By Payer, 2017
Racial And Ethnic Disparities Among COVID-19 Cases In Workplace Outbreaks Read More
RACIAL DISPARITIES AND NOMENCLATURE IN NEUROSCIENCE
Early life adversity, exposure to toxins throughout life, and racial discrimination are factors contributing to psychiatric disorders, while differences in how nomenclature is used by clinicians and family caregivers may compromise the quality of treatment for Alzheimer’s patients. Read More
AUTOPSIES, HEALTH DISPARITIES, AND INFORMED CONSENT
Differences in autopsy rates between blacks and whites may reflect health disparities while the incorporation of genetic testing in the performance of autopsies raises important questions pertaining to informed consent by relatives of decedents. Read More