The Death Of The Autopsy And Its Implications For Public Health

Death_Rembrandt_autopsy_Harmensz_van_Rijn_painting.jpgAutopsies are a routine part of hospital deaths, right? Well, actually, no. Today autopsies are only performed in five percent of hospital deaths, down from over sixty percent 40 years ago.
As the incomparable philosopher/economist Robin Hanson notes at, would we let it slide if only five percent of airline crashes were investigated?
Hanson argues that hospitals don’t want autopsies to be performed because they reveal too many doctor errors. According to a 1998 article published in The Journal of the American Medical Association, autopsy results show that doctors misdiagnose the cause of death at least 40 percent of the time. Hanson asks, “Could there be any clearer evidence that docs care more about getting paid than about healing patients, yet the public can’t bring itself to imagine docs are that selfish?”
I wholeheartedly agree with Hanson that the medical profession is not seriously committed to studying and learning from its mistakes. If it were, it would follow the model of the aviation industry and adopt the same kind of safety principles that the aviation industry has implemented.
But I disagree with Hanson that the medical profession’s atavistic impulses for self-preservation are the reason we’ve seen this dropoff in autopsies. I think we don’t get autopsies because insurers don’t pay for them. Private insurers generally do not pay for them and Medicare never pays for them because, under Medicare regulations, a dead patient does not meet the statutory definition of a “beneficiary.”
If we paid for autopsies, we’d get them done.
Autopsies are terribly important. It was autopsies that first made doctors realize that smokers were dying of lung cancer.
So what should we be doing? A lot of libertarian-leaning commentators (including liberals like Matt Yglesias) have been urging us to relax or abolish professional licensure requires that jack up the prices of services from hair salons to dental hygience to medicine.
I think autopsies are a perfect candidate for a procedure we should allow non-licensed professionals to perform. After all, what’s the worst harm that you can do to the person being autopsied? Kill them?
Let’s start doing autopsies again. We can do them at low cost and obtain all the benefits for public health.

This blog in maintained by the Boston medical malpractice lawyers at The Law Office of Alan H. Crede, P.C.