Lack of Awareness about Autopsy Practices
Green Lane Experience Reflects Lack of Awareness about Autopsy Practices Before 1990
The Ministry of Health says it's clear from the Green Lane Heart Library issue that before 1990 there was a general lack of awareness about what was involved in autopsies.
Deputy Director-General, Clinical Services, Dr Colin Feek said feedback to the Ministry from clinicians dealing with families where retained hearts have been returned for burial reveal that in the past there was a lack of information for families about what actually happened in autopsies.
He said this was a nationwide issue and clinicians from around the country wished to encourage public awareness.
Autopsies involve small tissue samples, and sometimes organs, being retained for examination. Where possible, body parts are returned to the body for cremation or burial.
If it is not possible to return the organs or tissue to the body, for example where a longer, complex examination of a brain is required, then the tissue or organs are cremated. The same practice is followed for the disposal of any other body parts removed during surgical procedures, unless patients have specifically requested the return of a particular body part.
Dr Feek said while these days the separate disposal of tissue and organs following autopsy was minimal, in the past families might not have fully understood that body tissue or organs might have been disposed of separately.
"This was most likely to occur when the brain was needed for examination. Procedures have now changed to allow more rapid processing, taking hours or days, and not up to six weeks as was previously needed."
Dr Feek said for many years human heart valves were removed during an autopsy to replace defective heart valves in patients undergoing heart surgery. Before 1988 consent procedures were less rigorous than they are now.
"These procedures, such as harvesting heart valves at autopsy without consent and brains being examined and then separately cremated without explicit consent, are practices of the past."
"The practice of medicine is continuously evolving and it is inevitable that past practice looked at through modern eyes, will be judged as lacking."
Dr Feek added that there might also be a lack of public awareness about Coroner's cases. A Coroner does not require informed consent to perform an autopsy or to retain or dispose of tissue or organs.
Dr Andrew Tie, Vice President (New Zealand) of the Royal College of Pathologists of Australasia, believes there is a need for public debate on the issues and greater understanding by the public about what is involved.
"In the past clinicians may have been influenced by family sensitivities when explaining at length the medical procedures involved in an autopsy. At times clinicians feel they are intruding on a family's grief."
"From personal experience, I think doctors would have expected the same treatment for themselves in similar circumstances. It is a difficult and delicate task to ask grieving relatives for consent to an intrusive procedure."
"For these reasons in the past, families may not have explicitly asked, nor doctors explicitly stated, that not all the organs or tissue would be returned and that some tissue may be disposed of separately," Dr Tie said.
Dr Feek said clinicians had resolved the issue and now explained as much as they thought the family wanted to hear and then provided information, often in written form, which set out exactly what was involved, asking the family to consider it and then provide consent."
"Nationally, since the 1990's, and after the Cartwright Inquiry, we would have expected improvements in the procedures for obtaining informed consent for autopsies."
Dr Feek said he appreciated that Maori had been particularly concerned about these issues for some time. Last year, the Ministry reinforced with health care providers the use of guidelines on the retention, removal or return of body parts for Maori, as a useful guide for all New Zealanders. The guidelines were developed by Te Puni Kokiri, the Ministry of Maori Development, for health care providers in 1999.
"Both the College and the Ministry acknowledge that this whole issue is a very sensitive area and that some families may wish to now find out if their loved ones who had an autopsy performed prior to 1990 were buried or cremated with all their organs or tissues. Unfortunately this information is not kept by hospital records and there is no practical way of finding this out now."
Dr Tie concluded by saying there were benefits and advantages of stored human samples, including review of patient diagnosis, investigation, and research.
"There is also a substantial benefit in educating doctors and other health professionals. After careful thought, some patients see more benefit in donating their removed organ to an educational collection than disposing of it".