Autopsy: moribund art or vital science?

The autopsy rate in the United States has fallen dramatically in the past 40 years. Factors contributing to its decline include diagnostic over-confidence among clinicians, competing demands upon pathologists, difficulties obtaining consent from families, and its costs. The benefits of autopsy are clear: confirmation, clarification, and correction of antemortem diagnoses; discovery and definition of new diseases; evaluation of new diagnostic tests, new surgical techniques, and new drugs; investigation of environmental and occupational diseases; reassurance of family members; and contributions to medical and epidemiologic research. Proposals to revive the autopsy are reviewed, including altering the method of obtaining consent, altering autopsy procedures, structuring teaching around the autopsy, training autopsy pathologists in anatomic subspecialties, reinstating minimal autopsy requirements for hospital accreditation, providing financial support, and educating the public and the medical profession about its values. Accomplishing these changes quickly will prevent loss of its many benefits to the clinician, family, hospital, and society.