Post-mortem rates in England and Wales 'should be cut'

The number of post-mortem examinations in England and Wales could be cut by 60% if the system in Scotland was used, a leading pathologist has said.

Professor Derrick Pounder said the rate of 110,000 coroner autopsies per 500,000 deaths could not be justified.

Writing in the Journal of the Royal Society of Medicine, he said more use of external examinations should be used to determine cause of death.

Scotland's autopsy rate is 6% compared to 22% in England and Wales.

'Appropriate balance'

Professor Pounder said the state intervened on a family's private grief by ordering a full post-mortem examination in too many cases.

External examinations were also a more cost-effective method of identifying cause of death, he said.

Professor Pounder, of the Centre for Forensic and Legal Medicine at the University of Dundee, said: "There is a general lack of evidence about the utility of and justification for such a high level of activity.

"While the autopsy is an important tool in modern death investigation, an almost automatic recourse to it is inappropriate.

"External examinations are not only cost-effective but also a necessary element in any death investigative system which wishes to strike an appropriate balance between intrusion by the state and the rights of the bereaved."

Professor Pounder said the post-mortem examination rate in England and Wales was between double and treble that in other jurisdictions.

'Lowering of standards'

A successful trial was launched in Tayside in 1998 to maximise the use of external examinations.

It was extended to Fife and the Central region of Scotland in 2006, and has contributed to an overall drop in the number of post-mortem examinations in the country.

Professor Pounder said if such a system was introduced in England and Wales it could cut the number of autopsies from 110,00 to 30,000 a year.

"We need to change our approach and be much more thoughtful in selecting which deaths we autopsy, rather than carrying out autopsies automatically in large numbers of deaths and running a production line system," he said.

"Autopsies must be performed by skilled pathologists and we simply do not have the people to perform well such large numbers of autopsies.

"The inevitable result is a lowering of autopsy standards and a false sense of security that we have properly investigated the death."

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