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The autopsy. Some ethical reflections on the obligations of pathologists, hospitals, families, and society.

Since the 18th century, the autopsy has been seen as an essential tool for advancing medical knowledge and monitoring the quality of patient care. In recent years, based on the mistaken assumption that newer diagnostic antemortem procedures, especially imaging techniques, have rendered the autopsy obsolete, it has fallen into serious disuse and disrepute. Data disproving this assumption are now emerging. The autopsy is still needed as a final test of the newer diagnostic techniques and as a means for integrating anatomic, physiologic, biochemical, and clinical features of new, as well as established, diseases. This essay examines the sources of clinicians' and pathologists' moral obligations to obtain, perform, and attend autopsies. It underscores the ethical responsibilities of families, hospitals, and society to restore the autopsy to a place of importance in the elaboration of the natural history of human disease.