Editing Autopsy (section)

==Purpose==
The principal aims of an autopsy are to determine the [[cause of death]], mode of death, [[manner of death]], the state of health of the person before he or she died, and whether any [[medical diagnosis]] and treatment before death were appropriate.<ref>{{Cite web |date=2023-08-02 |title=Do you need an autopsy for a wrongful death case in Georgia? |url=https://baderscott.com/blog/is-autopsy-necessary-wrongful-death-case-georgia/ |access-date=2024-03-02 |website=baderscott.com |language=en}}</ref> In most [[Western world|Western countries]] the number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologist and former ''[[JAMA (journal)|JAMA]]'' [[editing|editor]] [[George D. Lundberg]], have charged that the reduction in autopsies is negatively affecting the care delivered in hospitals, because when mistakes result in death, they are often not investigated and lessons, therefore, remain unlearned. When a person has permitted an autopsy in advance of their death, autopsies may also be carried out for the purposes of teaching or medical research. An autopsy is usually performed in cases of sudden death, where a doctor is not able to write a death certificate, or when death is believed to result from an [[unnatural death|unnatural cause]]. These examinations are performed under a legal authority ([[medical examiner]], [[coroner]], or [[procurator fiscal]]) and do not require the consent of relatives of the deceased. The most extreme example is the examination of [[murder]] victims, especially when medical examiners are looking for signs of death or the murder method, such as [[bullet]] wounds and exit points, signs of [[Strangling|strangulation]], or traces of [[poison]].
Some religions including [[Judaism]] and [[Islam]] usually discourage the performing of autopsies on their adherents.<ref>{{EMedicine|article|1705993|Religions and the Autopsy}}</ref> Organizations such as [[ZAKA]] in Israel and [[Misaskim]] in the United States generally guide families on how to ensure that an unnecessary autopsy is not made.
Autopsies are used in clinical medicine to identify a [[medical error]] or a previously unnoticed condition that may endanger the living, such as [[infectious disease]]s or exposure to [[hazardous material]]s.<ref>Michael Tsokos, "Die Klaviatur des Todes", Knaur, Munich, 2013, pp. 179–89</ref>
A study that focused on [[myocardial infarction]] (heart attack) as a cause of death found significant errors of omission and commission,<ref>{{cite journal |last1=Ravakhah |first1=Keyvan |title=Death Certificates Are Not Reliable: Revivification of the Autopsy |journal=Southern Medical Journal |date=July 2006 |volume=99 |issue=7 |pages=728–733 |doi=10.1097/01.smj.0000224337.77074.57 |pmid=16866055 }}</ref> i.e. a sizable number of cases ascribed to [[Myocardial infarction|myocardial infarctions (MIs)]] were not MIs and a significant number of non-MIs were MIs.

A [[systematic review]] of studies of the autopsy calculated that in about 25% of autopsies, a major diagnostic error will be revealed.<ref name="pmid12783916">{{cite journal |vauthors=Shojania KG, Burton EC, McDonald KM, Goldman L | title = Changes in rates of autopsy-detected diagnostic errors over time: a systematic review | journal = JAMA: The Journal of the American Medical Association | volume = 289 | issue = 21 | pages = 2849–56 | year = 2003 | pmid = 12783916 | doi = 10.1001/jama.289.21.2849 }}</ref> However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors.

A large [[meta-analysis]] suggested that approximately one-third of [[death certificate]]s are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died.<ref>{{cite journal |last1=Roulson |first1=J |last2=Benbow |first2=E W |last3=Hasleton |first3=P S |title=Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review |journal=Histopathology |date=December 2005 |volume=47 |issue=6 |pages=551–559 |doi=10.1111/j.1365-2559.2005.02243.x |pmid=16324191 }}</ref>  Also, it is thought that over one-fifth of unexpected findings can only be diagnosed [[histology|histologically]], ''i.e.'', by [[biopsy]] or autopsy, and that approximately one-quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue.

One study found that (out of 694 diagnoses) "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11  myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others".<ref name="pmid14980989">{{cite journal |vauthors=Combes A, Mokhtari M, Couvelard A, Trouillet JL, Baudot J, Hénin D, Gibert C, Chastre J | title = Clinical and autopsy diagnoses in the intensive care unit: a prospective study | journal = Archives of Internal Medicine| volume = 164 | issue = 4 | pages = 389–92 | year = 2004 | pmid = 14980989 | doi = 10.1001/archinte.164.4.389 | doi-access = free }}</ref>

Focusing on [[intubated]] patients, one study found "abdominal pathologic conditions&nbsp;– abscesses, bowel perforations, or infarction&nbsp;– were as frequent as [[Pulmonary embolism|pulmonary emboli]] as a cause of class I errors.  While patients with abdominal pathologic conditions generally complained of abdominal pain, results of an examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued".<ref name="pmid1992186">{{cite journal |vauthors=Papadakis MA, Mangione CM, Lee KK, Kristof M | title = Treatable abdominal pathologic conditions and unsuspected malignant neoplasms at autopsy in veterans who received mechanical ventilation | journal = JAMA: The Journal of the American Medical Association | volume = 265 | issue = 7 | pages = 885–87 | year = 1991 | pmid = 1992186 | doi = 10.1001/jama.265.7.885 | url = http://www.escholarship.org/uc/item/51r977ch }}</ref>