We've had a lot of end-of-life discussions here recently, but no one has mentioned autopsy.

[hedgehog]

As far as i know, an autopsy costs the family nothing.

When my mother died, we were offered an autopsy and my father said no. Maybe it was a knee jerk reaction, maybe he'd thought it through.

Here's the issue: a year later, at least two of my siblings are second guessing my mother's care the last year in her life. My brother is wondering if she was on a medication that killed her; my sister is feeling guilty that she insisted on an DNR order too soon. I think an autopsy would have settled these questions and helped the doctors make better decisions in the future.

Maybe people always chew over what happened when a love one dies, but I think an autopsy would help.

[MADem]

1. Before Legionaire's Disease was well known, one of my relatives died from it.

The Primary Next of Kin said no to an autopsy. Regretted it later.

I suppose this is something that should go in a will, or be discussed ahead of time with family members, just so there's none of that guilt going on. Cut me up, it's no skin (nyuck, nyuck) off my nose!

[Warpy]

2. Sometimes an autopsy is triggered and you get one, no matter what

but in my experience, they're generally not offered unless the docs are also wondering why the person died.

When a patient asks for a DNR, it's not premature. It means they've had enough of the best medical care and they're not interested in getting their chests pounded and tubes shoved down their throats if their hearts stop. It doesn't mean "do not treat," it means "no heroics."

[hedgehog]

7. It can be more complicated than a simple DNR. Is a feeding tube a heroic

measure or simple care? If there's a chance for the person to recover, the feeding tube might be the difference. What about an antibiotic? If the person is dying, the feeding tube extend the dying process and cause distress. Many medical interventions are themselves distressful and worthwhile only if there's a chance to return to where the patient was before the crisis. When a chronic condition approaches end stage, it's hard to know when to stop trying to resolve the latest crisis.

(I used DNR as short hand for the series of decisions involved.)

[DURHAM D]

3. An autopsy is not free in my experience.

When my Mother died just her head she was autopsied and it confirmed she died of Alzheimer's. My Father - from his autopsy we found out he had a type of dementia called Lewy Body. Both my parents had requested head autopsies in their health care directives that they had updated when they both received an Alzheimer's diagnosis. They made the change because as they put it - Our children and our grandchildren ask a lot of questions and they like answers, not speculation.

We changed my father to full when other issues came into question. He was 94.

The cost for my Mother $600. My Father $1200.

Personally I think everyone should have an autopsy. You learn a lot and it helps researchers.

On Edit: We were required to pre-pay for the autopsy. When we decided to upgrade on my Dad we were fortunate that my sister was in a position to quickly run down and pay the extra charge while I worked the phones.

[hedgehog]

6. I think any costs must depend on the jurisdiction .

http://familydoctor.org/familydoctor/en/healthcare-management/end-of-life-issues/autopsy.html

[DURHAM D]

9. Both of my parents were in a Memory Unit prior to their deaths.

My Mother was 88 and my Father 94. They would not have been autopsied without the family involvement. In fact, my Father's doctor argued against the full autopsy. We had to work "around" him. The autopsy revealed why.

And one further note - my parents died a year apart and the staff/nurses were the same team for both transitions. After receiving both reports we took copies to the floor. Apparently no one had ever done this for them before. They were fascinated to find out my Dad had Lewy Body and spent a great deal of time discussing (with us and each other) the differences between Lewy and other memory diseases. They were very emotional and grateful and they expressed their gratitude because they felt the autopsy reports could help them do their jobs better.

My sister is on a one woman crusade to encourage children to have autopsies performed and to take the report to the staff, not management, but staff to help them understand what they were/are dealing with. We had both an uncle and an aunt who transitioned in the same facility a few years before and several of the staff members remembered them as well. Copies of their autopsies were also taken to the floor. I realize this is an odd little situation but its important to remember that the men and women who work in this area of care carry a heavy burden and really, really want to provide comfort.

[hedgehog]

10. It's also important to remember that everyone dies of something.

Maybe my mother would have lived another 3 weeks if X had been treated, only to die from Y. Basically, there was a cascade of system failures. I guess what I'm saying is that when a very elderly person with a lot of things wrong dies, don't be picking up the phone to call the lawyers unless there was gross negligence or malpractice. Bear in mind, the person dying of Alzheimer's may not really benefit from a pacemaker, for example!

[DURHAM D]

11. That is why I stressed that my Father was 94.

It didn't matter the cause - we didn't want to file a lawsuit or do an investigation. We just wanted to know what he died of for the family.

The Doctor told us he had leukemia about a week before he died unexpectedly. The Doctor also told us he had TB about three weeks before he died. Neither one of those things was true. We didn't followup with the doctor, we didn't call an attorney, it just didn't matter. The most interesting result - we found out he had Lewy Body, not Alzheimer's. We never thought he had Alzheimer's. He did not die of Lewy Body.

[hedgehog]

8. Sometimes finding out what killed one family member may help

the others. There have been too many cerebral hemorrhages in my father's family; it'd be nice to know what that's all about!

[dmallind]

4. The same ooga booga big sky fella concerns screw up both though.

The silly ideas that we should have no controlled, dignified and legal way to end life and that we shouldn't cut up the lifeless cadaver that is left when it does end both come from the superstition that our lives are not our own.

It's a bit ironic in that those who cherish an incorporeal component of personality the most are the least likely to want to disturb the decidedly corporeal remnant after the "soul" has departed.

Personally as long as I am definitely, 100% DEAD you can do what you like to my body. Feed it to dogs, do an autopsy or make it into a puppet for all I care, although my preference would be to transplant whatever bits are usable to people who need them firs. Purely from a utilitarian perspective there not any remaining identity for me personally - I'll be utterly absent and destroyed as soon as the brain functions are gone for good.

[hedgehog]

5. To be fair, after the necessary indignities of medical care ( catheters,

IV, oxygen mask etc) I think most families find the thought of one more bodily insult is too much. The emotional reaction is that the person has already suffered enough. It's not logical, but it's human.

[dmallind]

13. I think everyone agrees there is no suffering after death

Albeit for varying reasons. Pretty sure the idea of dignity for the dead is based on superstition too. If people manage to get it through their heads that corpses have no feelings in any sense of the word, and never will either, then we can both accelerate medical science AND free up much-needed land AND decrease the profits of a gouging and worthless funeral industry.

[NNN0LHI]

12. I think the decision is usually age related?

Here in Illinois if someone younger dies an autopsy is done automatically. Has to be done.

Not sure what the age cutoff is?

My father was in his 80's and had several heart attacks and stroke before he finally passed away and an autopsy wasn't even mentioned. Would have kind of been a waste of money.

Don