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Post mortem scientific sampling and the search for causes of death in intensive care: what information should be given and what consent should be obtained?
  1. J P Rigaud1,2,
  2. J P Quenot1,3,
  3. M Borel1,4,
  4. I Plu1,
  5. C Hervé1,5,
  6. G Moutel1,5
  1. 1Laboratoire d'Ethique Médicale et de Médecine Légale, Faculté de médecine, Université Paris Descartes, Paris, France
  2. 2Service de Réanimation Polyvalente, Centre Hospitalier de Dieppe, France
  3. 3Service de Réanimation Médicale, CHU Dijon, France
  4. 4Département d'Anesthésie Réanimation, CHU Rouen, France
  5. 5Service d'accès aux soins et de droits des patients, Hôpital Corentin Celton, Assistance Publique Hôpitaux de Paris, France
  1. Correspondence to Jean-Philippe Rigaud, Réanimation Polyvalente, Centre Hospitalier Dieppe, Avenue Pasteur, BP 219, Dieppe 76200, France; jrigaud{at}ch-dieppe.fr

Abstract

Purpose The search for cause of death is important to improve knowledge and provide answers for the relatives of the deceased. Medical autopsy following unexplained death in hospital is one way to identify cause of death but is difficult to carry out routinely. Post mortem sampling (PMS) of tissues via thin biopsy needle or ‘mini incisions’ in the skin may be a useful alternative. A study was undertaken to assess how this approach is perceived by intensive care doctors and also to evaluate how this practice is considered in ethical terms in France.

Methods A study of PMS practices immediately after death in 10 intensive care departments was performed. The medical director of each centre was interviewed by telephone and asked to describe practices in their unit and to outline the questions raised by this practice.

Results PMS is routinely performed in 70% of the units which responded, without systematically obtaining formal consent and without precise rules for communicating results. Approaches to PMS differed between centres, but all physicians felt that PMS is useful for the scientific information it gives and also for the information it provides for relatives. All physicians regret the lack of standards to structure PMS practices.

Conclusion Information from post mortem examinations is important for society to inform about causes of death, for doctors to improve practices and for decision-makers responsible for organising care. Debate persists regarding the balance between individual rights and community interests. It is suggested that an approach for identifying cause of death could easily be integrated into the relationship between carers and relatives, provided full transparency is maintained.

  • Post mortem sampling
  • autopsy
  • intensive care
  • ethics
  • informed consent
  • attitudes toward death

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Footnotes

  • An additional appendix is published online only. To view this file please visit the journal online (http://jme.bmj.com).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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