Letter: Post-mortem ethics

Sir: The distressing experiences of Jeremy and Sandra McKenzie ("Baby organ scandal", letter, 9 December) highlight the need for bereaved parents and other relatives to have a full explanation of the purpose of post-mortem examinations and of their legal basis.

Most post-mortem examinations are directed by law at the request of a coroner (or procurator-fiscal in Scotland). These are investigations of deaths either when a doctor is unable to issue a death certificate, because the cause of death is not known, or when death is suspected or known to be due to an event other than naturally-occurring disease. Under Rule 9 of the Coroner's Rules, the pathologist has to make "provision for the preservation of material which in his opinion bears upon the cause of death". In such cases, I believe that the bereaved family should be informed fully about what has been done and why, and their views sought on what should happen to any retained "material" at the end of the investigation.

Post-mortem examinations not directed by law are performed only with the agreement of a parent, the spouse or close relative. In such cases, the primary purpose is to verify the natural cause of death and to determine the effects of treatment. In my opinion, the parent or other relative agreeing to this should first be informed fully about what is necessary in order to achieve the purpose of the examination and, if retention of an organ is likely, a full justification given for this. The bereaved are asked to make these decisions at a time of great distress.

Many bereaved parents and relatives may share Jeremy and Sandra's appreciation that advances in medicine depend on the opportunity to use organs, after death, for research and medical education. If given the opportunity to agree to this, they may feel that they could help others with the same condition as that which affected their own child so that some benefit may come from their loss.

In collaboration with the Coroners Society, the Royal College of Pathologists is producing guidance, based on relevant law and on high ethical standards, to ensure that the examination of the body after death has public support and is conducted in a respectful manner in which bereaved parents and relatives can have confidence.

JAMES UNDERWOOD

Professor of Pathology

University of Sheffield