The rate of autopsies has fallen significantly in Our Lady's Hospital in Crumlin since the controversy over the retention of body parts, according to a leading paediatrician.
Dr Brian Denham, former paediatric cardiologist in Our Lady's, said autopsies were essential to establish the cause of death so doctors could help families to come to terms with their bereavement and help prevent such deaths in the future.
Dr Denham has made a personal submission to the Dunne Post-Mortem Inquiry, set up to investigate the manner in which post-mortems were carried out and the retention of organs. He told The Irish Times he had also spoken to the inquiry.
He expressed misgivings about its scope. "It is being asked to look at 30 years' practice of autopsy, in all hospitals in the State. That's crazily long," he said.
"It will be very costly both in terms of money and clinicians' time, and hospitals are being asked to meet the costs of dealing with the inquiry out of their own budgets. That will come from the budget for patient care.
"The point of autopsies is to find the cause of death and whether the treatment was all right. Between a quarter and a third of all autopsies find factors that were relevant to the death and that were not apparent prior to the death. Errors and omissions will not be detected without autopsies," he said.
He said the number of autopsies in Crumlin had declined from about 200 a year some years ago to 20 annually now. They had been halved since the controversy about autopsies in 1999. One of the reasons was the lack of consent.
"Most of the autopsies we have now are coroners' autopsies, where consent is not required, although parents are still giving consent for autopsies on neonates.
"Describing an autopsy and asking for consent is a very distressing conversation. An autopsy is a very unpleasant and gruesome procedure. For example, if a brain is removed for examination it usually cannot be put back in the brain cavity, if it is replaced in the body it is placed in the abdomen," Dr Denham said.
"The time to tell the family you are going to have an autopsy is not when they are in the throes of bereavement. I think it's the wrong time to tell people.
"Our experience would tell us that the more information you can give a family six or eight weeks after the death, about the cause of death, the more likely it is they can come to closure.
"The less information you can give them the more likely they are to go into an anxiety reaction. The nastier the information the more likely they are to have an abnormal bereavement reaction."