Madam, - Maurice Neligan (Health Supplement, January 24th) makes a strong case for the practice of post-mortem examinations being essential for the maintenance of the highest standards of clinical practice in our hospitals. I believe this is a view with which the majority of doctors would wholeheartedly agree.
Post-mortems are necessary not only for the continuing medical education of both undergraduate and postgraduate students and doctors, but also as a method of medical audit of personal, speciality and hospital management policies.
It is very clear that the recent organ retention debacle has seriously reduced the number of post-mortem examinations for which relatives are giving permission, leaving only those requested by the coroner. In part this is due to the notoriety given to this subject in recent years, but also to the extreme detail with which the post-mortem procedure now has to be explained to the near relatives, in order legally to obtain their consent. By any criteria post-mortem examinations are a messy business and hardly a subject that recently bereaved relatives of loved ones will appreciate having to discuss in detail, even when they have the very best of intentions. Indeed nowadays, when permission is being requested of relatives by medical personnel, it is not unknown for both parties to end up in tears.
In my view it should be possible to interview relatives and, as in the past, simply ask their permission to carry out an examination on the deceased without having necessarily to go into the finer details, except when specifically requested to do so. Documentation could be available to explain the relevant procedures employed, and these could be read in private as and when necessary.
Post-mortem examinations are also, I believe, very much in the best interests of patients. I have always advised my friends that if they have the misfortune to have to be admitted to hospital, they should sign a document which requests that, if they were to die, they should have a post-mortem examination, the results of which should be discussed at the monthly hospital "death conference-grandround".
You may be assured that there are few things as nerve-racking for your consultant and his/her staff as having the details of their management of your illness discussed and dissected by their peers in front of all the hospital personnel and students. I suggest that there is no better way of ensuring that you will get the very best attention from your medical staff. - Yours, etc,
DONALD WEIR, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8.