To the Editor: The Royal College of Pathologists of Australasia Autopsy Working Party highlighted the decline in the numbers of hospital autopsies.1 Forensic and hospital autopsies are a valuable safety and quality tool for improving healthcare systems. Autopsies provide an accurate cause of death and are a valuable audit tool to evaluate medical diagnostic processes and therapeutic interventions. Declines in both types of autopsies are cause for concern.

A forensic autopsy is an integral part of the coronial process. The Coroner’s role is to establish the identity of the deceased, where he or she died, the cause of death and, perhaps most importantly, how the person died.2 Without an autopsy, it can be difficult to determine the cause of death.

At the Victorian Institute of Forensic Medicine (VIFM), about 80% of all deaths that are reported to the State Coroner (in Melbourne and Geelong) undergo a full forensic autopsy. Senior next-of-kin can object to an autopsy being performed. Section 29 of the Coroner’s Act 1985 (Vic) details the objection process.2 The decision to grant an objection is dependent on the opinion of the Coroner and his or her view on the circumstances of death.

We reviewed the number and rate of forensic autopsies performed by the VIFM between 1992 and 2002, as well as the number and rate of objections under Section 29.

The rate of forensic autopsies remained relatively stable over the decade, at 80% of deaths reported to the State Coroner. There were 94 successful Section 29 applications in 1992. This accounted for 3.25% of all deaths reported to the Coroner. Objections to autopsies have been steadily increasing since 1992. In 2002, there were 212 successful applications, accounting for 7.1% of all deaths reported to the Coroner and representing about a 4% rise over the decade.

When a coronial autopsy has been requested, but not carried out because of a Section 29 objection, substantial additional work is required. This includes medical record reviews; external forensic examinations; reviews of statements from treating doctors, independent experts and family; and inquests.

The other major ramification associated with objections to autopsies is the discrepancies between causes of death that are determined clinically and at autopsy (with 28% of presumed causes wrong in one study).3 Without an autopsy, important pathology may remain unrecognised, and this can substantially affect the accuracy of the stated cause of death.

The inherent right of next-of-kin to object to coronial autopsies will remain. However, healthcare professionals and coroners need to be aware of the public health implications associated with objections to autopsies.