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The Moribund Autopsy:  DNR or CPR?

James E. Dalen, MD, MPH
Arch Intern Med. 1997;157(15):1633. doi:10.1001/archinte.1997.00440360019001.
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THE DECLINE in the performance of autopsies in the past 3 decades is remarkable: from 41% of hospital deaths in 19611 to 5% to 10% in the mid-1990s!2

House officers in the 1960s were urged to "get the post" on every patient dying in a teaching hospital. Observing the postmortem examination of patients whom they had taken care of was a critical part of the training of residents in internal medicine. Currently, the residency review committee for internal medicine requires autopsies in at least 15% of deaths on the medical service in accredited residency programs. From 1991 to 1994, less than half of the internal medicine programs reviewed for accreditation met these minimal requirements.3

Numerous reasons for the abrupt decline in autopsies have been cited. In 1971, the Joint Commission on the Accreditation of Hospitals eliminated autopsy requirements for hospital accreditation. Autopsies have become very expensive, and


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