Autopsy: The Importance of After-Death Diagnosis

Death is an inevitable natural phenomenon. Like birth, people die every day. Some circumstances of these deaths raise questions suggestive of probable homicide, missed diagnosis by the healthcare workers, and poor attention of the patient or their caregivers to diseases.

Emotional assessments of illnesses have no place in medical practice. Once there is no objective proof of the likely cause(s) of someone’s death, autopsy or postmortem is the other option to ascertain why the person died.

Autopsy is still an unpopular discussion in the general population of Nigeria due to ethno-religious and financial reasons.

This piece tries to shed light on the importance of autopsy. All the cases cited below to address the relevant points are fictional. Should any appear similar to cases you know, it is a mere coincidence.

1. Mr A, a 52-year-old artisan, an unknown person in hospital B, was rushed there when he began to vomit blood copiously. Within twenty minutes of getting to the hospital, he had vomited 1 liter of fresh blood. Those who took him to the hospital could not give the doctors enough history to establish a diagnosis. The doctors nevertheless commenced efforts to stop the bleeding and transfused him with blood. He died within 12 hours of getting there. Blood transfusion was ongoing when he died. The doctors suspected perforated peptic ulcer disease, cancer of the gastrointestinal system, or blood cancer. Mr A's family members blamed the blood transfusion for his death. 

Only an autopsy could resolve the matter. After opening the dead body of Mr A, his brain down to his feet were examined. Blood samples and tissue samples were taken for several tests. A big hard mass with bleeding surfaces was found in his stomach. The brain and lungs showed deposits of cancerous tissue from histology results. Advanced (metastatic) cancer of the stomach was the cause of his death. The family members were better informed thereafter.

2. Mrs B died in her sleep. She had only complained of mild headache to her family members. Investigations requested by the doctors, including brain scan, were ignored. The husband and kids were shocked by the sudden death of Mrs B few weeks to her 60th birthday. The family members wanted to know what killed her. The doctor recommended a postmortem. A pathologist was invited to carry out the autopsy. Massive bleeding was noticed in her brain from multiple aneurysms (abnormal swelling of the wall of an artery). Multiple cysts (abnormal sacs of fluid) were also found in her kidneys and liver. The cause of her death was known. It was Polycystic Kidney Disease. Because polycystic kidney disease can affect blood relatives, her kids and siblings were advised to have a comprehensive medical check to identify if they also had the disease despite being free of symptoms.

3. Mr C had repeated fever, cough, and difficulty with breathing. His doctor treated pneumonia every time. Chest Xrays and blood investigations were requested which confirmed pneumonia always. He died during his fourth admission for pneumonia within 18 months. He had taken a life assurance policy. For his family to get the full benefits, a death certificate was needed. They requested for autopsy. Postmortem found cancerous growths in one of his lungs. If the doctor had asked him to do more detailed tests of the chest apart from Xrays, the cancer most likely would have been discovered. He could have been cured of the cancer if he took the recommended treatment.

4. Mrs X, a 77-year-old wealthy widow, died after having sudden arrest of her breathing in her sleep. She had been at loggerheads with her sons over the properties of her late husband. Her sons were unreasonable. She had instructed her lawyer in her will to conduct an autopsy if she died mysteriously. Her sons fought against the need for autopsy. Their mother was not too young to die, they argued. The court prevailed on the matter; autopsy revealed that she died from brain damage following asphyxia (lack of oxygen supply). Blood test showed toxic amount of diazepam, a sleeping medication, which can cause respiratory arrest in lethal doses. Her sons were implicated in her death after more forensic investigations were done.

5. Mr J died within 24 hours of admission. Though he was critically ill, his doctors didn't expect him to die so soon. They needed to know if they missed the diagnosis or there was another problem that could have caused his death. Autopsy was done. It confirmed predictable changes in his brain and lungs which are found in people who have the disease diagnosed in him. The autopsy simply confirmed that his disease had advanced beyond remedy.

There are other situations in which autopsy is essential to give the family closure when their relative dies. Autopsy also assists the doctors to take better decisions with other patients, confirm suspected homicide, and also forewarn the family members of an inheritable or genetic disease.

Autopsy costs money. In some western countries, the government pays the bill for the examination. In Nigeria, the family members do in more than 90% of cases. Religious or traditional factors are cited as other reasons to withdraw consent to autopsy.

To improve the health system, autopsy should be institutionalized by the government. The ball is in the court of our legislators.

Ademola Orolu

About the Author

Ademola is a Consultant Family Physician and writer. He founded the online health magazine, The Family Doctors, and was its Editor-in-Chief from 2017 to 2020. He is the medical director of Nathaniel Health Consulting, a family hospital in Matogbun, Ogun State. 

He is an author of many books including storybooks. He regularly writes on health-promoting topics and encourages positive behavioural change in his articles.