Decreasing autopsy rate in Sweden reflects changing attitudes among clinicians.

Abstract

The autopsy rate has declined in the last 20 years in Sweden and is now approximately 30%. Clinical autopsies constitute about 18% and medico-legal autopsies somewhat more than 10%. There is an obvious geographical variation in clinical autopsy rate, whereas the variation in medico-legal autopsy rate is narrower. The difference in autopsy frequency between males and females seemed to be mainly dependent on the higher number of medico-legal autopsies among males. In order to explore the reasons behind the decline in autopsy rate we accomplished a study of the autopsy rate in 1986 and 1991 in three Swedish hospitals of various types and sizes. The hospitals studied were one university hospital and two community hospitals of different sizes. The autopsy rate varied between 0 and 100% among the different departments within these hospitals and also varied considerably between wards within the same department. The number of clinical autopsies declined between 1986 and 1991 in all three hospitals. The fall was greatest in the university hospital and in the larger of the two community hospitals. However, in these two hospitals departments with active research of clinico-pathological relevance maintained or even increased their autopsy rate during this period. The decline in autopsy rate in general and the difference in rate between hospitals, departments and wards could be explained neither by the Autopsy Act of 1976, or by the reluctance of relatives to give consent to the autopsy of a relative. A change in attitude toward and interest in the autopsy activity of clinicians seemed to be the major explanation for the decline of the autopsy.