Abstract
After a general overview of death in current medical-cultural context, this chapter examines the main moral aspects of postmortem imaging (PI). In the current debate the stressed ethical issues are fundamentally the following: (1) the noninvasive character of postmortem imaging that very likely makes the procedure less objectionable to relatives of the deceased; (2) the reliability of the methods that ought to be as effective as traditional autopsy, both when PI precedes and completes or substitutes traditional autopsy; and (3) the cost-benefit analysis, in individual and social terms. The chapter emphasizes the common prerequisite of these ethical aspects, that is, the corpse’s dignity and, consequently, the duty to find the procedure that could ensure in a better way such dignity. Furthermore, another ethical issue concerns the relationship between physicians and the relatives in front of the tragic event of death itself. Finally, the chapter deals with the case of pediatric postmortem examination as the paradigmatic example of all ethical issues about PI.
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- 1.
See Illich I (1974) The Political Uses of Natural Death, “Hastings Center Studies”, Vol. 2 (1); 3–20.
- 2.
See Sesta L, Argo A (2017) Identifying migrant’s corpses: a really worthy duty? forthcoming.
- 3.
Loughrey MB, McCluggage WG, Toner PG (2000) The declining autopsy rate and clinicians’ attitudes, Ulst Med J; 69: 83–89.
- 4.
Stawicki PS, Aggrawal A, Dean AJ et al. (2008) Postmortem use of advanced imaging techniques: Is autopsy going digital? Scientist Vol. 2 (4): 17–26; Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of postmortem histology: a meta-analysis and review. Histopathology; 47:551–559.
- 5.
See Quigley Ch (1996) The Corpse. A History, McFarland, Jefferson-London.
- 6.
Stawicki SP, Gracias VH, Schrag SP, Martin ND, Dean AJ, Hoey BA (2008) The dead continue to teach the living: examining the role of computed tomography and magnetic resonance imaging in the setting of postmortem examinations. J Surg Educ 2008; 65: 200–205. See also Ciaffi R, Gibelli D, Cattaneo C (2011) Forensic radiology and personal identification of unidentified bodies: a review, 116(6): 960–968.
- 7.
Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FR, Reijnders UJ, Zuidema WP (2015) Post-mortem imaging compared with autopsy in trauma victims - A systematic review, Forensic Sci Int. 257: 29–48.
- 8.
Hayakawa M, Yamamoto S, Motani H, Yajima D, Sato Y, Iwase H (2006) Does imaging technology overcome problems of conventional postmortem examination? A trial of computed tomography imaging for postmortem examination. Int J Legal Med; 120: 24–26.
- 9.
Oyake Y, Aoki T, Shiotani S, Kohno M, Ohashi N, Akutsu H, Yamazaki K (2006) Postmortem computed tomography for detecting causes of sudden death in infants and children: retrospective review of cases. Radiat Med; 24:493–502. More generally, “La principale metodica radiologica applicata alle Scienze Forensi al giorno d’oggi risulta essere la multi-slice TC (CT-Virtopsy, MSCT-v), senza utilizzo di mezzi di contrasto; essa presenta numerosi vantaggi, quali la non-invasività, l’accuratezza, la riproducibilità, la rapidità di esecuzione e l’ampia possibilità di rielaborazione e ricostru- zione delle immagini (MPR, MIP, VR, etc) per la valutazione anche di organi specifici, della superficie cutanea o delle ossa” (Serraino S, Scopellitti L et al. Ruolo dell’imaging TC nella valutazione post-mortem dei soggetti deceduti per caduta da altezze elevate: nostra esperienza, “Il giornale italiano di Radiologia Medica”, 2016, 3: 58–64, 58).
- 10.
Underwood J (2012) Post-mortem imaging and autopsy: rivals or allies? The Lancet, 379; 100–102 and Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) Virtopsy: minimally invasive, imaging guided virtual autopsy. Radiographics; 26: 1305–1333.
- 11.
Serraino S, Scopellitti L et al. (2016) Ruolo dell’imaging TC nella valutazione post-mortem dei soggetti deceduti per caduta da altezze elevate: nostra esperienza, “Il giornale italiano di Radiologia Medica” 3: 58–64; Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R. (2007) Virtopsy—The swiss virtual autopsy approach, Legal Med; 9: 100–104 and Burton JL. A bite into the history of the autopsy (2005) Forensic Science, Medicine, and Pathology; 1: 277–284.
- 12.
Judge-Kronis L. et al. (2016) Consent for paediatric and perinatal postmortem investigations: Implications of less invasive autopsy, “Journal of Forensic Radiology and Imaging”, 4: 7–11, 7.
- 13.
Beauchamp TL, Childress JF (2001), Principles of Biomedical Ethics, fifth ed. Oxford University Press, Oxford.
- 14.
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Sciences (1978), The Belmont Report. Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Dhew Publication No. (OS) 78-0012, Washington.
- 15.
Stawicki PS, Aggrawal A, Dean AJ et al. Postmortem use of advanced imaging techniques: Is autopsy going digital?: 19.
- 16.
About this topic, beyond postmortem examination, see the drammatic case of Child B in the United Kingdom, where it was denied experimental therapy for leukaemia, arguing that it was too expensive and of untested efficacy. See Ham C (1999) Tragic choices in health care: lessons from the Child B case, “British Medical Journal” 319: 1258–1261.
- 17.
Kumar P, Taxy J, Angst DB, Mangurten HH (1998) Autopsies in children: Are they still useful? Arch Pediatr Adolesc Med 152:558–563.
- 18.
Judge-Kronis L. et al., 7.
Further Reading
Beauchamp TL, Childress JF (2001) Principles of biomedical ethics, 5th edn. Oxford University Press, Oxford
Burton JL (2005) A bite into the history of the autopsy. Forensic Sci Med Pathol 1:277–284
Ciaffi R, Gibelli D, Cattaneo C (2011) Forensic radiology and personal identification of unidentified bodies: a review. Radiol Med 116(6):960–968
Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) Virtopsy: minimally invasive, imaging guided virtual autopsy. Radiographics 26:1305–1333
Ham C (1999) Tragic choices in health care: lessons from the Child B case. Br Med J 319:1258–1261
Hayakawa M, Yamamoto S, Motani H, Yajima D, Sato Y, Iwase H (2006) Does imaging technology overcome problems of conventional postmortem examination? A trial of computed tomography imaging for postmortem examination. Int J Legal Med 120:24–26
Illich I (1974) The political uses of natural death. Hastings Center Stud 2(1):3–20
Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FR, Reijnders UJ, Zuidema WP (2015) Post-mortem imaging compared with autopsy in trauma victims—a systematic review. Forensic Sci Int 257:29–48
Judge-Kronis L et al (2016) Consent for paediatric and perinatal postmortem investigations: implications of less invasive autopsy. J Forensic Radiol Imaging 4:7–11
Kumar P, Taxy J, Angst DB, Mangurten HH (1998) Autopsies in children: are they still useful? Arch Pediatr Adolesc Med 152:558–563
Loughrey MB, McCluggage WG, Toner PG (2000) The declining autopsy rate and clinicians’ attitudes. Ulster Med J 69:83–89
Oyake Y, Aoki T, Shiotani S, Kohno M, Ohashi N, Akutsu H, Yamazaki K (2006) Postmortem computed tomography for detecting causes of sudden death in infants and children: retrospective review of cases. Radiat Med 24:493–502
Quigley CH (1996) The corpse. A history. McFarland, Jefferson-London
Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of postmortem histology: a meta-analysis and review. Histopathology 47:551–559
Serraino S, Scopellitti L et al (2016) Ruolo dell’imaging TC nella valutazione post-mortem dei soggetti deceduti per caduta da altezze elevate: nostra esperienza. G Ital Radiol Med 3:58–64
Sesta L, Argo A (2018) Damnatio memoriae? Migranti, giustizia e medicina legale. Riv Ital Med Leg 2:869–879
Stawicki SP, Gracias VH, Schrag SP, Martin ND, Dean AJ, Hoey BA (2008) The dead continue to teach the living: examining the role of computed tomography and magnetic resonance imaging in the setting of postmortem examinations. J Surg Educ 65:200–205
Stawicki PS, Aggrawal A, Dean AJ et al (2008) Postmortem use of advanced imaging techniques: is autopsy going digital? Scientist 2(4):17–26
Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, Dirnhofer R (2007) Virtopsy—the Swiss virtual autopsy approach. Legal Med 9:100–104
The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Sciences (1978) The Belmont Report. Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Dhew Publication No. (OS) 78-0012, Washington
Underwood J (2012) Post-mortem imaging and autopsy: rivals or allies? Lancet 379:100–102
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Sesta, L. (2020). Bioethical Aspects of Postmortem Imaging. In: Lo Re, G., Argo, A., Midiri, M., Cattaneo, C. (eds) Radiology in Forensic Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-96737-0_29
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