Arch Pathol Lab Med—Vol 124, May 2000 Declining Autopsy Rate in France—Chariot et al 739 Editorial Consortium Declining Autopsy Rate in a French Hospital Physicians’ Attitudes to the Autopsy and Use of Autopsy Material in Research Publications Patrick Chariot, MD; Karine Witt, MD;Vivien Pautot, MSc; Raphae ¨l Porcher, PhD; Guy Thomas, MD; Elie Serge Zafrani, MD; Franc ¸ois Lemaire, MD ● Context.—Autopsy rates have been declining throughout the world, although preservation of the autopsy is consid- ered a fundamental principle of medical care. In France, the 1994 bioethics law requires physicians to inform rela- tives before performing an autopsy. Objective.—To analyze the following factors that poten- tially influence hospital autopsy rates: legal constraints, au- topsy reporting times, opinions of physicians requesting autopsies and pathologists regarding the usefulness of au- topsy in patient care, and use of autopsy material in re- search publications. Design.—Record of the annual numbers of deaths and autopsies during a 10-year period (1988–1997). Record of the delays for transmission of final autopsy report to the requesting physician. Questionnaire analyzing the possible factors influencing autopsy rate. Categorization of articles published by pathologists according to the use of autopsy material. Setting.—A 1000-bed, university teaching hospital in the Paris, France, area. Participants.—Questionnaire addressed to physicians, head nurses, and mortuary staff. Results.—A total of 1454 autopsies were reviewed. The autopsy rate declined from 15.4% in 1988 to 3.7% in 1997. This decline was marked after 1994 and tended to be slower for neurologic indications than for other indi- cations. The final report had not been communicated with- in 180 days in 620 (42.6%) of 1454 autopsies. Fifty-five of 105 respondents considered that the bioethics law was one cause of the recent decrease of autopsy rate. Considering the contribution of autopsy to medical research, 94 (81%) of 116 articles dealing with central nervous system but only 28 (6%) of 464 articles dealing with other organs used autopsy-derived material. Conclusions.—The 1994 bioethics law seems to contrib- ute to the decline of autopsy. Inadequate delays for com- municating autopsy results are frequent. Except for neu- ropathologists, autopsy is a minor source of research ma- terial. (Arch Pathol Lab Med. 2000;124:739–745) A utopsy rates have been declining throughout the world during the last 30 years. 1–3 Numerous reasons have been suggested. Some physicians hesitate to ask for the relatives’ consent or fear that the autopsy would reveal misdiagnosis. 4,5 Most pathologists became reluctant to per- form autopsies for fear of an infectious risk and because they feel that many autopsies are unuseful, considering modern diagnostic technologies. 4,6,7 Inadequate delays in communication of autopsy results by pathologists may take part in the decline of autopsy rates. 8,9 Whether long autopsy reporting times are the rule or the exception has been seldom studied. 2,10 In France, one additional factor might be the recent change in the law governing autopsy permits. 11 Before 1994, autopsy could be performed with- out informing the family, except if it had been formally Accepted for publication November 30, 1999. From the Unit of Legal Medicine (Drs Chariot and Witt and Mr Pau- tot) and the Departments of Pathology (Dr Zafrani) and Intensive Care Medicine (Dr Lemaire), Ho ˆpital Henri-Mondor, Creteil; Faculte ´ de Me ´- decine de Cre ´teil, Universite ´ Paris, Creteil (Dr Chariot); Unit of Biosta- tistics (Drs Porcher and Thomas) and the Unit of Legal Medicine (Dr Thomas), Faculte ´ de Me ´decine Saint-Antoine, Paris, France. Reprints: Patrick Chariot, MD, Me ´decine le ´gale, Ho ˆ pital Henri-Mon- dor, 94010 Cre ´teil, France (e-mail: pchariot@cybercable.fr). refused by the patient before death or by relatives after death. Since the 1994 bioethics law, 12 physicians must in- form relatives that ‘‘postmortem samples are taken,’’ which implies that they have to inform the relatives of their intention to perform an autopsy and ask if the patient had refused autopsy. Practically speaking, the relatives’ consent is now needed to perform an autopsy. 13 Preservation of autopsy is often claimed a fundamental principle of medical care and quality control in medi- cine. 14,15 The still persisting high discordance rate between clinical and autopsy diagnoses is also given as confirming the value of postmortem examination by its defenders. 16–19 These defenders also claim that autopsy is a valuable tool for detection and evaluation of emerging diseases. 15,20 Medical research could be an additional incentive to per- form autopsies, 1,8,21 but only limited quantitative informa- tion is available on the contribution of autopsy findings to medical research. One study indicated that the proportion of autopsy-based research papers increased between 1966 and 1993. 1 In brain pathology, where biopsy is a minor source of pathological material, a higher contribution of autopsy findings to medical research could be expected but has not been determined. 1 Studies conducted about autopsy usually address either