Arch Pathol Lab Med—Vol 124, October 2000 Medical Examiner Autopsies for Research and Education—Roberts et al 1485 Editorial Consortium Perceptions of the Ethical Acceptability of Using Medical Examiner Autopsies for Research and Education A Survey of Forensic Pathologists Laura Weiss Roberts, MD; Kurt B. Nolte, MD;Teddy D. Warner, PhD;Teresita McCarty, MD; Lizabeth Stolz Rosenbaum, BA; Ross Zumwalt, MD ● Background.—Forensic pathologists face difficult moral questions in their practices each day. Consistent ethical and legal guidelines for autopsy tissue use extending be- yond usual clinical and legal imperatives have not been developed in this country. Objective.—To obtain the perceptions of medical ex- aminers regarding the ethical acceptability of autopsy tis- sue use for research and education. Method.—A written, self-report questionnaire was de- veloped and piloted by a multidisciplinary team at the Uni- versity of New Mexico, Albuquerque. All individuals who attended a platform presentation at the National Associa- tion of Medical Examiners Annual Meeting in September 1997 were invited to participate. Results.—Ninety-one individuals completed the survey (40% of all conference registrants and approximately 75% of presentation attendees). Sixty-three percent of respon- dents had encountered an ethical dilemma surrounding au- topsy tissue use, and one third reported some professional ethics experience. Perspectives varied greatly concerning the ethical acceptability of using autopsy tissues to dem- onstrate or practice techniques (eg, intubation, brachial plexus dissection) and of fulfilling requests to supply vary- ing kinds and quantities of tissues for research and edu- cation. Most respondents indicated that consent by family members was important in tissue use decisions. Respon- dents agreed on the importance of basic values in educa- tion and research, such as integrity, scientific or educa- tional merit, and formal institutional approval of a project. Characteristics of the decedent did not influence decisions to release tissues, except when the individual had died from a mysterious or very rare illness. Attributes of medical examiners, with the exception of sex, also did not consis- tently predict responses. Conclusion.—Significant diversity exists in beliefs among medical examiners regarding perceptions of the appropri- ate use of autopsy tissues for education and research.There is need for further inquiry and dialogue so that enduring policy solutions regarding human tissue use for education and research may be developed. (Arch Pathol Lab Med. 2000;124:1485–1495) T he autopsy has long been a focus of medical education and biomedical research. Generations of physicians have learned anatomy, pathology, and pathophysiology at the autopsy table. Furthermore, autopsy tissues have been used to help identify new diseases, to clarify the mecha- nisms and patterns of illness, to explore treatments that may ameliorate suffering, and to trigger and sustain ad- vances throughout the basic sciences. 1–5 Despite this long tradition of cadaveric tissue use, there has been an 80% decline in the rate of hospital autopsies during the past 50 years. 3–10 Consequently, cadaveric tissues used in med- ical education and research increasingly derive from med- icolegal autopsies performed by forensic pathologists. 8 The ethical acceptability of using medicolegal autopsies Accepted for publication April 19, 2000. From the Department of Psychiatry, University of New Mexico School of Medicine (Drs Roberts, Warner, and McCarty and Ms Ro- senbaum), Office of the Medical Investigator, University of New Mex- ico School of Medicine (Drs Nolte and Zumwalt), and Consultation Psychiatry, University Hospital (Dr McCarty), Albuquerque, NM. Reprints: Laura Weiss Roberts, Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, Albuquerque, NM 87131 (e-mail: lroberts@salud.unm.edu). for education and research is complex. This is because such autopsies are performed in compliance with legal im- peratives that supersede ethical safeguards present in practice standards for hospital autopsies and other areas of clinical medical practice. 8,11–14 For instance, the concept of privacy refers to the belief that there is an area of per- sonal life, encompassing both body and mind, that should be respected and free of intrusion. 12 This ideal gives rise to the physician’s duty to preserve patient confidentiality (ie, to not disclose patient information without permission) to the extent allowed by law. 14 When a death occurs under circumstances that mandate a medicolegal autopsy (eg, deaths due to violence or suicide), the purpose of the au- topsy is to determine the condition of the body and the precise cause and manner of death. In compliance with legal statutes, this information is then documented and formally reported and may be accessible to all interested individuals. 1,15–17 In the context of the medicolegal autopsy, exceptions to preserving confidentiality have been seen as necessary and defensible, if regrettable, for the immediate good of society. Similarly, informed consent is a philo- sophical and legal doctrine that requires that individuals truly understand and freely make choices about ‘‘intru-