The Faculty of Pathology of the Royal College of Physicians in Ireland has issued new guidelines to hospitals and pathologists following the recent controversies surrounding post-mortem practices.
Publication of the guidelines comes as hospitals throughout the State check records to see if human tissue samples were given to pharmaceutical companies. This follows confirmation that pituitary gland tissue from Our Lady's Hospital for Sick Children was used to manufacture growth hormone for the treatment of short stature. This practice ceased in 1985.
The guidelines include a new post-mortem consent form which specifically addresses issues such as the retention of tissue for educational and research purposes. It also allows families to limit the extent of a non-coroner's autopsy to specific areas of the body.
Included in the document is a recommendation that written information on post-mortems be made available to relatives. This will include information regarding the legal and practical arrangements of both autopsy and the subsequent disposition of retained organs.
In a novel development for the health services, the guidelines propose a post of "designated bereavement officer". Such a person will be trained to discuss issues of consent with bereaved relatives. Post-mortem requests will continue to be made by senior medical and nursing staff involved in the care of the deceased patient. The previous practice of delegating these duties to junior members of staff will no longer be acceptable.
The new code of practice directs that families who wish to delay funeral services to allow retained organs to be returned to the body should be accommodated. Referring to the practice of earlier burial in Ireland, the Pathology Faculty says that a different approach to organ retention had developed here compared to Britain, where burial is traditionally carried out at a later stage.
Tissue and organs retained here "have usually been disposed of within three to six months by incineration, but in some instances for various reasons have been kept much longer," it says.
The guidelines draw heavily on current practice as recommended by the American College of Pathologists and the Royal College of Pathologists (RCPath). They acknowledge the lead role of the UK college in drawing up recommendations following the Bristol inquiry. "Most of the RCPath discussions are relevant to Ireland, with the exception of the sections in relation to organ retention," the document notes.
It directs that where families express no wish to reclaim organs, "a sensitive acceptable arrangement should be put in place by the hospital, for instance, cremation, burial in a suitable plot or incineration.
In a section entitled "Next of Kin", the guidelines state "medical staff seeking consent should satisfy themselves that no closer relatives (who may therefore have a superior right over the disposition of the body) exist. Similarly, they should be satisfied that the patient had not made a living will specifically precluding a post-mortem examination. The pathologist should be directly informed of any disputes that may have arisen between relatives regarding the performance or extent of a post-mortem examination."
The reference to living wills is a significant development.
A consultant pathologist has confirmed to The Irish Times that following the Our Lady's Hospital revelations, relatives are no longer giving permission for discretionary post-mortem examination. He indicated that the new guidelines were aimed at reversing this trend, as well as reflecting the Faculty of Pathologists' concern over the distress that recent events have caused.
Noting that the guidelines are interim ones, he said they would be revised to take into account the reaction of lay people. The faculty also said it would welcome a public inquiry into the benefits and practice of autopsy in Ireland.