At the limits of patient autonomy: an ethical re-evaluation of coroner's postmortems

Patient autonomy is one of the four pillars of modern medical ethics. In some cases, however, its value is not absolute and autonomy may be overridden by sufficiently important matters of public interest. Coroner's autopsies represent an example of when the wishes of the deceased and their family may come in conflict with the benefits of knowledge gained from understanding the cause of death. Current legislation governing coroner's autopsies relies on the assumption of their obvious public benefit, hence consent for them need not be sought. This interpretation has attracted controversy, as exemplified by the case of Rotsztein vs HM Senior Coroner and a recent study questioning the prevalent use of invasive autopsy. However, this issue has received little recent attention in ethical literature. In this essay, the ethical nature of coroner's autopsies in cases of natural deaths with unexplained causes is examined as a balance between patient autonomy and the value of knowledge gained from them. This is done by analysing a case which under current legislation warrants coroner's autopsy, however, its ethical justification remains contentious. This discussion is expanded by discussion of non-invasive alternatives and comparison to another situation which balances individual autonomy with public benefits-organ donation. The conclusion of this analysis is a moral middle ground in which objection to invasive autopsy could be respected once issues of overriding public interest are excluded, or at least non-invasive alternatives should be considered, with coroners left responsible for demonstrating specific public needs that could override objection.