Concerns about falling autopsy rates have given rise to new
autopsy legislation in Norway.
G. Cecilie Alfsen1*, Peer Kåre Lilleng2, Sonja Eriksson Steigen3, Christian Lycke Ellingsen4.
Departments of Pathology at the University Hospitals in Akershus1, Bergen2, Tromsø3, 4Norwegian Institute of Public Health,
*Faculty of Medicine, University of Oslo.
Autopsy rates (%) hospital deaths: http://data.euro.who.int/hfadb/
EU members since 2004
Nordic
countries
EU members before 2004
Autopsy rates (%) hospital deaths: http://data.euro.who.int/hfadb/
Denmark
Finland
Norway
Sweden
Suicides, poisoning and forensic autopsy rates in Norway
800
Decreasing suicide rates or
simply lack of investigation?
700
600
Antall
500
Suicides
Acute poisoning
400
Forensic
autopsies/10
300
200
100
0
Years 1980 -2008
www. ssb.no and http://legeforeningen.no/Fagmed/Den-norske-patologforening/
Influence of autopsies on cause of death statistics
+7%
incidence rate
45 %
of individuals
transferred
+2,1 %
incidence rate
30 %
of individuals
transferred
Tidsskr Nor Legeforen 2012; 132:147 – 51
Regulation of medical autopsies in Norway
Alder Hey
1999
1973
«Law on Transplantation and
hospital autopsies».
• Presumed consent.
2004
New regulations.
• Informed, oral consent
2016
Until 2016: a law of «hospital autopsies»
Place of death
100
primary
health
care
50
Hospital
0
1973
2014
http://statistikk.fhi.no/dar/
Regulation of medical autopsies in Norway
Alder Hey
1999
1973
2004
«Law on Transplantation and
hospital autopsies».
• Presumed consent.
• Only for medical reasons
2016
New regulations:
• Informed, oral consent
New medical autopsy law.
• Informed, oral consent.
• Wide ranging introduction
• A duty to assess the need for an autopsy
in all deaths
and to document the assessment
https://lovdata.no/dokument/NL/lov/2015-05-07-26?q=obduksjonslova
The new Norwegian autopsy law from 2016:
§ 1. The purpose of the law is to:
a) contribute to the performance of autopsies with respect for
the deceased and relatives
b) contribute to a gain of knowledge about death and causes of
death, to ensure reliable reported cause of death in statistics,
and
c) facilitate quality assurance of health and care services, teaching
and furtherment of knowledge.
http://lovdata.no/lov/2015-05-07-26/§1
The new Norwegian autopsy law from 2016:
§ 5. Autopsy request
A medical autopsy can only be requested by a medical doctor.
The doctor that pronounces death shall, if possible, assess
the need for a medical autopsy and document that this
assessment has been made.
The hospital who receives an autopsy request decides if a
medical autopsy can be carried out.
The authorities may regulate the routines for requests.
http://lovdata.no/lov/2015-05-07-26/§5
Norway:
Inhabitants 5.2 millions
40 000 deaths yearly
Autopsies (medical and
forensic) at 18 units
All medical autopsies are
within the public health
system.
All costs are covered,
including transport.
Conclusion
Falling autopsy rates have become a political issue in Norway.
New Norwegian autopsy legislation is meant to facilitate
quality control in health care and public statistics.
A duty to assess the need for autopsy in all deaths,
regardless of place of death, will hopefully contribute to an
increase of autopsy rates.
We look forward to present the resulting increase
of autopsy rates in Norway in not too many years.
We have got the tools!
Thank you for your attention!
[email protected]