Declining clinical autopsy rates versus increasing medicolegal autopsy rates in Halifax, Nova Scotia - Why the difference? A historical perspective

The downward trend in the rate of clinical autopsies has been extensively d ocumented in the literature. This decline is of concern when the benefits o f the clinical autopsy are considered. In contrast, the rate of medicolegal autopsies has not been studied in such detail. What little reference there is to medicolegal autopsy rates suggests an absence of the same downward t rend. A retrospective review of autopsy data over a 13-year period from the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, and fro m the Office of the chief Medical Examiner of Nova Scotia was conducted. Th is review showed a difference between the rates of clinical and medicolegal autopsies for the metro Halifax area. The clinical autopsy rate was consis tently less than 30% and declined to 15% in 1999, while the medicolegal aut opsy rate was consistently greater than 40% and rose to 62% in 1999. The li terature proposes many reasons for the decline in the clinical autopsy rate , but none for this difference between rates. The explanation proposed here is the changing and currently uncertain purpose of the clinical autopsy ve rsus the clear, and consistent over time, purpose of the medicolegal autops y.