Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Further scope for evidence review
- Irene J Higginson, Elizabeth Davies, Agis Tsouros (28 May 2007)
-
Technology and Death: The Virtual Postmortem Examination
- Shaheen E Lakhan (28 May 2007)
|
|
|||
|
Irene J Higginson, Professor KIng's College London, Elizabeth Davies, Agis Tsouros
Send e-letter to journal:
|
We thank Shaheen E Lakhan for pointing out the need to consider the experiences of carers and relatives whose loved ones die suddenly and violently or who need to undergo autopsy. The experience of these individuals have perhaps been less often studied and research so far has focused on the experience of carers and relatives throughout a final illness. This research has emphasised the importance of a good symptom control, communication and co-ordinated services and support to both patient and relative. A common theme that emerges from these studies is the importance of the sense that a patient was well looked after and did not suffer unnecessarily. We do not claim to be experts in the forensic issues involved or in the details of autopsy by imaging. We would suggest that the evidence based on its use should be reviewed in order that it is clear that it does provide definitive answers to the questions that carers and relatives very often have following a sudden death Conflict of Interest:None declared |
|||
|
|
|||
|
Shaheen E Lakhan, Executive Director Los Angeles, CA 91412, USA
Send e-letter to journal:
|
Higginson and her colleagues [1] present three pressing needs for palliative care: awareness, political commitment, and standardized systems. Although her analysis ends with public reporting on the quality of a death, the dying process (and its potential integration with technology) does not stop there. This letter discusses measures to perform noninvasive postmortem investigations to advance the field of forensic medicine and ultimately improve the quality of care for both the family and patient (yes, even after death). Interviews with surviving family members of autopsied patients demonstrate a multitude of specific concerns, ranging from disturbed post- autopsy appearance to detached limbs and fluid leakage.[2] Also, the family may be concerned with timing, for instance, when religious law constrains burial or cremation timelines. Moreover, parents often experience troubling ethical quandaries after the death of an infant.[3] A new modality has surfaced--full-body virtual autopsies--that may alleviate these concerns. Virtual autopsies utilize either computed tomography (CT) or magnetic resonance (MR) imaging modalities to create 2D or 3D maps.[4] The operator can analyze many pathologies, including emboli, bone fractures, and internal bleeding. Given that the data generated can be in the gigabyte range, protocols in real-time, CT scanning acquisition; storage; and processing are being optimized for clinical use.[5] Remarkably, these utilizations may offer "virtual histology" or high-resolution imaging as an alternative to conventional histology in forensic wound analysis.[6] Followers of many world religions aim to keep their bodies intact until they undergo a reunification process, for instance, as the physical body and gross mind reunite with the Earth during the final act of cremation in a Hindu funeral ceremony. Some traditional Hindus believe an incomplete or even disturbed body--as in the case of a traditional postmortem exam--remains in a "state of animation" and that family members consequently assume a karmic burden. Thus, the virtual autopsy can benefit not only the medical practitioner and surviving family members, but also the deceased patient. As Higginson and her colleagues [1] envision a future where family members of dying patients are provided with palliative care services regardless of their socio-economic status, I see the prospect of a family that is assured its loved one's body will be examined in a noninvasive manner in an effort to reveal the patient's pathology and cause of death. By providing culturally appropriate care without compromising medical investigation, this modality offers harmony among the patient, family, provider, and public interests. Acknowledgement The author wishes to thank the members of New World Editing for their contributions and services. References 1. Irene J Higginson1, Elizabeth Davies2 and Agis D Tsouros3. (2007) The end of life: unknown and unplanned? European Journal of Public Health. doi:10.1093/eurpub/ckm003 2. Oppewal F and Meyboom-de Jong B. (2001) Family members' experiences of autopsy. Family Practice 18:304–308. 3. Downie RS. (2003)Research on dead infants. Theoretical Medicine and Bioethics 24(2):161-75. 4. Ljung P, Winskog C, Persson A, Lundstrom C, and Ynnerman A. (2006) Full body virtual autopsies using a state-of-the-art volume rendering pipeline. IEEE Transactions on Visualization and Computer Graphics 12(5):869-76. 5. Thali MJ, Jackowski C, Oesterhelweg L, Ross SG, and Dirnhofer R. (2007) VIRTOPSY - the Swiss virtual autopsy approach. Legal medicine (Tokyo, Japan) 9(2):100-4. 6. Thali MJ, Dirnhofer R, Becker R, Oliver W, and Potter K. (2004) Is 'virtual histology' the next step after the 'virtual autopsy'? Magnetic resonance microscopy in forensic medicine. Magnetic Resonance Imaging 22(8):1131-8. Conflict of Interest:None declared |
|||