The next-of-kin will need to be involved in decisions about autopsy. If the doctor or nurse says there is no need to notify the medical examiner, or if the medical examiner declines to do an autopsy, the next of kin should still consider having an autopsy done. Autopsies help answer questions about what really happened. They also keep doctors and other caregivers "on their toes," since autopsies can turn up shortcomings that would otherwise have been unknown.
The body after an autopsy still looks normal and can be shown in an open casket if that is the family's wish. If the person died in a hospital, an autopsy is usually free. If the person died in a nursing home or at home, the situation is more complex. Sometimes the doctor can arrange for a free autopsy, sometimes there is a fee (of up to a few thousand dollars, which the family must pay), and sometimes one just cannot find a way to get an autopsy. Obviously, this situation is complicated enough to warrant having considered it in advance whenever possible, especially for deaths at home.
If the death is sudden or unexpected or just at home, the medical examiner must be notified in order to make a determination about whether there will be a required autopsy. Family members have very little authority to stop public officials who want an autopsy because they are concerned with public safety.
People also do not realize that it often takes two months after the death to complete an autopsy. A preliminary set of findings is available shortly after the body leaves the morgue, but much turns on making microscopic examination of various tissues, and that takes more than a month. Often, family members have to remind the doctor or pathologist that the family wants the autopsy results. Sometimes, the best way to get them is to set a meeting time specifically for this purpose. Even when done with great sensitivity, this will be a little cold and jarring, so it might be wise to bring along a trusted friend or counselor.
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