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Is Systematic Neuropathological Examination of the Whole Brain Ethically and Scientifically Licit in Forensic Context?

Charlier P, Cavard, Veneau, Gray, Chrétien, Hervé, Lorin de la Grandmaison G

To date, the whole brain is classically freshly examined during the autopsy, and can be removed in entirety in order to perform a complementary neuropathological examination. Is-it legitimate to bury a corpse without the brain – this symbolic organ – in order to satisfy the physician’s curiosity and/or the scientific necessity? Indeed, brain is an organ with a strong symbolic signification. In order to estimate the accuracy of such post-mortem neuropathological examination of the whole brain, a brief survey was carried out in the Department of Pathology and Forensic Medicine of the R. Poincaré University Hospital (West Paris, France) between 2009 and 2011. On a total of 32 brains (=13.4%) removed on a total of 238 autopsies of adult individuals (in a good state of preservation, without exteriorization of the intra-cranial structures) and get full analysis by a neuropathologist, the final diagnostic of the cause of death given at the end of the autopsy was never changed. However, circumstances of death has been modified and/or completed in almost 62.5% of the cases (n=20). Our hypothesis is that post-mortem examination of the whole brain is scientifically legitimate, but not from a purely ethical point of view. Several practical solutions can be proposed in order not to deprive a human dead body from one of its most symbolic organs (but their efficacy facing neuropathology has to be tested). Indeed, behind this case of full brain sampling is the problem of the introduction of emotions and cultural visions that we have about internal organs; this global problem for all physicians could change their current practice when confronted to the death of their patients.