The inevitability of death used to be followed by an almost certain medical ritual: the autopsy. Today, though, fewer than one in 10 deaths in the U.S. results in an autopsy, the Los Angeles Times reports.

Cost is a barrier. An autopsy can cost thousands of dollars and isn’t covered by most insurers or Medicare, the paper writes. Many doctors also think that autopsies aren’t as important anymore because of all the whizbang technology, such as MRI scans, that supposedly tells them what’s wrong with someone before trail’s end.

But we may be missing out by not having as many postmortems. “The scientific, educational, and public health benefits of the autopsy, though generally acknowledged, remain difficult to quantify. However, autopsy plays a demonstrably important role in confirming or overturning diagnoses entertained by treating physicians,” said a paper titled “The Vanishing Nonforensic Autopsy” in the New England Journal of Medicine in February. (See the decline in autopsy rates in the chart at right from the paper.)

One of its co-authors, Kaveh Shojania, of the Ottawa Health Research Institute, told the Times: “Autopsies could reveal that, unbeknownst to practitioners, a certain disease presents differently than people think.” Take, for instance, a tear in the artery mistaken for a heart attack.

Shojania and his co-author acknowledge that it’s not financially feasible to reverse the decline in autopsies. Small increases in autopsy rates at individual hospitals wouldn’t do much to advance medicine either. Other options might be the creation of regional autopsy centers or the use of minimally invasive techniques that would be easier and faster, though limited compared with full necropsies.

Most autopsies today are performed at the order of the local coroner or medical examiner. Unexplained deaths or deaths during surgery are two reasons an autopsy might be required, the Times writes.

For families searching for answers, the Times mentions another option: 1-800-Autopsy, a private company that specializes in autopsy services.

Chart from the New England Journal of Medicine

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