Citation

Shuster S. Lancet 2024; 403(10425): e436.

Copyright

(Copyright © 2024, Elsevier Publishing)

DOI

10.1016/S0140-6736(23)02281-X

PMID

38309777

Abstract

Explanations as to how the Letby murders continued undetected have mostly settled on administrative neglect of suspicion,1, 2 although the absence of autopsy reports was ignored. Failure to do autopsies was the error that allowed the Letby murders to continue; had they been done, it would have been shown that there were no obvious causes of death, and further pathological and police investigations would have exposed them as murders. There will be explanations of this omission, but there can be no excuse.

As long as prediction of murderous intent remains impossible, the only protection (excluding the absurdity of draconian surveillance) is early detection. Correcting the failure to do autopsies for unexplained deaths—as revealed by the Letby murders—is important, but perhaps more so is reversing the change in clinical practice that allowed the omission. Since the early 2000s, autopsy has mostly been done on television thrillers; between the 1950s and 1980s, hospital autopsies were a daily event.3 Presentation of clinical findings was followed by autopsies, and the lessons to be learnt from their differences were discussed. Relatives gave permission when the continuous need to learn was explained but, sadly, this educative and investigatory function has been lost: autopsy frequency decreased from 30–40% of hospital admissions in the past century, to just a few percent now...

Language: en