Obtaining informed consent in a rare and fatal disease at ED: Medical practice versus perception of family

Cardiac tamponade with acute type A aortic dissection is a rare and fatal duo of a real emergency [1]. Clinical post-mortem could provide a definitive diagnosis in fatal cases, but the issue of refusal of consent is faced in Malaysia. Case Report: A 75-year-old man presented with sudden onset of shortness of breath followed by unconsciousness and hypotension. He was resuscitated as a case of cardiac tamponade, but if the diagnosis were cardiac tamponade with aortic dissection, controlled pericardiocentesis would have been performed instead. Although the autopsy was requested, his family members did not give consent. Clinical post-mortem is essential to confirm the definitive diagnosis, improve the management, and for future reference. The benefits and procedures of the autopsy should be explained well to the family members by the physician in obtaining consent.