A survey was undertaken of all hospitals with more than 400 beds in North East Thames Region to ascertain the way in which permission for an autopsy was obtained, in an attempt to explore reasons for declining autopsy rates. We found that there was a considerable variation in autopsy rates, and in the systems within hospitals whereby permission for autopsy is sought. The responsibility for requesting an autopsy is often delegated to younger doctors who have not received any training in how it should be done. A sensitive lay person can achieve high rates of permission for autopsy. Most consultants interviewed stated that they requested less autopsies now than 5 or 10 years ago. They seldom attended autopsies, and one-third of pathologists have given up contacting the clinician before an autopsy.