ReviewThe EndWiles, Austin B. MDAuthor Information From the Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA. Reprints: Austin B. Wiles, MD, Department of Pathology, Virginia Commonwealth University Health System, PO Box 980662, 1101 E Marshall St, Richmond, VA 23298. E-mail: [email protected]. The author has no funding or conflicts to declare. AJSP: Reviews & Reports: 3/4 2021 - Volume 26 - Issue 2 - p 145-151 doi: 10.1097/PCR.0000000000000440 Buy Metrics Abstract Arguments in defense of the medical autopsy tend to be grounded in quantitative ideas of utility. As such, these defenses limit their techniques and core concepts to the same principles that ground the practice of contemporary medicine. While this tactic seems reasonable, as arguments should always be cognizant of the context for which they are intended, the practice of medical autopsy continues to decline. The conceptual framework of the practice of medicine itself plays a role in the decline of the autopsy. It is difficult to imagine stopping or reversing the effacement of the medical autopsy without overcoming this framework. This review examines the genealogy of arguments about the importance of medical autopsy and develops some new conceptual tools to defend it. Three related notions are explored. Each of these goes beyond the customary, and often unexamined, types of argumentation in contemporary medicine. This review seeks to answer the question: What if the autopsy was gone? What would an autopsy of the practice of autopsy itself reveal? Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.