The Public Autopsy: Somewhere Basis for the Action

576 TEACHING AND LEARNING ETHICS J Med Ethics: first published as 10.1136/jme.2003.003079 on 30 November 2004. Downloaded from Public autopsy Hagens and the ambulance driver, the ...... action was carried out by a qualified practitioner and, seemingly, for worth- while reasons, even if there was no legal The public autopsy: somewhere basis for the action. Moreover, each case presented new, challenging questions between art, education, and for the way in which legislation is structured in medicine. For the case of entertainment the speeding ambulance driver, it involved what counts as the legitimate A Miah exercising of an ambulance driver’s responsibilities. For the public autopsy, ...... the matter involves what counts as a legitimate execution of a medical proce- While another von Hagens style public autopsy should not be dure. Both examples involve question- encouraged, the public should nevertheless be able to experience ing the relationship between people and such events as a public autopsy. medicine. Beyond the legal concerns, commentators have been preoccupied with the uring 2002 and 2003 there was 2002, in front of a randomly picked (but moral and ethical controversy surround- considerable discussion about the paying) audience. Later that same night, ing the use of a human cadaver in what work of Gunter von Hagens, one of the UK’s five terrestrial television D 1 appears to have been, for many, merely famed for his Body Worlds exhibition, channels, Channel 4, broadcast an edi- a public spectacle. Yet a number of these which was publicised extensively and ted, documentary style version of the moral and ethical issues concerning the with considerable success. The exhibi- event in the UK, after having first made autopsy have become conflated in the tion is a tribute to, and celebration of, headline news on both BBC1 and ITV. analyses, and questions remain about his method of preserving organic life All discussions concerning this event, whether such an activity should have through the process of plastination, procedure, performance, or whatever it been allowed to take place at all. developed by von Hagens in the 1980s. should be called, have been controver- A further approach, which I will not The process entails a form of preserva- sial. Even before the autopsy began, von address in this paper, is whether the tion, whereby body parts (mainly Hagens’s integrity was in question, importance of public autopsy has some- human) are dehydrated and filled with because it was not clear whether he thing to do with the role of ‘‘autopsies’’ polymer resin, making them more had a UK licence to perform the specifically. For some commentators, robust than conventional formaldehyde autopsy. Thus, the event needed to take the public autopsy was important pre- does. place in secret because of its ambiguous cisely because consent to autopsies is in While it was in the United Kingdom, legal status. As a result there could be decline and because this decline has the exhibit was housed at a back street no advance publicity, since this would something to do with people feeling gallery in Brick Lane, London, though have alerted the authorities much ear- afraid and distrustful of how deceased the exhibition has toured throughout lier, in which case they might have been loved ones are treated.34While this is a the world. Despite many millions having able to halt the entire event. As it was, valid concern, I suggest that this is not http://jme.bmj.com/ flocked to see the exhibition, the rea- officials did decide, eventually to allow the most relevant feature of the public sons for its success are open to inter- it to take place. In spite of the low level autopsy. Rather, I argue that the con- pretation and have provoked strong of advance publicity, the event made troversy concerning the autopsy speaks opinions from the medical community headlines on major TV channels just more broadly to the way in which as to whether this physician ought to be hours before it began. Simply on the people make sense of medicine. entitled to create exhibits from real basis of the legal ambiguity of the event, Nevertheless, my approach does not bodies. Von Hagens (and others) would it is possible to conclude that von neglect the concerns about autopsies argue that these works are justifiable Hagens did not act ethically, though specifically. on September 26, 2021 by guest. Protected copyright. because they have artistic merit. Others this seems a relatively weak point at In this paper, I attempt to address a would claim that viewers are being which to conclude the ethical inquiry. number of criticisms about the public brought to the gallery by the immense There are far richer discussions to be autopsy. My analysis has two related publicity. Alternatively, one might sup- had, which are to do with ethics, and aims. The first is to consider the way in pose that those who attend the exhibi- which are over and above the legal which ethics has been ‘‘mediated’’, tion do so mainly because of a questions involved. Indeed, it is mis- using the public autopsy, and to discuss fascination with the extraordinary and leading to suggest that the ethical the importance of the media in repre- with the grotesque. Indeed, such fasci- concerns were solely or even largely senting and creating ethical issues. This nation with death, and human remains about the legality of the issue. evaluation will derive from an analysis specifically, was the focus of a meeting Nevertheless, it is not possible to of how Channel 4 chose to frame the hosted by the Institute of Ideas and the dismiss the legal argument, although it moral controversy concerning the Royal College of Physicians in May is similar to the recent controversy autopsy. The second aim is to evaluate 2003, which was entitled Morbid concerning the ambulance driver in the the value of the public autopsy as an Fascinations: the Body and Death in United Kingdom who was charged by opportunity to explore the role of Contemporary Culture. the police with speeding while deliver- medicine in society and to advocate a The controversy arising from the Body ing a human organ to a hospital in a more socially sensitive approach to Worlds exhibition pales in comparison, civilian vehicle.2 This incident has cre- bioethics. This latter aim draws upon however, to von Hagens’s most recent ated a significant confusion in the UK as the conceptual potential of the public performance—the first ‘‘public autopsy’’ regards the legal definition of an ambu- autopsy to provoke a meaningful, com- in Britain for nearly 200 years. It took lance and what counts as legitimate plex, and interesting engagement with place on the evening of 20 November speeding. In the cases of both von concepts of life, death, and medicine,

www.jmedethics.com TEACHING AND LEARNING ETHICS 577 J Med Ethics: first published as 10.1136/jme.2003.003079 on 30 November 2004. Downloaded from which are tied to cultural identity. On the public autopsy took place, Dr a manner that was medically profes- this basis, I argue that a sociobioethical Richard Bryan gave a ‘‘rapid response’’ sional or whether the cadaver consented approach to ethics would provide a use- in the BMJ expressing his disapproval.5 to be dissected for such purposes. ful mechanism for coming to terms with Referring to Andreas Vesalius, the 16th Rather, it involves taking into account the potential value of the public autopsy century anatomist, Bryan mistakenly other ethical and cultural arguments, specifically, and of bringing medicine assumes that there are direct and clear such as the importance of placing people closer to people more generally. comparisons to be made between the in a position where they can engage two physicians by virtue of Hagens’s with notions of life and death. Indeed, one could argue that the value given to HOW TO CRITIQUE A PUBLIC autopsy being public. this procedure by the consenting person AUTOPSY Yet such straightforward analogies reveals something meaningful about the The public autopsy does not lend itself are not appropriate, even if von Hagens role of medicine in society. This decision to a straightforward ethical analysis, referred to his ancestors as a justifica- to permit a public dissection of one’s though to understand the context tion for wearing his trade mark black body seems an integral, rich aspect of within which it took place, it is useful hat throughout the procedure; a choice the informed consent process. to know a little more about Gunter von that angered one of the audience mem- The way in which I will discuss this Hagens. The Body Worlds exhibition is bers, who felt compelled to shout out synergy will be through interpreting the presented as an exhibition which has that it revealed a lack of respect. On the public autopsy as a televisual mediation both artistic and educational merit. For criteria Bryan sets himself for his which was integral to its moral and this reason, the exhibition seems to evaluation of the von Hagens autopsy, ethical evaluation. A further justifica- require that one’s intuitive ethical or his claims are accurate and in accor- tion for framing the ethical debates in moral condemnation of it must be dance with one of Channel 49s inter- the context of the televisual representa- tempered by a willingness to engage viewees during the broadcast, the tion is that the broadcast neatly cap- with more creative and conceptual renowned surgeon, Harold Ellis, who tures a number of these diverse facets of aspirations. Literally, this argument expressed a similar disgust for this the public autopsy and the main tenets requires one to accept a less strict spectacle. The meaning of its ‘‘educative of my critique. adherence to ethical principles in pur- value’’ cannot, however, be so easily suit of some higher beauty. For this taken for granted. reason, the way in which it is possible to This is because the educational rheto- ‘‘EXPERT’’ WITNESSES: DID VON critique the exhibition is unclear and the ric of the public autopsy did not fit with HAGENS ACT PROFESSIONALLY? same kind of argument is also relevant how medicine traditionally understands In documentary style television, it is for the public autopsy. what counts as educational merit. The common to use an expert to comment Conceivably, the autopsy was an public autopsy was not merely trying to on the proceedings, particularly in attempt to critique or demonstrate a show how the anatomy of a human scientific programmes. The public rejection of the strict discourse of being is put together. Rather, it also autopsy broadcast was no exception medical ethics in Western culture. In intended to be instructional at revealing and Channel 4 relied upon opinions particular, the public autopsy can be how inadequately medicine was under- from medical and ethical experts. seen as a rejection of conventional stood by the public. Thus, the public Specifically, these consisted of Michael concerns for human dignity, or at least autopsy was not solely about under- Wilks, chair of the ethics committee of a crisis in understanding precisely what standing how an autopsy functions. It the British Medical Association; Harold is meant by such a term. On this view, was also about educating people about Ellis, emeritus professor of surgery at http://jme.bmj.com/ the autopsy challenged the way in the need to engage with their lives in a the University of London, and Christine which medicine creates boundaries more meaningful sense. In short, it Odone, deputy editor of The New between what is public and private encouraged people to confront their Statesman. The role of these guests was and what counts as a legitimate exercis- mortality and, perhaps, brought people to provide their synopsis of the event, ing of personal autonomy. Unlike the closer to the fragility and contingency of largely offering a moral interpretation of Body Worlds exhibition, however, the their own bodies. In this sense, it is its proceedings. public autopsy avoided the rhetoric of perhaps more important to give value to Despite the legitimate worries about on September 26, 2021 by guest. Protected copyright. an aesthetic component to its value. this event as some form of ‘‘enlight- von Hagens’s legal basis for conducting While Body Worlds is presented as an enment’’ rather than as ‘‘education’’, the public autopsy, one can question exhibition (with a strong educational though this would be a far grander whether perspectives from the medical component), the public autopsy seemed claim, which I will not explore further community were the most useful that premised solely upon its educational here. could have been sought. Not surpris- importance. Consequently, it might This greater context and aspiration for ingly, the reaction from the medical seem that our basis for critique must the public autopsy is why I argue that it experts was not particularly positive. Dr rely upon whether the autopsy achieved must be critiqued using a broader Wilks was concerned about whether the this educative function in any way that synergy between theoretical perspec- performance was, indeed, ‘‘educational’’ justified its public nature. On this tives in medicine, ethics, and cultural in any meaningful sense. Alternatively, argument, the assumption is, that if theory. These three strands of the Professor Ellis perceived the event to be the autopsy failed to promote education, evaluation can be understood more much more of a spectacle than anything then it was little more than a spectacle generically as a ‘‘sociobioethic’’ else and questioned the need to con- and a terrible use of a human cadaver. approach to medical ethics, which, in duct ‘‘real’’ autopsies in order to Even this way of critiquing its this case, asserts that the autopsy educate people, arguing that it is possi- approach is not, however, straightfor- cannot be understood without recognis- ble to convey the same level of under- ward, since the manner in which ‘‘edu- ing broader ‘‘horizons of meaning’’ in standing through audiovisual means. cation’’ is effected by the autopsy does the sense articulated by Charles The only dissenting voice was Chistine not fit with what might commonly be Taylor.67 In the case of the public Odone. Her opinion, however, was mar- assumed by medical practitioners or autopsy, understanding its ethical justi- ginal to the debate and this is precisely medical ethicists to be the way educa- fication requires asking more than why the discourse within the broadcast tion ought to be conveyed. The day after whether the autopsy was carried out in tended towards very simplistic and

www.jmedethics.com 578 TEACHING AND LEARNING ETHICS J Med Ethics: first published as 10.1136/jme.2003.003079 on 30 November 2004. Downloaded from partial interpretations of the meaning THE NOT SO BROADCAST: LIVE V ridiculous sensationalism, also miscon- of this event. Christine Odone began RECORDED strues the context of such comments. to make the case that the public The way in which Channel 4 framed Similar criticisms might easily be made nature of this autopsy was valuable ‘‘the’’ moral issue of the autopsy is some about the spontaneous applause, which just because it brings medicine into indication of how this strictly medical, erupted at the point when von Hagens the public sphere in a very explicit conceptual lens distorts the way in removed the cadaver’s internal organs. way. which one can make sense of ethical The somewhat awkward ripple of appre- Importantly, this perspective re- issues in science and medicine. In this ciation seemed to reinforce the perfor- inforces a number of criticisms coming context, there is a further level of mance-like or sensationalistic nature of from the field of cultural theory and analysis that is important to take into this event. More likely, however, it was medical humanities over the last few account before concluding what was an indication of the audience’s unease, years. Such journals as The Sociology of achieved by von Hagens’s public provoked by the manner of the removal, Health and Illness, and the JME’s sister autopsy. Specifically, it is necessary to which resembled the triumph of child journal, Medical Humanities have been stress that the public autopsy was public delivery or, indeed, the manner in which making the case that medicine is, in on two quite different levels: the audi- a magician removes a rabbit from a many meaningful ways, necessarily a ence at the event and the remote hat.13 social construct and that cultural values television viewers. This is also important are an integral, contingent aspect of for understanding how von Hagens CONCLUSION medical decisions. This is particularly demonstrated his professional integrity. From the medical perspective, perhaps relevant when considering ethical ques- For example, while the autopsy took the most useful lesson of the public 8 tions in medicine. While this matter more than two hours to complete, the autopsy is that it is an indication of remains highly contested in relation to Channel 4 broadcast was only thirty public curiosity about medicine, which 9–12 medical epistemology, it would seem minutes long, which gave the impres- might reflect a feeling of exclusion from that something such as the autopsy can sion of it being far more rushed than it medical discussions concerning health best be understood as a social construct, actually was. care. For this reason alone, there seems the specific parameters of which are Richard Bryan’s5 response fairly typi- to be some merit in the positive dis- subject to interpretation based upon cally fails to distinguish between these course surrounding von Hagens’s works, given or assumed values. Thus, the very two ways of making sense of the even if his own justifications for many, fact that autopsies tend not to be public autopsy. Almost no criticism or in depth including myself, remained weak. On is a product of a particular historical inquiry has been levelled at Channel 4’s this view, it can be useful for medical contingency, rather than something edited programme, even though the practitioners to recognise that the public ethically or morally absolute. It has to stronger reasons for condemning the autopsy was an opportunity for re- do with our cultural interpretation of autopsy would seem to be in relation to addressing the relationship between the body, privacy, and dignity and the its broadcast, rather than to the autopsy the medical community and its prospec- autopsy raises the question about how itself. Channel 4 scheduled the viewing tive patients. we currently make sense of these con- at 11.45 pm, took substantial short cuts There is an underlying premise to the cepts. in the presentation of the event (giving public autopsy that is highly appealing Thus, if one expects to understand the impression of it being incredibly and intellectually rich, even if one finds why the commentary provided by Wilks rushed) and omitted to show certain von Hagens’s justification of the public and Ellis is not sufficient, then a more images (perhaps to the relief of some autopsy to be lacking. An exploration of http://jme.bmj.com/ culturally informed approach to ethics is people). It was apparent that Channel 4 death through art is certainly a worthy necessary. This is because these medical was not prepared (or allowed) to broad- theme, offering a rare and needed experts are themselves part of the cast specific images, because while philosophical insight into medicine. context of critique to which the von cameras were continually close to the Moreover, knowing that the bodies used Hagens’s discourse seemed to be direc- cadaver’s body and the points of inci- in the Body Worlds exhibition and the ted. In some respects, it was inevitable sion, the viewer rarely saw such images. autopsy are real, adds some additional that medical experts would condemn There seemed to be much more interest value to both. Yet, von Hagens is not the on September 26, 2021 by guest. Protected copyright. this performance, which is precisely on the part of the programme makers in first person to raise questions about the why their criticism was not particularly viewing the reactions on the faces of the meaning of death through artistic enlightening, even if it was an impor- audience, rather than engaging the endeavours. Nor is he the most thought tant part of understanding the different viewer in what was taking place. provoking. perspectives on this issue. Consequently, any interest in presenting Unfortunately, neither the Body Worlds Thus, I suggest that a conventional something that was educationally infor- exhibition nor the public autopsy was a medical discourse is not sufficient as a mative seems to have been marginal. reaction to post(modern) humanity or a basis for concluding whether the Bryan also uses one response by meaningful re-engagement with death, public autopsy was morally acceptable. Christine Odone, given midway through through the medium of the body. The Rather, the significance of the event the procedure, as a basis for arguing reason why these events have attracted requires a strong sensitivity to the why the autopsy trivialised an impor- such attention, however, is precisely sociological understanding of medicine. tant procedure. Odone tried to make the because people feel there is a need for Moreover, such sensitivity must encom- case that there was an appealing and them. The exhibition and the autopsy pass a broad, philosophical appreciation valuable realness to the event, claiming were more like a 19th century freak of the argument that society has become there to be a ‘‘whiff of death’’ in the air. show. People are not watching out of an far too sanitised or clinical and that In reply, Bryan notes that audience interest in engaging with broad philo- people no longer engage with the members would only have smelled sophical concepts about being human. messiness of being human. These kinds formalin from such a corpse, so this They do not care much whether we, as of ideas would best serve to explain was an entirely fictional realness and humans, have undermined something (rather than justify) what was poten- one that belittled the dignity of essential about ourselves by obscuring tially meaningful about the public the cadaver. To interpret Odone’s com- the grotesque aspects of life with arti- autopsy. ment, however, as being some form of fice. What they are really attracted by is

www.jmedethics.com TEACHING AND LEARNING ETHICS 579 J Med Ethics: first published as 10.1136/jme.2003.003079 on 30 November 2004. Downloaded from the spectacle of real bodies displayed applauded upon seeing the cadaver’s Correspondence to: Dr A Miah, Lecturer in inside out. Since Channel 4’s broadcast internal organs lifted out of the body; Media, Bioethics & Cyberculture, University of Paisley, Scotland, UK; [email protected] was conducted in a manner that fed this why the event was allowed to take place fascination with spectacle, it reinforced despite von Hagens not having a licence; Accepted for publication 10 June 2003 this perspective. This is unfortunate, why the Body Worlds exhibition has mostly because it could have been generated so much interest, and why REFERENCES otherwise but also because there is a all this attracted Channel 4 to broadcast 1 Body Worlds Exhibition http:// philosophically credible rationale for it, and other major television channels www.bodyworlds.com (accessed 19 July 2004). von Hagens’s work, as I have tried to 2 British Broadcasting Corporation. MP’s plea for to place it in their headlines, arises ambulance driver. London, BBC News, 2003 suggest. precisely because at the same time there http://news.bbc.co.uk/1/hi/uk_politics/ If Channel 4 had avoided framing the is an equivocation about the relation- 2960448.stm (accessed 19 July 2004). moral issue of the autopsy solely in the 3 Carr NJ, Burke MME, Corbishley CM, et al. 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