The public autopsy: somewhere between art, education, and entertainment.

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