human body exhibitions: public opinion of young individuals and contemporary bioethics
TRANSCRIPT
Surg Radiol Anat (2012) 34:433–440
DOI 10.1007/s00276-011-0925-4ORIGINAL ARTICLE
Human body exhibitions: public opinion of young individuals and contemporary bioethics
Athanasios Raikos · George K. Paraskevas · Maria Tzika · Panagiota Kordali · Fani Tsafka-Tsotskou · Konstantinos Natsis
Received: 8 September 2011 / Accepted: 18 December 2011 / Published online: 1 January 2012© Springer-Verlag 2011
AbstractPurpose The exhibitions of plastinated cadavers andorgans have attracted millions of visitors globally, whileraising serious controversy about their content and purposeof implementation.Methods We performed a survey based study on 500 ran-domly chosen individuals, aged 18- to 35-year old, in orderto access their opinion regarding the conduction of suchshows as well as body donation for scientiWc purposes.Results We found that 46.3% of the participants hadmoral concerns, and 46.1% did not. Religious and philo-sophical beliefs concerned 21.8% of the sample, while 28%believed that the exhibits may aVect visitors’ mental health.Human dignity violation was stressed by 21.6%, whereas26.6% disagreed with body donation to science.Conclusions The desire for qualitative-guided anatomyeducation is evident from the highly popular plastinatedbody and specimen exhibitions. Hence, additional focused
eVort could be provided to educate the public about normaland pathological anatomy in order to amend their life-style.This could be eVected by certiWed anatomy demonstratorsin graduated steps according to the cohort’s age, education,occupation, and health status.
Keywords Bodies · Body worlds · Cadaver · Education · Plastination
Introduction
The plastinated human body and specimen exhibitions,inspired from “Body Worlds” (Körperwelten) by Guntervon Hagens, have attracted enormous success, controversy,and constitute a tribute to the technique of plastination andfamiliarization of the public with the science of anatomy.Plastination is an innovative organic-life preservation tech-nique in which water and lipids are substituted by curablepolymer that is subsequently hardened. The procedures’basic stages are Wxation, dissection, dehydration, forcedimpregnation of polymer in a vacuum, and hardening, asdeveloped by von Hagens [8, 25], while several technicalupdates have been proposed thenceforward [23]. The pro-cess allows life-like full-body posing and provides colorful,odorless, non-hazardous, and permanent anatomic speci-mens, which can be esthetically presented expressing a“museum ethos” [4]. Thus, the human “inner face” can beaccessible not only to the privileged life-sciences profes-sionals and students but also to the general public. Thetechnique aspired to replace the traditional, private, statical,and artless formalin-Wxed body parts or organ displays asan attempt to “democratize” anatomy [1, 11]. In commonpraxis, the human anatomy knowledge is an impassable bythe medical professions, whereas the general public usually
A. Raikos (&) · G. K. Paraskevas · M. Tzika · P. Kordali · F. Tsafka-Tsotskou · K. NatsisDepartment of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box 300, 54124 Thessaloniki, Greecee-mail: [email protected]
G. K. Paraskevase-mail: [email protected]
M. Tzikae-mail: [email protected]
P. Kordalie-mail: [email protected]
F. Tsafka-Tsotskoue-mail: [email protected]
K. Natsise-mail: [email protected]
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is dealing the topic with dread. However, the utilization ofplastinated bodies in entertaining art-shows is believed thatquestions their educational merit by presumably undermin-ing the human dignity and uniqueness.
The aim of the study was to investigate the opinion ofyoung individuals in Greece about the exhibitions of plasti-nated human corpses and specimens as well as body dona-tion, and expose their positive or negative comments andworries on the topic.
Materials and methods
An anonymous questionnaire survey was conducted to arandom sample of 500 young individuals, aged between 18and 35, with a mean age of 24.5 years, in order to record thepublic opinion about shows exhibiting plastinated humanbodies, specimens, and organs, while additional interestwas shown on body donation strictly for the scientiWc use.Fourteen questionnaires were excluded from the study dueto missing data or invalid answers, thus 486 completedforms (97.2%) were used for further data elaboration. Sta-tistical analysis was performed using SPSS version 17(SPSS Inc., Chicago, IL, USA). All participants were ofGreek nationality (Caucasian whites), 57.8% women and42.2% men. The sample was divided into students and non-students, while additional delamination was eVected tohealth-care professions, such as medical doctors, nurses,and lab technicians, and into professions irrelevant to medi-cine. Every participant who was studying regardless if hewas also employed for less than 35 h per week was consid-ered as a student. If an individual had a dual merit but isemployed more than 35 h per week, then the attribute ofnon-student was prevailed during elaboration of the data.The unemployed persons were incorporated in the non-student group. The questionnaire consisted of severalquestions (Table 1), while a short introduction was appliedbefore the questions’ section in order to enunciate the topic
of the study. The process of collection of the completedquestionnaires as well as the validation of the answeredWelds was supervised by an academic teacher in collabora-tion with medical students.
Results
Out of the 486 valid questionnaires, 8.2% of the respondentswere students of health-care professions, while 61.3% werestudents of other scientiWc Welds. From the non-studentgroup, 7.2% were employed in the health-care sector,including physicians, whereas 23.3% were employed in pro-fessions irrelevant to medicine and health-care. The elabora-tion of the surveys resulted that all the participants weremore or less quite familiar with the scope of the exhibitionspresenting plastinated corpses and organs owing to suYcientpromotion and reports by the local electronic and printedmedia regarding the event of “Bodies… The Exhibition” thattook place in Athens/Greece in 2009. The company organiz-ing the event was not related to von Hagens’ “Body Worlds”.To the best of our knowledge, a similar event was conductedfor Wrst time in the Southern Europe/Balkan area.
The 4.5% of the participants have already visited anexhibition of plastinated human corpses, 51% intend tovisit one in the future, while and 36% are not considering toattend one (Table 2). Moreover, 46.3% of the sampleexpresses doubts about the moral aspect of such exhibi-tions, while no moral issues are denoted almost equiva-lently (46.1%) (Table 3). The positive replies wereadditionally classiWed into four major classes of moralissues in order to allocate the opinion of the participants inthe study. Out of the 225 individuals with moral worries,21.8% raised issues of religious/philosophical beliefs thatcan be evoked from the visit of such shows, 28% stressedthe potential psychological/mental health disturbances,whereas 21.6% pointed out human dignity violation(Table 4). Additionally, eight participants described in
Table 1 Template of the main questions of the survey in cumulative form
The participant needed to check only one of the provided answers for questions Q1a, Q1b (if applicable), Q2a, Q2b (if applicable), and Q3
DK/NR do not know/no reply
Question Answer choices
Q1a Have you ever visited a show exhibiting plastinated human bodies? Yes No
Q1b If NO, are you intending to visit a similar show in the future? Yes No DK/NR
Q2a Do you believe that moral issue(s) arise from the conduction of human cadavers exhibitions?
Yes No DK/NR
Q2b If YES, which is your major moral issue/worry? Religious/philosophical beliefs
Potential psychological/mental health disturbances
Human dignity violation
Other reasons, describe in brief________________
Q3 What is your opinion regarding body donation for educational purposes? Agree Disagree DK/NR
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written other moral issues such as the “ambiguous sourcingof the plastinated cadavers”, “commercialization of humancadavers”, “absence of social provision in regard to famil-iarization of the public with the human body”, “disrespectto the human body”, “the creators of the exhibitions couldachieve similar results with wax or other material models”,and “the plastinated models may cause repugnance to thehuman body”. We noticed that moral concerns were men-tioned more often by people not involved in the health-caresector and by female individuals. Moreover, 39.1% of thosewho report that they intend to visit an exhibition of humancadavers dispute its morality. Surprisingly, 15.4%, thehealth care portion (students and employed professionals)of the same group, share a similar view.
Furthermore, the survey was aimed to record the publicopinion about the donation of human cadavers for educa-tional dissection courses in medical schools and workshops.
The majority of participants in the study (73.4%) agreedwith certainty about body donation for educational use,while only 13.8% disagree, and 12.8% did not reply or theydo not know (Table 5). Particularly, 53.8% of the groupthat agrees with the body donation for scientiWc purposesdoes not have moral concerns about the exhibitions,whereas 79.1% of those who disagree with the educationaluse of human bodies believe that moral issues may arise(Table 6).
Discussion
Morality, legality, and visitors’ reactions
The phenomenon of exhibitions of plastinated bodies hasoccurred in a shortness of bioethical precedent, provoking
Table 2 Summary of frequency regarding the individuals who have already visited a show exhibiting plastinated human bodies and organs
Additionally, the intention to visit a similar show by those who have not visited one yet is also presented. The Wgures correspond to individuals,while those in brackets are percentages. The numbers in square brackets are percentages included in those that answered NO in the Wrst question
DK/NR do not know/no reply
Occupation Gender Have visited an exhibition If No, intend to visit an exhibition in the future?
Yes No Yes No DK/NR
Student group
Health care students 40 (8.2%) Male 1 11 8 3 0
Female 2 26 16 6 4
Other students 298 (61.3%) Male 5 109 58 40 11
Female 5 179 95 70 14
Non-student group
Health care professionals 35 (7.2%) Male 2 13 7 6 0
Female 2 18 7 11 0
Other profession/occupation 113 (23.3%) Male 2 62 30 24 8
Female 3 46 27 15 4
Total 22 (4.5%) 464 (95.5%) 248 [51%] 175 [36%] 41 [8.5%]
Table 3 Summary regarding the stance whether moral issues arise from the conduction of the shows exhibiting plastinated human bodies
Occupation Gender Moral issues speculation
Yes No DK/NR
Student group
Health care students 40 (8.2%) Male 1 11 0
Female 17 10 1
Other students 298 (61.3%) Male 50 58 6
Female 88 84 12
Non-student group
Health care professionals 35 (7.2%) Male 7 7 1
Female 12 4 4
Other profession/occupation 113 (23.3%) Male 26 30 8
Female 24 20 5
Total 225 (46.3%) 224 (46.1%) 37 (7.6%)
The numbers correspond to individuals, while the numbers in brackets are percentages
DK/NR do not know/no reply
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moral controversy about the use of a human corpse on behalfof entertainment, and education. The numerous debates aris-ing from exhibitions of plastinated cadavers reXects a num-ber of the historical controversies between science and art,religion and art, and science and religion that surpasses thecultures of the sciences and humanities [20]. The humanbody’s “inner face” has been peered by anatomists andexposed on general display leading to questions about post-mortem human dignity [11]. Indeed, 21.6% of our surveyparticipants complained about human dignity oVence.
Dignity demonstrates the intrinsic worth of beinghuman, possessed by virtue, while decency is a matter of
self-esteem and is closely related to tradition, religious, cul-tural, and social policy [4]. Every community has its tradi-tions and special practices referring to the handling of thedead. The symbolism of the dead body represents an emo-tionally charged eVort to honor the life and memories of theperson who owned it, whereas burial and cremation areregarded as the most respectful disposing practices [1]. Fol-lowing the classic age civilization, the modern Greek cul-ture has been strongly inXuenced by the writings andteachings of the Orthodox Christian dogma so the burialand funeral are mandatory, while the cremation of the dead islegally accepted only since 2006. Therefore the conservative
Table 4 Rundown analysis of the frequency of replies by those who claimed that moral issues are arising from the conduction of shows exhibitingplastinated human cadavers (n = 225) delaminated into four major classes
The Wgures correspond to individuals, the numbers in brackets are percentages, while the numbers in square brackets correspond to the percentagein respect to the total number of participants in the study (n = 486)
DK/NR do not know/no reply
Occupation Gender Moral issue classes
Religious/philosophical beliefs
Potential psychological/mental health disturbances
Human dignity violation
Otherreasons
Student group
Health care students 18 (8%) Male 1 0 0 0
Female 6 6 5 0
Other students 138 (61.3%) Male 12 13 22 3
Female 17 25 42 4
Non-student group
Health care professionals 19 (8.5%) Male 0 2 5 0
Female 2 4 6 0
Other profession/occupation 50 (22.2%) Male 8 8 10 0
Female 3 5 15 1
Total 49(21.8%)[10.1%]
63(28%)[13%]
105(46.6%)[21.6%]
8(3.6%)[1.6%]
Table 5 Synoptic table regarding body donation for educational purposes delaminat-ed by occupation and gender
Occupation Gender Body donation stance
Agree Disagree DK/NR
Student group
Health care students 40 (8.2%) Male 9 1 2
Female 19 4 5
Other students 298 (61.3%) Male 91 8 15
Female 133 30 21
Non-student group
Health care professionals 35 (7.2%) Male 14 1 0
Female 9 5 6
Other profession/occupation 113 (23.3%) Male 43 12 9
Female 39 6 4
Total 357(73.4%)
67(13.8%)
62(12.8%)
The Wgures correspond to indi-viduals, those in brackets are percentages
DK/NR do not know/no reply
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religious aspect incriminates the denial of burial, whichcannot take place after plastination [21].
Various attempts were carried to ban the exhibitions inmany west-world countries [1], although this kind of reac-tion has not been noticed in Greece. The German Anatomi-cal Society tried to prevent the initial “Body Worlds”exhibition in Mannheim in 1997 [15], whereas the AmericanAssociation of Anatomists supported it oYcially just in 2008[5]. It is evident that through the last three centuries whatwas illegal and unethical in the past is not in the present timeand vice versa [7]. However, the educational value of theexhibitions remains untested and undisputed [18]. Accord-ing to the International Society of Plastination the publicexhibition of Xayed or gold-plated bodies cannot provideany educational value, while the dignity of the diseasedshould not be compromised for noneducational uses [26].
During plastination, the original tissue Xuids arereplaced by synthetic polymers, while the DNA and pro-teins remain unaVected, leading to a debate about the deW-nition of human and non-real [1, 21]. Thus, the previouslyhuman tissue is transformed into a transcientiWc naturalstructure model and a permanent anatomical specimen [9],according to von Hagen’s legal point-of-view, the plasti-nated corpses are becoming permanent anatomical speci-mens [9]. However, despite the privileges of thepreservation technique, the money-making scheme of theexhibitions and shows allows and encourages the public
“voyeuristic” view of the anatomy beauty, creating suspi-cions for commercialization of death [4, 21]. The humanremains are esthetically presented as artistic lifeless statuesdecorating a museum hall and are available to observe for aticket price variable between diVerent social and agegroups. In this perspective, the exhibition may resemble toa “freakshow” considering that “abnormal” bodies are dem-onstrated for proWt [4, 19].
Serious skepticism surrounds the topic, regardless theinformed body donor consent. The self-determined decisionof plastination, accompanied by suggestions about the pla-stinate’s posing seems democratic and legal. However,using a human cadaver for entertainment purposes or satis-fying artistic intents is still controversial. The donor’s con-sent form that needs to be completed does not constitute acontract but a declaration of intent which can be revoked atany time [9]. It is a legal evidence of donor’s last will andtestament, although it does not demonstrate interest orrespect to the relatives. As far as von Hagen’s plastinationprogram is concerned, the transportation of the body toGermany burdens the survivors, while an autopsy cannot beconducted and the cadavers must be intact [9] thus aVectingpotential legal matters related to death.
The exhibition’s debate cornerstone is the visitors’response and reactions. In a survey study, almost 50% ofthe participants reported that they have been disturbed bythe exhibits and 75% report that curiosity was the main
Table 6 Crosstabulation between the answers on the question treating with the body donation for educational pur-poses (X) and those dealing with the moral issue(s) arise from the conduction of human cadavers shows (Y)
Questions
What is your opinion regarding body donation for educational purposes (X)
Do you believe that moral issue(s) arise from the conduction of human cadavers exhibitions (Y)
Total
Yes No DK/NR
Agree
Count 139 192 26 357
%within X 38.9% 53.8% 7.3% 100.0%
%within Y 61.8% 85.7% 70.3% 73.5%
Disagree
Count 53 12 2 67
%within X 79.1% 17.9% 3.0% 100.0%
%within Y 23.6% 5.4% 5.4% 13.8%
DK/NR
Count 33 20 9 62
%within X 53.2% 32.3% 14.5% 100.0%
%within Y 14.7% 8.9% 24.3% 12.8%
Total
Count 225 224 37 486
%within X 46.3% 46.1% 7.6% 100.0%
%within Y 100.0% 100.0% 100.0% 100.0%
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motive of their visit [17]. Moreover, 13% of our surveyrespondents seem concerned about the eVect of the exhibitsto the visitors’ psychology and mental health. Frankly, thevisit to the shows is voluntary and the freedom of choicerequires a certain level of responsibility, an issue thatshould be carefully inspected in case of school visits with-out the previous approval from the parents or chaperons.The potential psychological eVects of the visitors cannot beprevented if they are not well informed or unable to handlethe potential stress. Indeed, according to Leiberich et al.[17] 57.5% of the visitors were not aware that the speci-mens and embalmed bodies belonged to real people, whilechildren cannot be aware or responsible for their atten-dance. Additionally, people with sensitive personality, suchas elders or those suVering from incurable diseases, may beindelibly aVected due to repulsion or personal equation andtheir acquired pessimism may disturb their physical health(Fig. 1). Furthermore, it has been mentioned by the exhibi-tion’s management that in the sight of the plastinated spec-tacle the visitors very often feel dizzy and faint [24]. Theorganizers need to fulWll a higher level of responsibility interms of physical and mental security of the visitors whenconsidering presenting speciWc exhibits. By contrast, someauthors claim that the contact with human anatomy in itsentire splendor, including public autopsies, may be the linkfor improving the relationship between medical science andpotential patients [19].
The exhibitions have also been regarded as a mementomori, assisting in the familiarization with the death idea.The human body vulnerability, contingency, and theesthetic presentation of the dead could encourage peoples’curiosity and intimacy with death and incite them to con-front mortality. Particularly, through gestalt plastination,the specimens’ lofty stature dubiously satisWes the condi-tions of a death totem [21].
Education and art
The “BODIES” and “Body Worlds” as well as any similarexhibition are meant to serve educational purposes throughartistic inspiration for medical students and health carestaV, and for the general public. From the medical perspec-tive, the plastinates are featured by advantages on durabil-ity, facile storing, and material characteristics demonstrateanatomical variations in incredible detail bridging macro-scopic and microscopic anatomy [12]. The dry, odorless,life-like preserved anatomical specimens constitute an irre-placeable tool for anatomical instruction [8]. The techniqueof even transparent-plastinized tissue slices creation may becompared to those of various imaging techniques [20], con-tribute to a 3D computer model construction [22], and isparticularly useful in neuroanatomy teaching for structureidentiWcation such as the grey matter and white medulla [8].Unfavorably, the depersonalized plastinates cannot moti-vate medical students to confront the grandness of thebody, while anatomy teaching in rigidly Wxed specimenscannot assist in improving their surgical skills [4, 27].
The “democratization” of anatomy intends to motivatelay people to concern about human anatomy, health issues,body donation, and primarily improve their health-relatedbehavior. The Greek Federation of State School Teachersof Secondary Education approved the inclusion of the“BODIES” exhibition as an instructional excursion destina-tion, in order to “discover how to enlighten, inform andinspire high school students to learn about the human body”[2]. The presentation of body structures in the shows is an“open anatomical course”, while the evident tissue impair-ment that is caused by common west-world lifestyle maylead to realization of the damage and avoidance of practicessuch as smoking and alcohol consumption [4]. Indeed, in asurvey study, the majority of the visitors reported that after
Fig. 1 A series of variable developed fetal and post-delivery humanskeletons. The exhibit is highly educative for medical students andphysicians in training but may challenge controversy in individuals
irrelevant to medicine or health care professions (Photo acquired afterpermission in: Anatomy Museum, Anatomy Center, Medical Faculty,Cologne, Germany)
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the exhibition they are better informed about the humanbody, but only a small percentage seemed willing to changetheir lifestyle [17]. However, the absence of a certiWedanatomy demonstrator for the interpretation of the anatomi-cal structures of the plastinated exhibits questions the edu-cational value of the shows, as the visitors are left with theimpression of the human body complexity and numerousunanswered queries [14]. Additionally, some authors insistthat health and anatomy education can be pursued via mor-ally uncontroversial alternative methods, such as imagingtechniques, computers, multimedia, and anatomical modelsvitiating the exhibition’s educational monopoly theory[4, 21]. The detractors may propose the limitation of plasti-nation technique in the dissecting rooms of the medicalschools in order to eradicate any moral controversy. How-ever, this is not possible in 21st century era due to the easeof access of any type of photographic or video material viathe internet and media.
As far as body donation is concerned, the exhibitions aresupposed to incite people’s interest about organ or full-body donation, an action that is mainly motivated by altru-ism and gratitude to science [3]. We strongly support andrecognize the body donation programs of anatomy labora-tories for educational and research purposes, and conse-quently any attempt promoting this action especially insome Mediterranean countries with short tradition in bodydonation. On the contrary, meditated body or organ donorsmay be discouraged due to fear of becoming eventuallyexhibited plastinates in museums [12] or even in publicplaces such as parks and buses [4].
According to von Hagens’ Institute for Plastination,beyond the instructive value:
“(…) creating a plastinate can be compared to thework of an artist who sculpts a Wgure from a block ofstone (…). However, the critical diVerence is that thepurpose of creating a permanent anatomical specimenis not to achieve a perfect shape with a beautifulappearance” [8].
The esthetic presentation of a dead body is provokingmany reactions. The detractors are commenting on humandignity violation and vulgarism, while the supporters arereferring to it as an aid to overcome the dead-body taboo[6, 13]. The variety of poses, accessories and even plasti-nated animals used in the shows visualizes the artisticintention of their creators and has led to a classiWcation ofthe exhibits into four types: categories A and B present“sporting” specimens and special anatomical characteris-tics, respectively [12]. Category C encompasses plastinatesinvoking the iconography of Renaissance and Baroque art-ists [1], while D corresponds to all non-classiWed exhibits.Although, categories A and B have indubitable educationalmerit, the last two categories comprise literally human-based
sensationalized art-facts. The art show concept is preservedby stylized labels accompanying the exhibits, in addition toa title and date of creation [4]. Hence, the identity of thebody donor is preserved, and the formerly breathingbecomes a “sculpture of Xesh”.
The anonymization of the body donors aims to protecttheir dignity [1] and is a prerequisite in the consent form, inaddition to the option to transform their body into a plasti-nated art model [10]. Therefore, it is evident that the bodyis donated as a raw material that may be shaped to any artis-tic will [4]. According to Leiberich et al. [17], 28.9% of thevisitors supported that the body donation for plastination isa form of immortality. Thus the human nature and life-work is substituted by “plastic” and esthetic creativity andgives birth to an art show. Art signature labels take theplace of the obituary writing and the gravestone engravings,while the date of creation replaces the date of death. Theindividuality formed by life-story, name and family back-ground is dematerialized into a generic pose which may noteven characterize the donor’s life-style [16].
Conclusion
Human body exhibitions constitute a form of “edutain-ment” in which the anatomy art is esthetically presentedembellishing the body’s “deadness” and leading thedonor’s life to oblivion for educational purposes. The sen-sationalization and the artistic demonstration of “plasti-nized” anatomy beauty raise bioethical issues interferingwith common moralism. Certainly, the plastination tech-nique is acknowledged by anatomists as an indispensabletool in research and anatomy teaching, and only its misusein terms of exhibitionism is under consideration. Asshown in our results, a considerable part of the partici-pants (46.3%) raise various moral worries, while 73.4%declared their agreement about body donation for educa-tional use. In our era, the frenzied rhythm of knowledgespreading via internet allows no more locked doors,impassables, or taboos. However, normal and pathologi-cal anatomy education requires special management and itwould be handled by specialists and in certain degrees ofsteps and levels in order the secure physical and mentalhealth of the public.
ConXicts of interest The authors declare that they have no conXictof interests. All authors have read and accepted the Wnal draft of themanuscript.
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