The dignity of the human corpse in forensic medicine

Teaching respect for body donors: A US medical student perspective

Recent controversies over the mismanagement of body donors in US medical schools have raised public concerns over the ethical treatment of bodies in "anatomical gift" programs. Despite widespread moral outrage at such cases, medical students may still make seemingly inconsequential mistakes or jokes that in fact constitute acts of disrespect. This may partially be attributed to the process of desensitization in working with human remains, and indicates a further need to inculcate into medical students the ethical responsibilities of working with body donors. Donation agreement statements that lack specific information about the respectful treatment of bodies in the anatomy laboratory may serve as an additional point of concern for potential donors seeking reassurance about the future treatment of their bodies. This viewpoint draws from the anecdotal experiences of medical students to portray two scenarios of medical students' disrespectful conduct toward body donors, and constructs an account of moral respect for human remains based on respect for posthumous autonomy and respect in attitude. It then provides suggestions for US medical schools to incorporate this ethical framework into their anatomy curricula to instill respectful dispositions in its students and facilitate a more robust informed consent process for potential donors who entrust their bodies to medical students.

Videoautopsy-A Minimally Invasive Autopsy Method Using Endoscopic Techniques in Forensic Medicine: Clinical Features

In light of falling global autopsy rates, one of the causes of which is the resulting body disfigurement, it has become crucial to search for new, minimally invasive post-mortem diagnostic tools. One of these methods is videoautopsy, a minimally invasive autopsy technique using endoscopic methods. In the years 2020-2023, 15 videoautopsies were conducted at the Department of Forensic Medicine of the Poznan University of Medical Sciences in order to determine the usefulness of the method in forensic approaches. Each post-mortem examination included laparoscopy and thoracoscopy, followed by a classic autopsy to assess the effectiveness of the method. In total, the endoscopic examination allowed for determining the cause of death in 53.3% of cases, and when the cause of death was located in the abdominal cavity or chest, the percentage increased to 80%. Traumatic lesions had good recognition efficiency. In addition, it was also possible to collect material for histopathological and toxicological tests. Retroperitoneal organs were difficult to assess. The main limitation of the method is the inability to assess the inside of the skull and the structures of the central nervous system. Videoautopsy may become an important tool in post-mortem diagnostics and in forensic cases, especially when the alternative is to not perform an autopsy. Further research is necessary to standardise the examination protocol, optimise the instrumentation, and assess the potential synergistic effect with other methods of minimally and non-invasive post-mortem examination.

The use of an educational video on forensic autopsy in curricular teaching for medical students-is it worth the effort? : A field report from lecturers and a survey among students

PURPOSE

The purpose of this work is to share our experience with an educational video on forensic autopsy. Using questionnaires, we attempted to answer the following questions: Does watching the video trigger emotions in students? Does the autopsy meet the expectations that they had before? Does the video help to prepare them for their subsequent autopsy participation?

METHODS

A total of 365 medical students who attended their classes during the COVID-19 pandemic measures were provided with the video on an online platform. Links leading to questionnaires were positioned before and after the video. One hundred seventy-six students returned to face-to-face teaching during their course in forensic medicine. Those among them who chose to participate in an autopsy at our institute were given the link to a third questionnaire after their autopsy participation. The data was analyzed using IBM SPSS 27.0 and Microsoft Excel.

RESULTS

One hundred seventy-two students completed a questionnaire before watching the educational video, 85 also completed one afterwards, and 28 completed the third questionnaire. The most intense feelings while watching the video were "curiosity" and "surprise". Out of twelve students (14.1%) who had imagined the autopsy differently in advance, five perceived the autopsy shown in the video as rougher or more brutal than expected. All autopsy participants who had previously viewed the video felt adequately prepared.

CONCLUSION

Teaching should include an introduction to the handling of the corpse and the general procedures in the dissecting room. Although a video cannot substitute for personal interaction, it is useful to prepare students for their autopsy participation.

Nobody Should Die Alone. Loneliness and a Dignified Death During the COVID-19 Pandemic

During the direst months of the COVID-19 pandemic, thousands of people died alone. This study analyzes these deaths, which occurred without the presence of loved ones, and seeks to a) examine the significance for relatives, as well as professionals, of dying alone, b) determine if these solitary deaths can be considered dignified, or good deaths, and c) evaluate if the treatment of the cadavers and the funeral rites transpired with the desired dignity and sensitivity. The study was carried out in the autonomous community of Madrid using a qualitative, phenomenological, and interpretative approach through in-depth interviews of 49 informants, professionals and relatives. Interviews were conducted between July and November of 2020, followed by an interpretive, categorical, qualitative analysis. Among the key findings are that during the most critical months, deaths lacked the desired dignity, even though the involved professionals did their best to accompany and dignify the deaths.

Applicability and usefulness of the Declaration of Helsinki for forensic research with human cadavers and remains

Bodies of deceased persons and human remains and their specimens (i.e., organs, bones, tissues, or biological samples) are essential in forensic research but ad hoc worldwide-recognized ethical standards for their use are still lacking. Such standards are needed both to avoid possible unethical practices and to sustain research in the forensic field. Pending consensus within the forensic science community regarding this topic, with this article we aim to stimulate a debate as to the applicability and usefulness of the Declaration of Helsinki in the field of forensic research involving human cadavers and remains. Considering the fundamental differences compared to clinical research involving human beings and the different moral obligations involved, we focus on the risks, burdens, and benefits of research, ethics committee approval, and informed consent requirements. The Declaration of Helsinki framework allows forensic researchers to focus on substantial ethical principles promoting the consistency, integrity, and quality of research. Consensus regarding ethical standards and the adoption of national and supranational laws that clearly regulate the use of human cadavers and remains, including those from autopsies, continues to be of primary importance for the forensic science community.

Welche Kriterien liegen der Beauftragung gerichtlicher Leichenöffnungen zugrunde, und welche Rückschlüsse ergeben sich für die rechtsmedizinische Praxis?

Hintergrund

Die Entscheidung, ob in einem Todesermittlungsverfahren eine Obduktion veranlasst wird, basiert nicht auf einheitlichen Kriterien. Die Erfahrung zeigt, dass ähnliche Fallkonstellationen je nach SachbearbeiterIn zu unterschiedlichen Entscheidungen führen können. Um ein einheitlicheres Vorgehen rechtsmedizinisch unterstützen zu können, ist ein besseres Verständnis der Entscheidungsprozesse in den Ermittlungsbehörden notwendig.

Ziel der Arbeit

Die vorliegende Studie widmet sich primär den folgenden Fragen: Welche Faktoren liegen bei den Auftraggebern der Entscheidung über eine Obduktion zugrunde? Fühlen sich die Akteure ausreichend informiert, um fundierte Empfehlungen abzugeben bzw. Entscheidungen zu treffen? Im zweiten Schritt sollen Möglichkeiten abgeleitet werden, die Zusammenarbeit zwischen Ermittlungsbehörden und Rechtsmedizin zu verbessern.

Methoden

Insgesamt 58 StaatsanwältInnen und mit Todesermittlungsverfahren betraute PolizistInnen in Rheinland-Pfalz wurden im Frühjahr bzw. im Sommer 2021 mittels selbstentwickeltem Online-Fragebogen zu ihrer Vorgehensweise hinsichtlich der Empfehlung bzw. Beantragung einer Obduktion befragt. Es folgten die deskriptive Auswertung und Bewertung im Hinblick auf die Fragestellung.

Ergebnisse

Insgesamt konnten die Antworten von 24 StaatsanwältInnen und 34 PolizistInnen ausgewertet werden. Als wichtigstes Umfrageergebnis ist festzuhalten, dass bei StaatsanwältInnen und PolizistInnen Unsicherheiten im Hinblick auf Möglichkeiten und Grenzen gerichtlicher Obduktionen bestehen, insbesondere bei besonderen Fallkonstellationen (z. B. bei Organexplantation). Die Beantragung einer Obduktion fällt den Befragten jedoch grundsätzlich leicht; die Fallaufklärung steht im Vordergrund, während die Kostenfrage eine untergeordnete Rolle spielt.

Diskussion

Aus den Umfrageergebnissen lässt sich die Notwendigkeit eines intensivierten Austauschs mit den Auftraggebern in Form von anlassbezogenen Beratungen und allgemeinen Fortbildungen über Indikationen und Möglichkeiten rechtsmedizinischer Untersuchungen ableiten.