"Autopsy is always for the living"
October 4, 2019 11:02 PM   Subscribe

Livestreaming the process of cutting into and dissecting a dead body may sound grisly or voyeuristic — almost like a snuff film or the unsettling wave of pimple-popping videos that flooded the internet a few years ago. But Margolis, who’s also an accomplished orchestral musician and improv performer, sees his services as an empowering tool for families of the recently deceased. Not only to provide useful information in the face of a tragic event, but also to help them come to terms with their loss.

"Families come to us for closure, for grief, to find out what happened."

[Article does not contain video or images; some description may be disturbing]
While the livestreams are an engaging project, Margolis puts even more effort into his edited videos, which he turns into educational resources. To get the Autopsy Center of Chicago videos out there, Margolis created an app and is still building out his Autopsy.Online platform, which is full of annotated autopsy recordings.

Margolis’ ultimate goal is to complete a virtual “body map” where viewers can click on a body part and watch a video clip of that particular organ being removed and examined — a resource he says is particularly valuable for students who don’t have hands-on access to cadavers.
posted by Johnny Wallflower (16 comments total) 23 users marked this as a favorite
Is that link directly to the livestream or an article? I'm not sure if I should click on a video of this.....
posted by mightshould at 2:45 AM on October 5, 2019

An article that I am looking forward to reading.
posted by TedW at 4:43 AM on October 5, 2019

[I added a note about the content, since some people are asking.]
posted by taz (staff) at 4:51 AM on October 5, 2019 [1 favorite]

The essay is quite powerful. I urge others to read it. There is a lot of respect and dignity being given to those who have made this gesture/donation to science & education. Great post JW.
posted by Fizz at 5:54 AM on October 5, 2019

I am deeply, deeply disturbed by this. Especially by the part where Margolis monetizes access (or uses Facebook, which is "free" but not free in that everything on that platform is de facto monetized.)

An autopsy is -- or ought to be -- private for the family of the deceased. It is not for edutainment or for profit. Covering the face and identifying marks is the bare minimum for preserving anonymity in something like this, not some kind of ethical huzzah, and the bioethicists quoted in the article rightly point that out. Strapping a GoPro to your head and charging people to watch a first-person POV of slicing through a skull feels just as gross as strapping a GoPro to your head to go to a strip club.

Look, opening a body is the most intimate act one person can do to another. I should know; I've done it. (I remain a strong believer in hands-on cadaver labs for medical students, not because you can learn better anatomy but because you can learn how to be respectful around a vulnerable body, and that's something that can't be taught in an app, and can't be taught by watching someone else do an autopsy.)

We need better ways to talk about death and definitely better public anatomy education, but livestreaming an intimate act on Facebook, as though it were a cooking video, is voyeuristic, full stop.
posted by basalganglia at 6:24 AM on October 5, 2019 [7 favorites]

Margolis did a fascinating Reddit AMA on his organization and the practice last month.

An autopsy is -- or ought to be -- private for the family of the deceased.

The families in these cases - or, sometimes, the actual deceased individual - explicitly feel otherwise.
posted by NotMyselfRightNow at 6:39 AM on October 5, 2019 [12 favorites]

From the article:

"Margolis offers clients — usually family members of the deceased who want answers or closure — the distinctly 21-century option to have their loved ones’ autopsies recorded or broadcast live. And many, he says, are taking him up on the offer."
posted by Former Congressional Representative Lenny Lemming at 6:49 AM on October 5, 2019 [1 favorite]

Yeah, I get that this guy is asking the families. Again, that's the bare minimum when it comes to consent, and a lot depends on how the ask is worded. I've consented families for autopsies (non-livestreamed, obviously) and "taping for educational purposes" is standard language; based on the article it sounds like he is indeed saying "and also I would like to livestream it" -- but I can't tell if he's making it clear that he is making $$ on it from his subscription model. That's where I have the ethical issue.

It's squicky -- and telling -- that he (or the writer of the article) refers to these grieving family members as "clients." I guess they are paying him too? Whatever this guy's business model is, he seems to be getting his cut (heh) at both ends.
posted by basalganglia at 9:01 AM on October 5, 2019 [2 favorites]

He's has a private practice, and was charging between $1,000–$3,000 for an autopsy in 2013. According to the FAQ on his site, families are not charged extra for live-streaming it.
posted by Johnny Wallflower at 10:06 AM on October 5, 2019 [1 favorite]

I have more experience with autopsies than most, and thought the article was good. As an intern circa 1990, I was on a team led by old-school attendings who encouraged us to ask for autopsies on our patients when they died, and then had us attend the autopsies as well. Really fascinating to find out what was going on in our patients' bodies as we were treating them as well as get an idea of what worked and what didn't. The actual mechanics of the process were interesting too; for example, the person doing the autopsy is able to use the aorta to deliver embalming fluid. Probably more effective than the procedure in most funeral homes. (It was also interesting to see the different types of embalming fluids available to choose from, such as ones specially formulated to hide the appearance of jaundice in the decedent.) All in all a valuable learning experience for a physician in training and one for which I always appreciated the families' willingness to let us have.

Fast forward several years; my father had been in declining health for some time and died, while not unexpectedly, a little more suddenly than we thought he would. An autopsy was actually my idea; his physicians were somewhat surprised when I brought it up (after conferring with the rest of the family). We assured him that we weren't gathering evidence for a malpractice claim, and since he died in a hospital it wasn't that difficult to get done within a day or so. The results reinforced how sick he had been, including the fact that he had actually died from a heart attack despite having had a clean cardiac cath a few months earlier. Furthermore, he was a participant in the Harvard Health Professionals Follow-Up Study, and I was able to furnish them with the results, thus advancing medical knowledge by some small amount. If I remember correctly, it was even covered by insurance; at least I don't remember mom ever saying she got a bill for it.

In 2018 my mother was at the end of life. She had been diagnosed with cancer of the gallbladder a year earlier and we had been preparing for her death. She died at her home, in hospice care, with all three children at her side. I don't remember who brought up the idea of an autopsy, but we all agreed that since dad's autopsy had helped bring closure to the family it would be good to get one for mom too. We wondered what the cancer had done (since stopping chemo a couple of months earlier there was no real reason to get imaging studies to see what was happening to her) as well as being concerned about a general decline in her mental status that had been going on since well before the cancer was diagnosed. There is a history of dementia in her family, and obviously we wonder what the implications are for her children and grandchildren. But when I brought up the idea to her oncologist, the hospice team, and the funeral home, they were all completely at a loss as to what to do. The funeral home was the most helpful; they worked with a pathologist in a nearby town that did autopsies where there was a question of foul play, malpractice, or other concerns about the manner of death. But they had apparently never heard of someone requesting an autopsy just to learn more about their loved one. The pathologist would do the autopsy, but would need payment in full up front (several thousand dollars), which would not be a problem, and it would take several days to get to, to the point where it would interfere with the planned cremation and memorial service, which were already on a tight schedule. So we elected to skip the autopsy, forever losing a chance to learn what we could. In the overall scheme of things not a huge loss, but disappointing nonetheless.

So given that context I am all for anything that raises awareness of autopsies and how important they are. I'm not sure if I would want a family member's autopsy broadcast, but would consider it. For myself, on the other hand, I would love to have my own autopsy broadcast. Of course, when that time comes I realize I won't have much say in the matter. I do notice he doesn't have pricing info on his site. I can see charging to defray the cost of the website, and better yet help subsidize the cost of the autopsies he performs, but wonder if that is what happens. Very curious to know what a subscription actually costs; I may contact them and see what I can find out.

A couple of articles on why autopsies are important, and why they aren't done routinely:

Without Autopsies, Hospitals Bury Their Mistakes (The title is a bit misleading; the lessons learned from autopsies and the reasons they aren't done more are more nuanced than simply hospitals wanting to cover their ass, although that certainly contributes.)

Why We Don’t Do Autopsies Anymore
posted by TedW at 11:13 AM on October 5, 2019 [21 favorites]

I noticed all the death themed FPPs this month, but didn't realize it was another Jonny Wallflower theme month. Well done!
posted by TedW at 11:25 AM on October 5, 2019 [3 favorites]

If he's live-streaming autopsies to a global audience without explicit permission, that's a problem. I don't think it's fair to project that he is doing this. Maybe someone should ask him instead of drawing moral judgements without full information.
posted by hippybear at 12:37 PM on October 5, 2019 [1 favorite]

Mixed feelings on this. Education is good, but a livestream increases the "spectacle" nature of it. If it's not actually interactive, with people being able to submit questions that he can answer while doing the autopsy, I don't think the livestreaming part is good.

I took a Human Gross Anatomy course in college, without even being on the medical track—I wanted to take it, and there was an opening. This is a course where the class receives an embalmed body from a person who donated their body to science and dissects it (as a group) over the course of two semesters, while also studying anatomy diagrams. It's a rare privilege, since many institutions don't offer this, and it's usually not available to people like me who are just curious, not doing it for degree reasons. The experience of cutting into a human body for the first time is rather hard to describe. I felt so grateful to this (former) person, and so sad to see the state of his body at the end of his time in this world. We learned as much as we could about him from his body, and may have learned things even he and his doctors never knew. There's a bit of the medical mystery experience to it: How did this body fail? (Congestive heart failure and then pneumonia, we deduced. You're not told much about the cadaver's history, if anything.) The inside of the body is quite beautiful. I took some photos, but I haven't published them, since I don't have permission to do so.

We kept the face and hands wrapped most of the time. These are the two most relatable parts of a human, I suppose. It's unsettling to see either exposed. When we finally bisected the head (with a bone saw, and then a hacksaw) I had the most unease I had experienced since the first cut. That was a more solemn day than usual, punctuated with a bit of uneasy laughter. In general there was a lot of humor, over the dissection table, but never at the cadaver's expense. Rather, it was the sort of dark humor you see people employ in the proximity of death, often quite self-deprecating. We always treated the cadaver with a great deal of respect.

At the end of the course and after all of our tests and assignments, we had a sort of debriefing and wrap-up session, just processing everything, talking about how we felt. Many of us ended up feeling an odd sense of intimacy with the cadaver.

It was an extraordinary experience, and I think it should be widely available. However, the equipment (dissection table and venting system) is expensive, and both instructors and cadavers are too rare for everyone to take such a course. I absolutely support putting these videos online so that people can learn more about the human body. We all have these bodies, but can't learn directly about how they work without damaging them! Watching a dissection is the closest we can get, for the most part. But I also think that maintaining a respectful atmosphere is important, if only to ensure that people continue feeling comfortable donating.

Personally, I don't care what happens to my body after death. And I know there are plenty of people who would be fine with having a lively "Twitch-style comments section" commenting on their dissection in real-time, perhaps because they think it's funny. But I do think there's some risk that others will see this and feel uncomfortable, even if their own cadaver were treated respectfully in a medical school classroom.
posted by Belostomatidae at 1:14 PM on October 5, 2019 [7 favorites]

If he's live-streaming autopsies to a global audience without explicit permission, that's a problem.

He always asks the family's permission, and pulls back if there's the slightest hesitation.
posted by Johnny Wallflower at 3:08 PM on October 5, 2019 [1 favorite]

I have rarely in my life clicked a link faster. (Then again, this was me 11 years ago.)

Thanks, Johnny Wallflower. And thanks everyone for the thoughtful and interesting discussion.
posted by minervous at 3:44 PM on October 5, 2019 [2 favorites]

I think, if you are not a person for whom this strikes as intensely interesting and thumbs-uppy, it can be easy to regard this as desecration or just have an instinctive recoil reaction to it. But there are lots of people in the world who are - well before death - very much "donate this entire rig to science when I'm done with it!" about the whole thing. It's actually pretty complicated to get done, most people don't manage the right arrangements in time.

In the current environment, where science feels increasingly threatened by other forces, I would happily have my autopsy livestreamed knowing that this is a method for getting information available quickly and (with a minute of research) personally archivable. In the event that formal academic cadaver studies become something only available to the "right" people under the "right" circumstances, I'd far rather the chance that someone somewhere might be able to learn, for example, the anatomy of the uterus...somehow.

And the work done isn't free. It's not free today, either, in many cases - there's some grant money, but it takes a lot of labor hours just to preserve and maintain a body for later research use, and the people doing that absolutely should be paid actual money and not expected to pay rent with the sense of a job well done. If this one guy is making an undue amount of money off this arrangement then yes, he should get his course corrected, but that doesn't mean the work itself isn't valuable.
posted by Lyn Never at 8:56 PM on October 5, 2019 [5 favorites]

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