4. Germany and Netherlands
My first time to be in Europe was in 2015, a year marked by amounts of work and leisure that at times felt like death itself. Through a strange mix of plans that featured misses, accidents, and adjustments, I ended that year having visited 21 countries and presenting seven papers across four countries. Given the workload, I still managed to fit in a visit to the offices of the Institute for Plastination in Heidelberg, Germany. As my spouse had at the time recently resigned from her post as a human resources professional in a multinational corporation, we had the luxury of time to embark on a tour of several European countries. We thus built in visits to Mainz, Germany and Amsterdam, the Netherlands, where there were at the time ongoing BodyWorlds exhibits.
Herzenssache (Ger. “things of the heart”) was the name of the Mainz exhibit. As was the case during my initial visit in Singapore five years earlier, I was fascinated by the fusion of art and science, particularly by the sight of a heart perfectly preserved, with arteries and ventricles set off in clear detail, accompanied by a compelling narrative that held my attention like no science textbook could. The exhibit also featured whole-body plastinates, among which were the plastinates of a male and a female in the middle of copulation.
On the other hand, the Amsterdam exhibit was dubbed The Happiness Project. Found at Damrak 66, this place has some personal significance. Years ago before making the decision to go full-time in academia on a tenure-track appointment, I worked in the business process outsourcing industry, first as a customer serving representative taking calls for American Express. Damrak 66 used to be the American Express building in Amsterdam; in answering inquiries from customers, I gave this address not knowing that I would be able to walk into it years later. With what I can only surmise as the inevitable moribundity of travelers cheques, the building has transformed from the place of purveyance of an essentially dead financial instrument to a place where the dead are given new life. The Happiness Project’s theme was, unsurprisingly, the effect of happiness on health. The whole-body plastinates that I remember being on display were those of people playing musical instruments and those at leisure.
The visit to the Institute for Plastination’s Heidelberg office was most memorable to me, in large part because of the hospitality of the team. We were met at the Hauptbahnhof (Ger. “main train station”) by a member of the team, who kindly took us to the office by car. At the office, we were introduced to the Institute’s employees; of particular importance to me were three persons: the person I continue to correspond with, the founder’s son (who had by then taken over the reins of the operation), and their resident plastinator, responsible for developing and testing new techniques. Further proof of the team’s hospitality was the presence of the team’s affectionate canine.
As I was already familiar with the procedure for plastination, i.e., essentially the removal of water and fat and the replacement of these by acetone before being subsequently replaced by polymers, the presentation was more for my spouse’s benefit. We also saw the long, steel operating table where initial work on a body is done. To my mind, it was clear that one day I may be the one on that table, and that my body will see its water and fat replaced by acetone and polymers. My spouse described the feeling as “surreal.”
After a final exchange of handshakes, well-wishes, and tokens, we were again taken by car to the city center, where we continued our tour of Heidelberg. Before parting ways, we thanked them for their time and kindness, and said that we would one day, sooner than later, visit the Plastinarium in Guben, a town in the state of Brandenburg. I look forward to being able to set foot inside its Teaching Workshop.
5. Post-Visit Thoughts
After these visits, several thoughts occurred to me, categorized as such: (1) on the history of anatomy; (2) the demand for specimens; (3) the arts and sciences, and how they impinge on plastination; (4) the question of dignity; and (5) self- and other-determination.
It appears to me that the BodyWorlds exhibitions are marketed with a certain reliance on so-called shock value. Body Worlds is a site of thanatourism, the traveling to sites of demise and affliction, anchored on the human curiosity being fueled by the intrigue of death. Shock value is only one of the obvious effects of the exhibits that feed the fascination of the audience by providing them a glimpse of a phenomenon they are all bound to face, but never have the opportunity to fully perceive and experience (
Stone 2011a;
Stone 2011b).
Even as it had none of the sort for me, I can imagine other visitors being shocked by the sight of exposed skin and bone, especially in the context of whole-body plastinates that are posed in varying ways. This initial thought led to some reading on the history of the anatomy. True to that adage that we do stand on the shoulders of giants, our knowledge of the human body today is borne of the work of intellectuals who were born ahead of us, the same intellectuals who had to take recourse to robbing graves in order to study bodies. The all-too visceral feeling of putrefaction and decay associated with dead bodies made for difficulties in studying anatomy and more important, in getting popular acceptance of the practice. The anatomical theater, where the dissection of human bodies was done in front of an audience, was a practice fraught with condemnation, even as purportedly its aim was for the advancement of knowledge (
IfP 2008).
The advancement of knowledge has always been one of the oft-cited reasons used by the Institute for Plastination (
Fischer 2007). Personally, it is the reason that resonates the most with me. The idea of using dead bodies for the education and training of physicians and other allied health professionals is reassuring to me, as I can imagine that this training is far better than working on models or
écorché in the mold of Honoré Fragonard. It is the sense of charity and desire towards utility of body donors that allow the science of anatomy to progress (
Fischer 2007). Some anatomists perceive Body Worlds as an insult to medical knowledge as it precipitates a reduced and shallow human perception of the human body focused on beauty rather than its function (
Jones and Whitaker 2009). The fact remains that plastination has changed the field of anatomy because of its convenience in dissection and storage. It also shows in great detail the uniqueness of human anatomy, which is in great contrast to almost singular looking simulacrums of the human in textbooks, computer simulations, and prototypes (
Walter 2004).
Among the varieties of plastinates invented by von Hagens are flexible ones. Flexible plastinates may be used by anatomists as a replacement for cadavers used in prosection or cadaver dissection (
Jones and Whitaker 2009). Thus, Body Worlds’ educational purpose puts validity in the anonymously stated medical belief that the dead shall teach the living. Apart from medical research, it also desensitizes the people from the “unpleasant” biological truth beneath their skin (
Preuss 2008, p. 25). Furthermore, it acts as a
memento mori, a constant stimulus of question marks that keep humans curious about the mystery of life and death (
Preuss 2008).
In the survey that I was asked to answer after agreeing to donate my body to the Institute, one of the questions was about my willingness for my body to be used for crash-testing. I ticked yes. This decision brought to mind bodies being used for the training of forensic specialists, specifically in ascertaining time of death. A steady supply of body donors ensures that the quality of investigations and analyses in the future will be better than those of today’s.
However, the very idea of “steady supply” of body donors brings with it its own set of ethical questions, particularly in the matter of who gives their approval to be body donors, and subsequently as plastinates.
On the acquisition of the bodies, Dr. Hans-Martin Sass, the bioethicist who viewed the documentation for the Institute for Plastination (IfP) donation program before the Body Worlds exhibition in the USA commenced, went to Heidelberg to review the body donation consent forms of those whose bodies were put up for public display. Dr. Sass was generally satisfied with the process, noting that the IfP donation form and Declaration of Intent were very specific and comprehensible. The bioethicist dismissed issues of incentives being given to the potential donors. If the donors received anything, Dr Sass argued that it was a disadvantage rooted from the unpleasant image of controversies brought upon Dr von Hagens and Body Worlds (
Moore and Brown 2007, p. 233).
There have been issues raised concerning the legitimacy in the process of obtaining bodies, as some reports claimed that the corpses of executed Chinese prisoners were used in the exhibits. This has been denied by Dr von Hagens; German prosecutors in 2004 averred that there was no evidence to support this.
Be that as it may, I am of the opinion that an informed decision to donate one’s own body is ethical, even as ultimately, donors have no control over what becomes of their bodies post-plastination. Among the options that are available to the Institute apart from using the body as a whole plastinate is for the body to be sent to medical facilities. In any case, identities cannot and will not be matched to the bodies to protect privacy. I actually put forward this question to my contact at the Institute, as I imagined that if I predecease my spouse, she could perhaps be informed of where my body is exhibited, if ever. The answer to that was a clear no.
There have also been accusations, to my mind unfair, that the exhibits are voyeuristic and cheapen the beauty of life (
Wetz 2007). First, the line that separates science from the enterprise of spectacle has always been vague. This long enduring debate remains amorphous for it is left undetermined by the different current knowledge and beliefs held by the exhibit’s diverse audience. The public and selected media institutions, without extensive medical knowledge, identify themselves to be attracted to the exhibit because of its sensational tendencies. Gunther von Hagens himself recognizes this kind of motivation. On the other hand, a medical practitioner’s leading motivation is logically and highly likely to be that of educating himself or herself (
Durbach 2014). Then again, it would be unfair to assume that being used to dealing with both living and dead bodies obliterates the tendency to be allured by the human body. After all, the fact that it is labeled as a spectacle only proves its strong capability to beguile as one fine and fascinating machine. Von Hagens himself does not deny the plastinates as a sensation; it is after all “anatomy art,” an acknowledgment of the fascination and realism at the core of plastination’s aesthetic and functional purpose.
Second, perceiving the bare human body display as voyeurism of the dead is problematic. Altering the dictionary definition of voyeurism for this paper’s subject now pertains to obtaining satisfaction from discerning literally naked (skinless) bodies instead of gaining sexual pleasure. The subjectivity of the word voyeurism, undeniably related to pornography, appears to be indicative of the motivations of those who make the accusation of voyeurism than those who are being accused of it.
I submit that this is the sort of bromide that has been thrown about by persons who refuse to consider possibilities. When in years past, anatomy was the exclusive province of doctors and scientists, occasionally done in secret owing to the mores of the times, today we find that anatomy is democratic as it were (
Fischer 2007). Through the exhibits, the study of anatomy becomes popularized and frees access to this biological branch for the masses. Thus, this takes anatomy to a humble footing, which obliterates the elitism of anatomical knowledge and allows the public to appreciate, consume, and eventually generate a thirst for education on the health sciences (
Preuss 2008). In this light, we see Body Worlds not only as a pioneer in the field of on-ground amusement, tourism, and education, but a radical force against the exclusivity of knowledge.
Evidence to this are transcripts of non-medical professional visitors trying to use the plastinates as educational visual aids as they discuss to others a biological process. A transcript included in
von Lehm’s work (
2006) was about a mother describing the process of giving birth to her young daughter and son. After the discussion, the son said labor must have hurt. On the other hand, the young girl reiterated her mother’s quite scientific discussion as a baby being pushed out of a hole, which is of course an acceptable idea restatement considering her youth. Responses obviously prove anatomical education, even at the most superficial level (
von Lehm 2006). Apart from this, the specimens showing how diseases corrupt body parts instill among museum goers that one’s exterior is never an accurate depiction of one’s health. More important than fear, awareness brought by inculcating in those who see the interior damage may possibly convince them to seriously and proactively take medical steps to maintain a good state of health (
Stephens 2007).
A person who is willing to donate his body to the cause of science may do so, provided that a facility is willing to accept such a donation. A facility can use this body to carry out experiments that may lead to improvements in investigative vigor and rigor, among other elements. A scientist and an artist, and these are not separate persons, can impart knowledge in a manner that provokes inquiry without provoking the disgust that is unavoidably elicited by the smell of rot (
IfP 2008).
Granted, Dr von Hagens has repeatedly pushed the envelope with several years’ worth of Body Worlds exhibits. Among the whole-body plastinates that I have seen, I can identify several that I can reasonably infer to cause discomfort to those with lesser intestinal fortitude. Specifically, the plastinate of a man with his own skin draped over his arm can cause either wonder or alarm. Plastinates with exposed genitals may discomfit those with more conservative outlooks, as would the plastinate of a pregnant woman. However, I submit that this pushing the envelope is necessary to foster awareness of anatomy and motivate people to ask questions that otherwise would not have occurred to them. I bring my own biases to bear on the discussion: if something is offensive to someone, then that someone is free to be offended and not attend to that something. What that someone is not free to do is to call for that something to be stopped merely on the basis of offense caused.
Another bromide used by those opposed to the idea of plastination is that of “dignity” (
Fischer 2007). The question of dignity is particularly sensitive as the long enduring feuds between science and art, science and religion, and art and religion have also revolved around the singular fundamental philosophical inquiry on the ownership of the human body (
Moore and Brown 2004a). I daresay that the word is challenging to define, in the same manner as defining pornography is difficult (
Wetz 2007), specifically Associate Justice Potter Stewart’s “I know it when I see it” in Jacobellis vs Ohio. Allegedly, the dignity of personhood is being violated by having bodies exhibited in such a manner. However, such an assertion leads to more questions to be answered. For instance, who decides what dignity and being dignified are? Is it religious authority that decides what is dignified at the time of death? Is it not more dignified for a person to be able to give clear directions in the conduct of his life and quite possibly, after it?
To the point of religious authority, I have been furnished an explanation which asserts that our bodies do not belong to us (
Fischer 2007). Specifically, 1 Corinthians 6:19 reads: “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own” (
Fischer 2007). As a critical thinker first and as an atheist second, I find the assertion unacceptable. Assuming that there is a god who has given such a body, then this god is ungenerous, one who gives a gift but attaches conditions to it.
We must not forget either that death has been on display, even before the first plastinate was ever mounted. From Tibetan sky burial practices to the conventional wake, death is visible. I submit that it is the influence of culture and religion that tells us what is dignified, and by implication, what is undignified. If for Tibetans, the act of leaving a body to decompose on a mountaintop and be consumed by carrion is dignified, there are no sufficient and cogent reasons to call the practice undignified simply on the basis of our not following the same practice (
Wetz 2007). Looked at from another manner, I would like to know where the dignity of the dead can be found when the dead is lying in a coffin while the rest of the living are talking and rehashing the circumstances of his death. When someone’s death turns into an impromptu reunion of the living, is there genuine dignity in the experience?
In the Muslim faith, a body must be buried as soon as possible, usually within 24 h. Cremation is explicitly forbidden. Burial is followed by a three-day mourning period. As a third-generation Filipino-Chinese, I have been exposed to traditional Chinese burial customs and rites. Among those that I have been witness to are the folding of paper stamped with the name of the decedent. The overarching belief behind this activity is that the paper will be used by the decedent as money in the afterlife. Another custom is the creation of papier-mâché artifacts, houses and automobiles for instance. Again, the logic here is that the decedent will use these in the afterlife. After the death and burial of my paternal grandmother over two decades ago, we observed a one-year mourning period, definitely longer than what would have been called for had I been born to a Muslim family.
The breadth of practices concerning death suggests that no one has an accurate idea of what happens in the afterlife. I would thus rather consider prospects that are empirically verifiable, prospects that are useful in the earthly realm as it were.
Pihlstroem (
2015) describes death as the ultimate challenge to our attempts to maintain control over our lives. I look at the multitude of practices concerning death as effete attempts to control lives and deaths; I look at plastination as a better attempt in retaining control over life and death at the very least.
The human body is subject to interpretation similar to a text endowed with metaphysical features. Interpretations may be that of a prophet or Prometheus. The investigation is dichotomous; perception may be from beliefs of healing and a positive life or of rationality and independence (
Moore and Brown 2004b).
I choose independence in thinking and acting. As a result, dignity, to me, is in self-determination (
Wetz 2007). Dictionary definitions refer to it as the quality of being worthy, honored, or esteemed. What better way of being worthy, honored, or esteemed is there than to be able to determine what happens to one’s self? Signing the forms was easy; assuaging the doubts of significant others was not. Even as my spouse has been fully informed of my decision, her approval is tentative. I recognize that even as I have made the effort to determine a possible outcome for myself, there is in a possible universe of outcomes at least one outcome that may see her ultimately not fulfilling my request to have my body donated. I approach that outcome with acceptance; after all, should I predecease her, she will live with the consequences of any decision she makes, while I remain dead. It is of course my desire that my instructions be followed, but I will never hold it against her if she does not. Such an approach, to my mind, is fair: I have explicitly stated my wishes and at the same time recognize her independence and agency in implementing these wishes. Even as I have attempted to determine outcomes for myself, I recognize full well the role that a truly significant other has in the final outcome.
Another significant other, my brother-in-law specifically, was clear and explicit in his misgivings. This was surprising to me, as our relationship has always been marked by mutual acceptance and tolerance of our different philosophies and lifestyles. I surmised that for him to have expressed his misgivings so clearly meant that the idea was sufficiently alarming to him. Even in the matter of getting the Body Donation Form witnessed, I saw how the self is ultimately determined with others. On one hand, my brother, an anesthesiologist, signed as one of the two witnesses on the Body Donation Form with nary a complaint. On the other hand, the second witness was my manager at Hewlett-Packard at the time, an Indian national. While he signed the forms, we had a lively exchange of ideas weeks after that day. Apparently, he had shared the experience with his mother, who was aghast at the entire idea. In so many words, the reason behind the horror was how it went against their culture.
In that conversation, I was reminded that human curiosity has always been the engine that has driven progress, which has often taken place only when socially accepted norms were violated (
IfP 2008). I was further reminded by what my contact at the Institute said that it had stopped accepting donors into the program, because there are well over 10,000 donors on tap. Even if we assume for the sake of argument that only a small percentage of these donors will actually make it to Heidelberg or Guben, there is still a significant number to deal with, given the length of time for the plastination process to be done.
My personal take is that life is a pilgrimage that we have been unwillingly thrust into. Choosing how our mortal coil is disposed lessens the part that is left to chance, a prospect I am comfortable with. The conventional ways of burial and cremation no longer appeal to me; the decomposition, whether in the span of years or hours, do not make for much utility. It is my hope to be useful even after death, whether I am reduced to a model of blood vessels or maintained as a whole body plastinate. I entertain no notions of immortality; my repeated bouts with eye disease have made me even more keenly aware of the finitude of my stay on this earth. It is my hope to be useful even with, and alongside, the anonymity that comes with being a body donor.