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Abstract
This paper explores the idea of death spaces, in particular the ways that diverse, at times disruptive, meanings about the dead are inscribed in mortuary spaces. The author draws upon data from an ethnographic study based in a hospital's Department of Anatomical Pathology to introduce the concept of three co-constructed spaces: that of sentiment, science and spirit. The author explores the daily interactions between the living and the materially dead through description of perceptions and practices that form the discursive space of the mortuary.
Acknowledgements
This research is a PhD project supported by an Australian Postgraduate Award Scholarship. Ethics approval was granted by the University of Melbourne and ‘Hillside Hospital’ Human Research Ethics Committees. I am grateful to the many staff of Hillside, most particularly those of its Department of Anatomical Pathology, who opened their workspace to me and shared their views. I also greatly appreciate those relatives of the deceased patients who shared their personal stories.
Notes
Notes
1. Across Western Hospitals, the rates of medical autopsy have dropped from the heights of the 1950s – 60–80% of deceased patients – to national rates well below 10% in countries such as Australia, USA and Britain. Such autopsies require the consent of family members and are different to forensic autopsies often required under Coroners’ Acts in Australia.
2. ‘Hillside’ is a pseudonym for a large teaching hospital in Melbourne, Australia.
3. For evocative descriptions of such areas see the work of medical ethnographers such as Cassell (Citation1998, Citation2005) and Timmermans (Citation1999).
4. I develop the concept of ‘the chimeric’ or tripartite corpse in work in progress.
5. I use the term ‘family’ here to refer to biological or social relationships accorded the authority for autopsy decisions and disposal. Under Victorian state law these include same-sex partners and the wider kinship responsibilities of Indigenous communities.
6. In this hospital (as with many others) the mortuary areas are part of the Department of Anatomical Pathology. They encompass all the areas where bodies or identifiable parts are present: the Cold Room (body storage), the private lift and mortuary reception (for body deliveries and departures), the Necropsy Room (adult autopsies), the Specimen Preparation room (foetal autopsies and autopsy review meetings), the Viewing Room (for relatives) and specimen storage areas.
7. In Victoria, where my fieldwork was conducted, in 2004–2005, 56.6% of deaths occurred in public and private hospitals and 30.5% of deaths occurred in nursing homes. The remaining 13% died at home or in a public place. In Australia overall, the institutionalisation of death was well underway in the late nineteenth century, with one-third occurring in public institutions by 1920 (see Jalland Citation2006).
8. Borrowed from Casey's notion of the concreteness of ‘being-in-place’ (Casey Citation1993).
9. The period of time individual bodies are held in public hospitals can be a few hours to two or three days, dependent on the relatives’ engagement of a funeral director, the time of death, cultural requirements for disposal and the kin's consent, if any, for a post-mortem examination. In hospitals with palliative care units, bodies are sometimes discharged directly from the bed to a funeral director, via authorisation through the mortuary.
10. Western mortuary practices are broadly similar processes. However, the work of Hillside's mortuary bears little resemblance to others sited with vastly different ethnic/cultural and medical contexts (see for example van der Geest Citation2006 and Brysiewicz Citation2007). At Hillside, the mortuary is well staffed and maintained, and most patients are elderly people dying of ‘natural causes’. Additionally, in Victoria a central mortuary, based at the Victorian Institute of Forensic Medicine, receives all the Coroner's cases for examination (unexplained deaths, accidents, suicides etc.).
11. The various state Anatomy Acts in Australia, instigated in the mid-1800s, have always allowed for such monitoring but this has been a largely disinterested and symbolic practice until recently (Parker Citation1999). More stringent processes are currently in place. For instance, in relation to the hospital I will describe, these include its Mortuary Methods and Procedures Manual (2004), the Victorian Human Tissue Act 1982, the post-mortem guidelines of the Royal College of Pathologists Australia (October 2003), the NATA Guidelines (Australia's national laboratory accreditation and inspection body), and the National Code of Ethical Autopsy Practice (Australian Health Ministers’ Advisory Council Citation2002) among others.
12. In the late 1990s, it emerged that hospitals across England and throughout Western countries, including Australia, had harvested thousands of organs from dead children without their parents’ consent. In the foremost case, Alder Hey hospital, organs had been permanently removed from 800 children without their parents’ knowledge or permission. Governments reviewed policies to ensure that relatives fully consented to any hospital procedures involving the dead.
13. The hospital aims to accommodate diverse cultural practices, for instance Buddhists need to leave the corpse undisturbed for eight hours. Its internal website lists a range of expected ‘standards’ in the form of fact sheets for the care of deceased patients who are Japanese, Hindu, orthodox and liberal Jews, Buddhist, Christian, Hmong, Vietnamese and Islamic. It also directs staff to contact its Indigenous unit in case of such deaths.
14. I employ the term as utilised by Fajans (Citation1983, 166): sentiment as ‘culturally constructed patterns of feeling and behaviour’ which bind us to a social entity, for example, honour and respect.
15. What appear in as ‘public’ entrances and exits of the mortuary – through the Viewing Room and the Mortuary Lift – are locked and keyed to allow only AP and select hospital staff access. AP's public reception is supervised to ensure that only authorised people are allowed beyond the waiting area.
16. Policy of the Royal College of Pathologists Australia, section 4.6.5, October 2003.
17. This dissatisfaction with the state of mortuary spaces is by no means confined to Hillside. Hospital staff in other countries (e.g., The Netherlands, Ireland) have expressed unhappiness with the look and maintenance of areas that families visit, with some arguing it should be treated as ‘sacred space’ within a scientific realm (Norwood Citation2006; O’Mahony-Browne Research Consultants Citation2005).
18. With the exception of an operating theatre when organ harvesting is underway on a ‘brain dead’ patient.
19. For instance, the Australian Broadcasting Corporation's four-part documentary, Dust to Dust (August 2005), was a behind-the-scenes look at the Sydney funeral industry.
20. Ironically, while medical students have a largely automatic entré as autopsy spectators, it is increasingly rare for any to avail themselves of the opportunity. One day, while sitting at the desk in the reception area, I noticed a pink hand-written note taped to computer: ‘Med students to view autopsy – pg xxxx – Susan, Vicky, Mary’. Permission was sought and approved through the Mortuary manager. This rare note sat there for some time, suggesting problems created by the current scarcity of autopsies, the ad hoc nature of their occurrence and the students’ availability.
21. Of course I acknowledge that many staff members have also experienced the death of family members, including some as patients at Hillside.
22. The Victorian Government Guidelines and the national code on autopsy practice (Australian Health Ministers’ Advisory Council Citation2002) make no mention of family viewing of an autopsy other than a vague principle in the latter that ‘The family must be consulted and given the opportunity to be involved to whatever extent they wish to be.’
23. In at least one Jamaican hospital, a pathologist has written, it is a common and ‘acceptable practice’ to have half a dozen family members present during the post-mortem, although ‘not infrequently a few got sick, vomited or left before we were finished’ (Obenson Citation2003).
24. Jewson introduced the term ‘medical cosmology’ to describe ‘conceptual structures which constitute the frame of reference within which all questions are posed and all answers offered’ (255).
25. I develop the central role of time in relation to death, place and perception in another work in progress.