How to conceive the dignity of the dead? A dispositional account.

In dealing with human corpses, notions of dignity play a decisive role, especially within legal texts that regulate a corpse's handling. However, it is quite unclear how the claim "Treat human corpses with dignity!" should be understood and justified. Drawing upon examples and problems from forensic medicine, this paper explores three possible lines of interpreting such demands: (a) positions that closely link the dignity of the human corpse to the dignity of the former living persons and (b) accounts that derive the dignity of the dead from consequentialist considerations. We argue that both lines heavily rely on contestable metaphysical claims and therefore propose an alternative account for the dignity of the dead. Our proposal (c) focuses on action-guiding attitudes and the symbolic value of the dead. Such a conception allows for a variety of morally appropriate groundings of individual attitudes. It avoids metaphysically troublesome premises and, at the same time, allows to classify certain actions and manners of acting as clearly inappropriate and blameworthy.

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.

Gender differences in homicides. A comparative analysis of 106 fatalities in forensic autopsy data.

While most homicides worldwide are committed against men, women and girls are disproportionately affected by domestic violence and its fatal consequences. The Istanbul Convention mandates the prevention of gender-based violence, particularly against women. This study analyzes the characteristics of male and female victims of homicides to provide a comprehensive understanding of the different situations and ways in which men and women are killed. Files of 106 forensic autopsies of homicide victims aged 14 years and older (51.9% males, 48.1% females) from 2012 to 2019 were reviewed. Demographic data, previous history with a focus on the perpetrator-victim relationship, substance influence, type of violence and law enforcement data were recorded. A gender-separated statistical analysis was carried out. Male victims were killed most often outside their own home (63.6%) by acquaintances or friends (54.5%). They were frequently under the influence of substances (56.4%). The perpetrators suffered from addictive diseases in 49.1%, and 52.7% had prior convictions. In both groups, stab/cut injuries were the most common causes of death, but stab/cut and gunshot injuries occurred more frequently in male victims. Female victims were killed most often in their own homes (76.5%) by intimate partners (62.7%). Compared to male victims, violent asphyxiation and blunt force trauma were more common causes of death. Furthermore, there was a higher frequency of multiple injuries (33.3%). The prevalence of a guilty verdict of the perpetrators was nearly equal in both groups. Gender-specific aspects should be considered when investigating homicides and establishing prevention and intervention strategies for interpersonal violence. Protective concepts are easier to establish in the public sphere than in private homes, which is why homicides against women require special attention in society, law enforcement, and legislation. Significant gender differences were found in the circumstances and the perpetrator-victim relationships of homicides. Gender-specific aspects should be taken into account when investigating homicides and developing prevention and intervention strategies. Homicides against women require special attention in society, law enforcement and legislation.

Comparison of the quality of clinical forensic examination of victims of physical violence conducted by clinicians and forensic examiners.

INTRODUCTION: The Istanbul Convention calls for comprehensive care for victims of violence while maintaining forensic standards. After violent crimes, court usable documentation of injuries and securing of evidence is essential to avoid disadvantages for those affected in criminal prosecution. MATERIAL AND METHODS: This retrospective study compares forensic relevant aspects in clinical forensic examination of victims of physical and sexual violence conducted by clinicians and forensic examiners. Forensic medical reports based on clinical documentation of individuals of all ages in the period from 2015 to 2018 (n = 132) were evaluated in comparison to a control group of examinations conducted by forensic specialists. A comparative statistical evaluation was performed. RESULTS: The study revealed statistically significant differences in forensically relevant aspects. In the clinical examinations, full-body examination was performed in only 37.9%, and concealed body sites were examined in 9.8%. Photo documentation was often incomplete (62.4%), without scale (59.1%), blurred (39.7%), or poorly exposed (31.2%). Information on size, color, shape, and texture of injuries was often missing. In about every third examination, the findings were not described purely objective. A body scheme was used only in 8.3% of the clinical cases. DISCUSSION: In order to establish nationwide care structures and the forensic standard required in criminal proceedings, intensive involvement of forensic medicine is essential. Standardized examination materials, regular training of medical staff, and telemedical approaches can improve the care for victims of violence regarding criminal prosecution.

The dignity of the human corpse in forensic medicine.

Working with the dead is a very specific kind of work. Although a dignified handling of the corpses is demanded by the legislator and by the general public, neither the legal status of the corpse is undisputed nor is it obvious what a dignified handling of the deceased should consist of. In our hypothesis generating pilot study, we asked which concrete considerations are involved in daily practice of forensic specialists. We used an online questionnaire (invitations via e-mail) consisting of questions with single choice, multiple choice, and free text entries. The answers to single or multiple choice questions were displayed in pivot tables. The data was thus summarized, viewed, descriptively analyzed, and displayed together with the free text answers. 84.54% of the physicians and 100% of the autopsy assistants stated that considerations concerning the dignity of the deceased should play a role in daily autopsy practice. 45.87% stated that the conditions surrounding the autopsy need improvement to be ethically suitable. The analysis of the survey's results was based on Robert Audi's ethics, according to which three aspects need to be lightened in order to evaluate the conduct of a person morally: the actions, the motivation, and the way in which the actions are carried out. This systematization helps to identify the need for improvement and to make the vague demands for a dignified handling of corpses more concrete.

An unnatural death by propan-1-ol and propan-2-ol.

A fatality of an inpatient ingesting a disinfectant containing ethanol, propan-1-ol, and propan-2-ol is reported. The alleged survival time was about 1 h. Major findings at autopsy were an extended hemorrhagic lung edema, an edematous brain, and shock kidneys. Concentrations of alcohols and acetone, a major metabolite of propan-2-ol, were determined from body fluids (blood from the heart and the femoral vein, urine, gastric contents) and tissues (brain, muscle, liver, kidneys, lungs) by headspace/gas chromatography using 2-methylpropan-2-ol as the internal standard. All samples investigated were positive for propan-1-ol, propan-2-ol, ethanol, and acetone except stomach contents, where acetone was not detectable. The low concentration of acetone compared to propan-2-ol likely supports the short survival time. The concentration ratios estimated from the results are in accordance with the physico-chemical properties of the particular alcohols, their different affinities towards alcohol dehydrogenase as well as their interdependence during biotransformation. Autopsy did not reveal the cause of death. According to the few published data, blood concentrations of 1.44 and 1.70 mg/g of propan-2-ol and propan-1-ol, respectively, are considered sufficient to have caused the death. This case also points to the need to restrict access to antiseptic solutions containing alcohols in wards with patients at risk.

Indicatory external findings in two cases of fatal cervical spine injury.

A fatality of an 83-year-old female experiencing acute circulatory failure as a result of a type II odontoid fracture is compared with the case of an 86-year-old female who died from delayed cardiopulmonary complications due to a lower cervical spine injury. Falls on the forehead from minor height can cause odontoid fractures especially in elderly patients, hyperextension of the neck on the other hand can lead to lower cervical spine injury with prevertebral hematoma. The latter can lead to extensive hematoma of the neck, but might be difficult to diagnose by computed tomography in the living patient. Especially in cases of elderly patients showing bruises on the forehead or extensive neck hematoma, the possibility of cervical spine fracture should be taken into account and postmortem examinations should be arranged commensurately.

[Inspection of the corpse]. / Die Leichenschau.

In Germany the postmortem examination has to be performed by a physician. It has to include the determination of at least one sign of death, a statement about the time and cause of death and the distinction between a "death by natural causes" in the sense of the law and its opposite.

Ammonium chloride influences in vitro-neuronal network activity.

UNLABELLED: The objective of the present work is to image functional alterations in hepatic encephalopathy (HE) by ammonia-induced changes of in vitro-neuronal network activity and to identify counteracting strategies. Synchronous bursting behavior of rat cortical cells which is the result of synaptic interaction of excitatory and inhibitory neurons was recorded in vitro on microelectrode arrays (MEAs) after ammonium chloride exposure. In order to test the involvement of astrocytic glutamine metabolism and N-methyl-d-aspartic acid- (NMDA-) receptor function in the observed ammonia-induced network dysregulation and to identify potentially protective strategies, we investigated effects of the glutamine synthetase (GS) inhibitor methionine-sulfoximine (MSO) and the NMDA-receptor antagonist DL-2-Amino-5-phosphono-pentanoic acid (AP-5), respectively. We observed a characteristic ammonia-induced increase of global network activity while network synchrony was suppressed. The increase of global activity, but not the suppression of network synchrony was prevented by inhibiting GS. However, blocking NMDA-receptors prevented both, network excitation and desynchronization. CONCLUSIONS: 1. The observed desynchronization of in vitro-neuronal network activity after ammonium chloride treatment might reflect global neuronal network changes in HE in vivo and suggests the MEA technology as a valuable tool for measuring changes of neuronal connectivity in vitro. 2. Astrocytic glutamine metabolism might be involved in increased global network activity, but not in the suppression of network synchrony. 3. Overactivation of NMDA-receptors might underlie both, the ammonia-induced increase of activity and suppression of network synchrony, suggesting that NMDA-receptor function is involved in HE and that their blockage might be protective. 4. Measuring neuronal network activity in vitro by the MEA technology might help to describe functionally protective measures in HE.