End of' or 'start of' life? Visual technology and the transformation of traditional post-mortem

Dissection of the human body has played a central role in the practice of autopsy in England since the 16th century. From the 19th century onwards a number of technologies have been employed by pathologists to inform this process. For example, microscopes were introduced to analyse cells in the body, X-ray's to identify problems in the skeleton.

Until recently, traditional practices such as these have remained the main way to establish cause of death in humans. Now, however, visual technologies used in hospitals such as Magnetic Resonance Imagining (MRI), are starting to be applied to certain areas of autopsy. Pregnancy loss and neonatal death are examples where the use of visual technology is particularly innovative and their use offers considerable practice and patient benefits, enabling the cause of death to be established without the need to dissect the body. At the same time, the technology produces an image of a baby which can be treasured by the parents forever and contribute to the parents' experiences of 'life', 'loss' and the memorial process.

With technological advances set to transform the centuries old practice of autopsy, our understanding of the boundaries between life and death are becoming equally subject to change. Such change requires the need for research that goes beyond disciplinary boundaries and examines the impact of visual technologies when used in autopsy. Responding to these developments, this project will consist of an interdisciplinary team. Building upon recent work conducted by Dr Reed (PI) on the rise of MRI use in the area of obstetric medicine, autopsy has been identified as an area undergoing transformation by visual technologies. The project will be based in a unique site, developing a case study of the mortuary at Sheffield Children's Hospital.

The PI & supporting research team will carry out an in-depth ethnographic approach drawing on a range of methods and encouraging respondents to participate in every stage of the research through an advisory group. Project staff will work closely with two pioneering UK specialists within the NHS whose works are at the forefront of fetal and paediatric pathology and imaging: Dr Elspeth Whitby (Consultant Radiologist) and Dr Marta Cohen (Consultant Pathologist). Similarly, Dr Reed (PI) an experienced medical sociologist and Dr Ellis (Research Assistant), have significant experience of conducting qualitative research in the sensitive area of neonatal loss and bereavement.

This study comes at a critical time. With increasing investment of private and NHS funds in visual technologies, it offers a much needed and timely contribution to broader debates on the ability of biotechnology to redefine the boundaries between life and death, human and machine. As the title suggests, this project, "'End' of' or 'start of' life?" will address the practical and emerging questions of how visual technologies inform, or advance, the practice and policy of health care professionals. It will also ask what they can contribute to the parents' experiences of 'loss', 'life' and memory and the implications this has for our current understanding of the space between 'life' and 'death'. Where does this space begin, or end? How might the use of visual technologies and the imaging potential they offer, redefine our understanding of these perceived 'boundaries' and what impact might this have for parents, practitioners and more broadly, the further application of visual technologies in other areas of the health care profession? The implications for the academic community, for practitioners, for parents and for organizations that support parents through their experience of neonatal loss, are significant.

Who will benefit?
This research will have three, specific key groups of beneficiaries as well as provide more general benefits to wider society. The research will have impact for parents who have experienced pregnancy, stillbirth or neonatal loss; health professionals involved in MRI use in autopsy; and the manufacturers of MRI machines

How will the research benefit them?
1. Research will benefit bereaved parents by providing information about potential choices they may have over fetal and infant autopsy. It will also raise general public awareness around prenatal and neonatal loss.
2. It will contribute to the ongoing professional development of pathologists and related professionals through the emergence of professional guidelines and educational materials on visual technology use in autopsy. It will also provide clinicians with information about how parents and other professionals feel about the use of this technology.
3. It will ensure that UK policy on autopsy is developed and applied in a way that is sensitive to practitioners and parents;
4. As this is a novel application of the technology, feedback obtained via advisory group will benefit the manufacturers and feed into future research, design and application of the technology.

How will we target key beneficiaries?
1. We will set up an advisory group with parents, professionals and representatives from industry. The AG will be used to ensure that the three main groups of beneficiaries have input into the research at every stage, from identifying respondents, to interview design, data analysis and dissemination of findings.
2. Professional impact will be developed through the production of educational materials targeted directly to professional organisations (e.g. Royal College of Pathology).
3. NHS and Clinical Research Networks (CRN) will be used to develop national policy on visual technology use in autopsy.
4. A collaborative studentship application will be developed with Siemens to explore the application of this technology from a manufacturers perspective
5. The study will have a dedicated website which includes blog space for user groups
6. An exhibition will be held in two locations. The exhibit will be called 'imaging across life and death' and will be aimed at user groups and public, both in Sheffield and London.
7. We will conduct outreach work in school. We will use images and artefacts from the study to talk to children and teenagers about sensitive topics relating to issues of life and death. This outreach work will be conducted as part of national curriculum subjects such as SRE (Sexual Relationship Education).
In order to ensure that potential beneficiaries have the opportunity to benefit from the research we shall:
1. Publicise it via our own and the ESRC web sites
2. Attend a number of the most appropriate national and international conferences in order to formally present our papers and to present posters relating to our work and to engage with other researchers.
3. Exploit our existing network of contacts within the NHS to ensure that the research has direct user group and policy implications
All those involved in the project have a great deal of experience in communicating their research to practitioners. They are often invited to provide short articles for such audiences and are well connected in this respect. All have experience of working with the media, thereby ensuring a wide dissemination of their work.