Autopsy Simulator is one of the most realistic games I've ever played, and it shows off the best and worst of the sim genre

My gripe with Autopsy Simulator is that it's inconsistently brilliant. Sawing off a corpse's head, pulling its brain out, and being treated to the best and most bizarre use of jiggle physics I've ever seen is up there as one of my favorite experiences of the year, but I also find something lacking. Or perhaps it's the other way around. Much like the food stuck in Jane Doe's trachea, there's something here that shouldn't be, and it's ruining all my fun.

Eye of the needle

As the name suggests, Autopsy Simulator is an in-depth and realistic simulation experience that puts you in the shoes of a pathologist. Taking up the mantle of a pseudo-detective for the dearly departed, your job is to examine bodies and determine the cause of death, all while our player character battles with his own personal demons. 

If the pitch sounds familiar to you, that's because DarkStone Digital's The Mortuary Assistant already exists. I'd go so far as to consider it one of the best horror games of recent years, balancing satisfyingly methodical embalming sim gameplay with a truly harrowing story that leads toward one of six unique endings to collect. I wanted to give Autopsy Simulator a fair shot without comparing the games too heavily, but with post-mortem body horror sims being an incredibly niche subset of the genre, I'm interested in how each game does a similar thing in markedly different ways.

Autopsy Simulator starts off strong in its effort to stand apart. Woodland Games' commitment to anatomical and professional accuracy means that all of the autopsy processes we play through have been designed in tandem with trained morphopathologist, Eric Benjamin. A wealth of forensic investigation tactics are at our disposal, from taking blood samples from eyes, hearts, and bladders to test them for drug levels to slicing open stomachs, weighing livers, and examining lung fluid under microscopes to discern whether a supposed drowning victim was dead before submersion.

Pathological analysis is performed by way of minigames, largely consisting of clicking and dragging or moving your cursor to trace shapes. The level of precision works very well in some places, bringing attention to the clinical methodologies in practice, but heavy realism doesn't always gel mechanically. The scalpel turns your cursor into a rather large icon of one, for example, its fixed-point angle obscuring the delicate Y-incision lines that you need to see in order to open the chest cavity. Still, given my fascination with mortuary sciences in general, I have the time of my life cracking ribs and disemboweling my dead patients with gusto. 

It should not be surprising that a game called Autopsy Simulator shines brightest when conducting simulated autopsies. The element of frustration comes when I'm forced to untangle not only the small intestine, but the sparse narrative threads tying each procedure together as well.

Trimming the fat

Autopsy Simulator is pitched on Steam as a "horror-sim hybrid", but unless you are squeamish about guts and medical procedures, the story is more of a psychological drama. Truth be told, I am relieved that Woodland Games will be adding an Autopsy Only mode to the game at a later date, because story mode is its current fatal flaw.

Autopsy Simulator shows the challenges posed by applying strict narrative rules to a game of its genre. The methodical nature of simulators is supposed to lull us into a sense of formulaic calm as we memorize each step in a new  process. There's a peacefulness in the mundane, in the rote nature of carrying out a task and doing it correctly. But for all the detective work ascribed to a job like a pathologist's, there is a disappointing lack of actual investigation in Autopsy Simulator, and it's all down to the storyline.

The consequence is excessive hand-holding. Our protagonist is constantly chattering away to himself, explaining his findings to a tape recorder or video camera instead of letting the player reach those conclusions. That's because there is nothing for us to actually figure out. Where The Mortuary Assistant sees players using the embalming process as one of elimination, working against the clock to identify a demonic vessel and banish it before getting possessed themselves, Autopsy Simulator as it stands today is purely about following instructions to get to the next narrative beat.

Unfortunately, that makes each autopsy just a means to an end. There doesn't seem to be any randomization at play, meaning the bodies you examine across the game's five chapters will always be the same, no matter how many times you replay it. There is no way to mess up, as messing up isn't written into the story. There are no real dangers put to you while you work – the flashbacks of your dead wife are quickly banished after choking down some pills. It all boils down to one sad fact: the game's story mode is so restrictive and objective-focussed that there's no room for player agency or discovery.

Once I realized how Autopsy Simulator's linear storyline effectively robs us of the detective fantasy, I found it hard to stay invested. So much research and passion has gone into its investigative procedures that I feel Woodland would have been better placed sticking to the shape of a more traditional simulator. Turning something as interesting and clinical as forensic pathology into a horror game without actually making it a horror game feels like a misstep, and it makes me question the game's intentions. Are we meant to find dead bodies scary purely because they are dead bodies? Or are we meant to see them as intriguing mysteries to be solved, shining a light on an important profession that many of us know little about? If Woodland is able to deliver the latter in Autopsy Only mode, I'll be elbows-deep in those putrefying entrails before you can say "coroner".

Check out all of the upcoming horror games still on the horizon for 2024 and beyond.