The Human Cadaver:
An Assessment of the Value We Place on the Dead Body
D. Gareth Jones
Department of Anatomy and Structural Biology
University of Otago
PO Box 913
Dunedin, New Zealand
From Perspectives on Science and Christian Faith 47
(March 1995): 43 - 51 .
© 1995 Americian Scientific Affiliation
The dead human body has failed to elicit much theological interest, and until recently, little ethical interest. However, many issues are forcing it into the center of ethical debate. These include the donation of cadaveric organs, fetal tissue transplantation, and what we do with archaeological human remains. This paper is an attempt to provide a backdrop to such issues by investigating the ways in which we treat dead human bodies, and specifically issues emanating from the way in which human cadavers historically were obtained for medical school purposes. My aim is to uncover crucial ethical principles for contemporary society's use of human material and human tissues. Throughout this analysis, there is an awareness of Christian perspectives to discover ways in which they may prove important in this debate.
It may seem exceedingly strange to devote attention to the value to be ascribed to the dead body or to ethical issues surrounding the dead body. After all, it may appear that there are few ethical issues surrounding dead bodies in comparison with living bodies and living people, where ethical constraints are undoubtedly required.
Tempting as this emphasis on only living bodies may be, it ignores crucial facets of current debate within bioethics. Although the debate is frequently focused on elements other than the value to be placed on the dead body, many diverse issues are liked by a common thread - society's attitudes toward the dead body. Some of these issues have existed for many years. A well-known historical example is the nefarious means of obtaining human cadavers for dissection in medical schools two hundred years ago. A more recent example is the growing ethical sensitivity about the study of archaeological human remains. In addition, the possibilities opened up by organ transplantation (including fetal neural transplantation) have brought to the fore important questions concerning how cadavers are to be treated. In this paper, my aim is to illustrate the intimate connection that exists between the valuation of the human body in death and the valuation of human beings during life. I shall also attempt to demonstrate that this is a debate in which Christians have a stake.
What to do with the Dead Body?
Imagine a world with a totally different view of the human body from anything remotely like the one we now have. In this other world, dead human bodies are regarded as of no significance with no monetary, spiritual, or sentimental value; people regard them as garbage. Consequently, when someone dies, instead of going to the expense and trouble of arranging a funeral with a funeral director, people do what they like with the bodies. It is a matter of individual choice and taste.
Inevitably, there will be some restrictions, if for no other reason than that bodies deteiorate. Poor people may throw the bodies away. They simply buy a cardboard `body box' from the supermarket, place the body in it, and put the box out with the garbage to be picked up with the next collection. People with gardens may decide to burn the body. This would be more difficult, and there would probably be a few restrictions, all of which would cost money. Nevertheless, it would still be far cheaper than employing a funeral director.
People with more financial resources may decide to get their loved one preserved, just as anatomy departments currently preserve bodies. Then the preserved corpse could be displayed in the clothes they wish to remember him or her in. The suitably-dressed corpse could be put in a position of honor in the living room, in a large case perhaps, with doors that could be opened whenever desired. An alternative would be to get the flesh removed, and merely keep the skeleton. That, too, could go on display.
A further possibility for the research-minded is to donate the body to some worthy cause. Let us imagine that a research group is experimenting on the effects of automobile crashes on the driver and passengers. It would be far more realistic to use real human bodies than artificial models or computer simulations. This use of dead human bodies may even prove of value for the living, and may be viewed as exemplary ethically since it would benefit others.
Such a macabre scenario seems frivolous, but its message is not the dead body should not be taken too seriously. What does such a world tell us about attitudes toward the dead body? Is it ethical to act in certain ways, and unethical to act in other ways? Is it nothing more than a matter of mere preference if one person arranges for a funeral director to bury his or her mother and another throws his or her mother's body on the local tip?
It is only possible to act as I have imagined if no value is placed on the human body. We can only dispose of it as we dispose of rats or mice, if we consider human beings to be disposable. One laboratory rat is like any other, and one human being is like any other; neither is there any difference between the rats and the humans. But do we think like this? After all, when one's favorite dog dies, we do not dispose of it without a second thought. We may not treat it exactly like the remains of our grandmother, but if it has meant something to us, we are aware of our loss and we treat the remains of the dog in a way that we consider is appropriate to our feelings during its life. In other words, most people have deep moral intuitions, which point toward valuing the dead remains of human beings in special, respectful ways consonant with what they were as human beings when alive. In the same vein, when we see pictures of corpses being dumped into mass graves after a holocaust, we are horrified. Such a sight touches something very deep in our moral sense of right and wrong; we recognize that this is a form of indignity, and we react appropriately. Not only this, but we would be even more horrified if one of the bodies was that of someone close to us.
Person and Bodies
Why, then, is the treatment of dead human bodies important? Several reasons have been proposed (Campbell et al., 1992). The first is that a person is so closely identified with his or her body that the two become almost inseparable. We recognize each other because we recognize each other's bodies, in particular, features such as the appearance, voice, and attitudes of each other. Although this applies during life, it is also true that some very important aspects of this identity continue following death. May (1985) has written: "...while the body retains a recognizable form, even in death, it commands the respect of identity. No longer a human presence, it still reminds us of the presence that once was utterly inseparable from it." If this is the case, it is not surprising that, in Wennberg's (1985) words: "...we don't treat human corpses as garbage, because the corpse is closely associated with persons: it is the remains of a physical organism that at one time supported and made possible personal life." This suggests that there may be a link between our treatment of the living and the dead, with the treatment of the living influencing our treatment of the dead. However, if this holds, so may the opposite, that mistreatment of the dead signifies a lowered evaluation of the living.
A second reason centers on other people's responses to the cadaver. Those who knew the person have memories of that person: what he or she was like, his or her personality, foibles, beliefs, and hobbies. In a way, therefore, the cadaver has an array of built-in memories that are integral to it. It is these memories that lead to the conviction that a corpse should be respected and treated decently. To desecrate the corpse is, in some way, to desecrate the person, though the person we knew is no longer `there.' We know that Mary has gone, because Mary's dead body can no longer do or think anything that Mary did or thought. Nevertheless, everything we remember about Mary is made even more poignant when we look at Mary's dead body. All that remains of Mary is her corpse, and yet our respect for Mary and for her memory leads us to respect her remains.
From this follows a third reason for treating a dead body decently, namely, that the deceased person was someone's relative or friend. As a result, these people are now grieving the death. Not only has Mary died, but those close to her are suffering the effects; they miss her and all for which she stood. A person has gone, and all the relationships of which that person was a part have been depleted. The living, Mary's friends and relations, are suffering a permanent loss, and so respect for the cadaver is respect for their grief. The intensity of this loss will decrease as time passes, but this is not to deny the significance of the cadaver as an integral part of the initial grieving process.
These reasons fail to provide any justification for the dissection of human bodies in medical schools, nor do they provide assistance in helping us understand why such bodies can be dismembered in ways society would not contemplate on other cadavers. Neither do they tell us why we allow organs to be taken from bodies for transplantation purposes, nor why we do not allow economics students to dissect bodies.
An initial reason, although not a very convincing one, is that society allows dissection under stringent conditions. However, this varies from one society to another; even in Western societies, attitudes have changed dramatically over the centuries. Consequently, it is essential to look for more substantial reasons, beginning with the notion that the bodies have been donated for a specific purpose, dissection or transplantation. Donation implies that the people concerned made a free and informed decision prior to their death. They decided to make a gift of their own bodies, freely willing that they should be used in this manner, for educational purposes in dissection or as a source of organs in transplantation. By acting like this, they are making a gift of something more closely identified than anything else with what they are and represent. As a result, a donation of this type revolves around the `gift' element, with its overtones of altruism by the person making the donation (May, 1985).
Ethical Principles Relating to Cadavers
Taking these concepts further, a series of ethical principles bearing directly on treatment of the dead body can be elaborated. Principles of relevance have been formulated with organ donation in mind (Vawter et al., 1990), and although they have to be adapted somewhat when used in a more general context, they constitute a useful position from which to start.
The first principle is that of autonomy. According to this, each individual should have autonomous control over the disposition of his or her body after death. Emphasis here is on what an individual decrees should or should not be done with his or her body at death, despite social need or public interest. This is a principle that has been overlooked far more frequently than it has been followed. In fact, it was ignored until the 1950s or 1960s at the earliest, and it continues to be ignored in many societies where bodies for dissection and organs for donation are scarce. The use of unclaimed bodies has become so much an integral part of the anatomical ethos that the ethical dimensions provided by the autonomy principle have been generally ignored. This is not true with organ donations, where the wishes of the deceased have been seriously taken note of, even in societies adopting an `opt out' stance (Teo, 1991).
Autonomy lays stress on the values of the individual at the center of the decision-making process. This individual, however, has sets of relationships, and this brings into focus a second set of ethical principles, those of the interests of family members. When this is allowed for, it leads to the ability of family members to override the wishes of the deceased, even when the latter has specified that his or her body is to be donated for teaching or research purposes. This is the one principle that comes through clearly in legislation governing bequests, and yet it manifests a clash of ethical principles - pitting the autonomy and interests of the deceased against the autonomy and interests of the living. The emphasis on the latter as opposed to the former may be because living family members are regarded as having greater interests, and are more susceptible to harms or wrongs, than is the dead person. A similar emphasis is frequently found in societies where the final decision regarding organ donations lies with living relatives, even if they oppose the prior wishes of the deceased.
Underlying the previous principles is a premise that the giving of one's body is preferable to being coerced into doing it. This is the principle of altruism, in which giving is better than taking, and the good of others is better than self-interest. This underlies the entire notion of body bequests, and of requiring consent for the use of organs from bodies for grafting purposes. In terms of this principle, bequests are preferable to the use of unclaimed bodies, while an opt-in scheme for organ donation is preferable to an opt-out scheme. The latter has no ethical merit, since it has no hint of being altruistic. Something (a body or organ) is taken without permission; the people from whom it is taken have no means of defending their own bodily integrity.
A further principle stems from the response of many who see death, especially premature or unexpected death, as evil or tragic. Such people may find solace and meaning in the use of body parts to help others. This is what is sometimes called the redemptive aspect of body or organ donations. The death of one person can be interpreted as conferring life on another. Out of the evil of a tragedy can come new life and hope. Such a transformation of the situation can only occur, however, if the body is willingly donated to a medical school or if organs are freely given to another in need of them. Consequently, this principle is intimately linked to the autonomy of the donor and to the altruism that the donation signifies.
Elements of a Christian Response
Up to this juncture, I have dealt with these issues in general ethical terms. In turning to the elements of a Christian response, the first one of note stems from examples in both the Old and New Testaments of the high view held of the dead body. An example is found in Amos, who specifically separated out for condemnation the crimes of one group of people who, not content with marauding, pillaging, and killing, unleashed their venom on the body of one of their enemies. Having killed the king of Edom (Amos 2: 1-3), they burnt his bones to ash. Not content with killing him, they desecrated his dead body, thereby undermining his integrity as an individual.
Another instance of the significance ascribed to the dead body is provided by Joseph who, prior to his death, had his relatives promise to take his bones with them to the land of Canaan when they were finally able to leave Egypt (Genesis 50: 22-26; Exodus 13:19). Dead though he would be, Joseph did not want his mortal remains to be left in Egypt, the land of captivity. This may have been symbolic, and yet it strengthens the notion that the dead body is sufficiently important to require commitment by others.
In the New Testament, we find that, following Jesus' death, his followers carefully and sacrificially tended his body (Matthew 27: 57-61; Mark 15: 42-16: 2; Luke 23: 50-24: 1; John 19: 38-42). They considered it inappropriate to leave his body on the cross, especially as this would have meant leaving it there over the Sabbath day. Joseph of Arimathea ensured that Jesus' body was laid in his own new tomb, while many of his followers, including Nicodemus and Mary Magdalene, were concerned that the body be anointed with spices and bound according to Jewish custom. While there are many cultural factors here, there is no hint that Jesus disapproved of their actions. There was nothing improper in looking after his dead body in this way. His followers may have underestimated the likelihood of his resurrection, but that was another matter. What is encountered in these instances is clear recognition that the dead body is to be treated with respect.
This conclusion is not surprising since there is no suggestion in the Bible that human beings can exist apart from the body, even in the future life after death. In unequivocal terms, Paul enunciated the point that the resurrection is a physical one (1 Corinthians 15:42-52; 1 Thessalonians 4:13-18), a belief foreshadowed in the Old Testament (Daniel 12:2). The biblical view, therefore, militates against any idea of humans existing apart from some bodily manifestation or form of expression (Banwell, 1980). The mortal body we now know will be replaced by a resurrection body, a form of spiritual body, which while not identical to our present material body has sufficient similarities to it to warrant the term `body.' Jesus' own resurrection body serves as the only guide we have to this (Luke 24:12, 31), with its recognizably human and personal features but also its ability to pass through material objects and leave no corpse.
Bearing this similarity in mind, we can go further and argue that respect for the dead body now foreshadows respect for the resurrection body in the future. While I am in no way suggesting there is a close parallel between the two, there would appear to be connections. A willingness to desecrate or devalue the dead body shows a disregard for what that person may become, as much as it shows a disregard for what that person has been. While it is not our prerogative to judge what any person may be like in eternity, it is our responsibility to provide support and protection as far as we know how. A Christian perspective, therefore, is to take account of this future dimension in deciding how a dead body is treated in the present, taking account of the notion that this present life is preparation for a future one. An element within this perspective is that the prior wishes of the deceased are respected as far as possible, since our body is the one common strand between what we are now and what we may become.
A Christian response has many similarities to the general ethical stance I have previously outlined. However, it goes further by recognizing that the dead body serves as a link between what that person has been and what that person may become. The body itself is an inadequate token of these dimensions, but it is all that remains. It is a reminder of the greater ongoing dimensions of human existence, of the reality of our limitations and needs, and of our mortality. We shall all die and be like this one before us who is now dead. Respect for the dead body reminds us, not only of the significance of the one who has died, but of the significance of all human life. All have been created by God, to reflect him and to serve all others, who equally mirror his image. Consequently, to value the corpse is to value the person, and to see that person as one who mirrors God. To devalue the corpse is to devalue those still alive; also to question the purposes and intentions of God in creating people in his image.
Dissection may appear to be the antithesis of these principles, amounting as it does to mutilation of the body. This is a crucial perspective from which we should not wish to escape, since its aim is to highlight the respect with which the dead human body should be treated. My argument is that the only way in which this perspective of respect and a dissecting or donation ethos can be held together is via altruism. In these terms, the sole justification for dissection within a Christian perspective stems from the altruism of the living, in that the person while alive decided to gift his or her body to a medical school to be used in a certain way following his or her death. The specific Christian thrust within this principle is that the supreme model, Jesus himself, gave up his own life for others. To give one's life for one's friends is ethically commendable, but to do it for those who are undeserving is the height of altruism (John 15:13). In first becoming a human being, and then in giving up that life voluntarily for others, Jesus showed in unequivocal terms the characteristics of a life of humility rather than of arrogance or conceit (Philippians 2:3-8). The gift of one's body after death in no way matches altruism of this caliber, but contained within it is the essence of altruism and it serves as a salutary reminder of the moral significance of even this limited form of altruism.
Against this background, I shall now consider one concrete illustration, that of the historical events implicated in the dissection of cadavers.
Obtaining Bodies for Dissection - the British Experience
Although it would be possible to use either British or American history (Lassek, 1958) in this section, I shall concentrate on the British experience since it shows very succinctly important ethical principles.
A central thesis for understanding the British history is that the Second Anatomy Act of 1832 made poverty the sole criterion for dissection in Britain (Richardson, 1988). To understand this thesis, some appreciation of the various sources of cadavers prior to 1832 is required, and it is here that we encounter the use of murderers' bodies, grave robbing (body snatching), and murder.
Early dissections in Britain (from the sixteenth century onwards) were of criminals executed for murder. The result of this was that dissection became recognized as a punishment, since it was something beyond execution itself. Following execution, the body of a murderer was normally hung on a gibbet (an upright post with a projecting arm) to emphasize the grim fate awaiting murderers by denying them burial. However, judges could substitute dissection for gibbeting, so that dissection became recognized as being as bad, if not worse than, gibbeting. Both denied burial to the murderer. Not only this, but dissection was regarded as doing something to the body beyond that already inflicted on the scaffold.
Unfortunately for these early anatomists, this means of acquiring bodies provided very few of them. Consequently, the beginning of the eighteenth century saw the emergence of another means, namely, grave robbing, which, with the passage of time, became by far the most significant means of getting bodies. The earliest grave robbers were surgeon-anatomists or their pupils, and there was often a close liaison between them and the body snatchers, with the latter providing several thousand bodies annually. However, most of the bodies stolen in this way were those of the poor.
Not surprisingly, by the early nineteenth century, these activities were frowned upon by many within society, who expressed disquiet regarding the moral and social acceptability of both grave robbing and the subsequent mutilation of the dead. The seriousness of the situation was aggravated by activities that apparently took place inside dissecting rooms, including sexual indecency and violence inflicted on bodies (Richardson, 1988). The urgent need to stop the grave robbers led to the first Anatomy Bill in 1829, recommending the use of hospital and workhouse patients (who were seen as consenting to dissection by the simple act of applying for treatment) with no relatives to bury them, or whose relatives were too poor to do so. The consequence of this move was to class the poor alongside the worst of criminals as potential subjects for dissection. It was this socially divisive aspect of the Bill that led to its rejection. Bad as this was, the situation was aggravated by the committing of murder to obtain bodies for dissection.
Around 1830, various options for obtaining bodies were being considered and, although there had been a steady stream of bequests between 1828 and 1831, this option was not taken seriously. The result was that the 1832 Anatomy Act reflected the predominant opinion within the medical profession that the most noncontroversial source of bodies would be `unclaimed bodies.' Since the Bill abolished the use of dissection as a punishment for murder, poverty became the sole criterion for dissection (Richardson, 1988), though no reference was made to the social status of the proposed subjects of dissection. As a result, in the 100 years following the passage of the Anatomy Act in 1832, less than 0.5 per cent of the bodies dissected in the London anatomy schools came from anywhere other than institutions housing the poor, that is, workhouses and asylums. It was not until the 1960s that bequests exceeded 70 per cent. A similar situation has been found to have occurred in some other countries, such as New Zealand, where, from the 1870s onwards, the bulk of bodies came originally from the `poor houses' and after this from mental hospitals (Jones and Fennell, 1991). The bequest ethos, in this instance, was established in the late 1950s.
The early history of obtaining bodies for dissection in the United States had much in common with the events in Britain, except that the early Anatomy Acts were less decisive than in Britain concerning the use of unclaimed bodies (Lassek, 1958). This prolonged the reign of grave robbing. Legislation to punish offenders occupied a more prominent place than in Britain, with fewer efforts being made to find a socially acceptable, let alone ethical, use of human bodies.
There need be no discussion regarding the unethical nature of practices such as murder and stealing. What is far more interesting is to ask whether a profession built on such an ethically dubious base can itself be ethical. There is no way in which historical calumny can be bypassed or ignored. It is there, and many past gains were built on unethical foundations. Are we today involved in moral complicity, accepting as we do the data and ideas obtained in such scurrilous ways? While we ourselves may not act in such a manner, we cannot totally isolate ourselves from the endeavors of our predecessors. Nevertheless, I have argued elsewhere (Jones, 1991) that there is a moral chasm between historical incidents, such as these, and our standards today, as long as our standards follow accepted bioethical principles in the area under discussion and as long as we are not guilty of serious ethical lapses in related professional areas. With these provisos, we today are not guilty of complicity in these unethical practices, even if we do use data emanating from them.
However, what are we to make of some other practices, such as exploitation of the poor and the lack of informed consent for the use of cadavers? There is no problem if contemporary procedures avoid these practices. If this is not so, ethical dilemmas remain. This raises the question of the use of `unclaimed bodies,' a practice that continues to this day in countries where too few bodies are made available by prior donation. How are Christians to respond to this practice?
The Use of Unclaimed Bodies
In an attempt to address such questions, a starting point is provided by asking why the treatment of cadavers is considered of ethical significance. One answer is that the cadaver has intrinsic value: it is an end by itself. An alternate response is that the cadaver has instrumental value: it can be used as a means to an end.
I consider that the cadaver has both intrinsic and instrumental value, and that the manner in which cadavers are treated is of moral significance (Jones, 1994). If this is the case, it can be argued that we show disrespect to a person now dead when we allow that person's body to be dissected in the absence of any consent on the person's part prior to death, and/or in the absence of any close friends and relatives to argue the case for the deceased. In other words, dissection of an unclaimed body may be a form of exploitation, since those with greater rights and opportunities pre mortem are protected from this. It may also follow that the manner in which unclaimed bodies are treated may differ from the manner in which bequeathed bodies are treated. The question with which I am concerned is whether the use of unclaimed bodies is accompanied by consequences such as these.
The use of unclaimed bodies has three parallels. The first is with grave robbing. The bodies have been taken and used, without asking anyone's permission, let alone because of someone's gift. The `taking' element is uppermost in both instances. Tempting as this connection is, there are ethical differences between the two situations - the absence of living relatives and their interests in the unclaimed bodies, but not in grave robbing. I find these differences more compelling than the similarities.
A second parallel is with presumed consent (opt-out) for the donation of organs from cadavers for transplantation (Teo, 1992). However, in most societies operating this scheme, there is in practice provision for consent by the family and it is this that separates it from the use of unclaimed bodies. It is true this is not universally the case, but it is sufficiently widespread for the purposes of my argument.
A third parallel is with the use of newly-dead patients for teaching and practicing intubation techniques in the absence of consent (Iserson, 1993). Here there is conflict between the respective claims of effective education and patient welfare on the one hand, and respect for the cadaver and the significance of consent on the other (Orlowski et al., 1988). However, what is done to these cadavers is slight compared to complete dissection of unclaimed bodies, and this difference imposes a major gulf between the two.
Consequently, my conclusion is that the use of unclaimed bodies in the dissecting room does not directly correspond to any procedure we use today in the realm of organ donation. What, then, are the problems with the use of unclaimed bodies?
The crucial problem revolves around the absence of altruism. The `unclaimedness' of these bodies stems from the weakness, vulnerability, and frequently dereliction of the people when alive, and it is this unclaimedness that mirrors their `unwantedness.' This may be warranted if cadavers are regarded as of instrumental value alone, although even here it is made possible only by treating cadavers for dissection and cadavers for organ transplantation in different ways. The result is that, rather than protecting the interests of such people, their interests have become subservient to other interests. But is this making the argument too strong, if for no other reason than that a dead body lacks interests? There is no hint that these people were, of necessity, mistreated during life, neither is there a general ethical objection to dissecting dead human bodies.
The inevitable query from which we cannot escape is a dual one, stemming from a lack of consent by anyone with an interest in the unclaimed person, and from the fact that such people come from disadvantaged sectors of society. Taken together, these considerations hint in forthright terms that the process may be unfair, and that it may allow the exploitation of one individual by another, or one group by another.
On the other hand, it may be argued that what is done to a few disadvantaged individuals has no repercussions for the far greater number of individuals who are not likely to end their lives as unclaimed cadavers. It may also be considered that these few (by-and-large) elderly individuals can be assessed in isolation from the many young individuals who are killed in road accidents, and who may be candidates for organ transplantation. Is there an ethical link between how bodies get in dissecting rooms and how bodies get in operating theaters as organ donors or how human tissue gets in research laboratories? I would argue that there is. How bodies come to be in dissecting rooms cannot be isolated ethically (and should not be isolated procedurally), from how the bodies come to be in operating theaters as organ donors, or how the tissue comes to be in research laboratories.
It may also be argued that when unclaimed bodies are used, there are no family interests. Therefore, these interests are not susceptible to being infringed by use of the deceased's body without prior consent. This may be used to justify employing unclaimed bodies. But does a willingness to ignore the previous interests of those who have now died lead to a neglect of the autonomy of similar individuals when alive? It is arguable that there is a link between treatment of the living and the dead. I suggest that ignoring the previous interests of those who have now died leads directly to a neglect of their autonomy when alive. At the very least, if the value of people after death is perceived as being greater than prior to death, there is a moral compulsion to improve conditions when alive.
The use of unclaimed bodies continues to this day where too few bodies are made available by prior donation, or where the legal system directs that unclaimed bodies automatically go to anatomy departments. My contention is that society's (and the medical profession's) willingness to use bodies without the consent of the `donors' before their death is a reflection of society's (and the medical profession's) attitudes towards the poor and the mentally ill. This attitude accords the educational value of dissection and possible future medical benefits stemming from dissection as more important than the autonomy of the disadvantaged within society. At the other end of the scale is the use of bequeathed bodies. Prior to their burial or cremation as dissected remains, they receive a memorial service (Bertman and Marks, 1989). While these services take a variety of forms, they bring together the altruism of the donors, the gratitude of the students and faculty, and the memories of close relatives and friends. Such services are fitting symbols of the positive use to which bodies can be put after death.
Putting these considerations together, I conclude that it is preferable to err on the side of using bequests. We may have to accept some educational inconvenience if we are to retain the more significant value of individual free choice (by an individual prior to death and by the family at the time of death). Nevertheless, what is done with dead bodies for good reasons is not the most important of all ethical matters. There is a balance to be attained at this point, a balance that emerges in other areas, where ethical strictures against use of organs from both adult and fetal cadavers for transplantation purposes have to be weighed against the potential benefits accruing to debilitated patients. The question with which we are left is whether the benefits of dissection are sufficiently great in practice to justify the type of ethical compromise I have discussed.
In view of the preceding discussion, many general statements about the use of human material can be made (Jones, 1991).
1. The study and use of human material are implicit within medicine, since there is no way of avoiding research on human persons. The ethical question is not whether this should be done, but how it should be done. Although the use of human material is not always justified, it is sometimes justified. We need to build a framework that balances the needs and aspirations of this human being, upon whom research is being conducted or who is being used for therapeutic purposes, against the needs and aspirations of that human being who is expected to benefit from the research or therapy. Clearly formulated ethical guidelines are essential in such circumstances, realizing that there will always be tension between the status we ascribe to the human body and human persons, and the scientific, clinical, or cultural value we ascribe to that material.
2. We have obligations regarding the human body, including honoring the wishes of the deceased or of the parents of infants, and protecting the integrity of the cadaver. These follow from the close identification a person has with his or her body, an identification so close that the two become almost inseparable. A dead body commands the respect of identity, since it reminds us of the presence that once was inseparable from it.
3. Present ethical standards frequently differ markedly from past ethical standards. While we cannot dissociate ourselves completely from how material was obtained, it is difficult to accept that the use of material obtained in an ethically dubious manner automatically reduces our own ethical standards to the same level. Nevertheless, we need to recognize that there is a danger at this point, and it is important that we address the question of the original ethical standards in these circumstances. It is also important to be aware that ethical standards and expectations may vary widely within society on medical issues and even among medical personnel, and these variations have to be both acknowledged and respected.
4. Much of the problem with the historical instances I have alluded to lay with the lack of informed consent that, in turn, highlights the importance of the gift principle. Such giving lies at the base of donating one's body for educational and therapeutic purposes. This is a gift of something that is more than anything else closely identified with what we are as persons. Informed consent lies at the base of the gift principle, and is crucial to all such transactions. This is also a recognition of what we are as persons. It is this that prevents the exploitation of one individual by another, or one group by another. While the notion of informed consent is strongest when the consent is made on one's own behalf, there are instances where it has to be made on someone else's behalf (proxy consent).
5. The supply of human material will always be limited, and will always be hemmed in by moral constraints.
Banwell, B. O. (1980) The Illustrated Bible Dictionary, Inter-Varsity Press, Leicester, pp 202-203.
Bertman, S. L. and Marks, S. C. (1989) "The dissection experience as a laboratory for self-discovery about death and dying: another side of clinical anatomy," Clinical Anatomy 2: 103-113.
Campbell, A., Gillett, G. and Jones, D. G. (1992) Practical Medical Ethics, Oxford University Press, Auckland.
Iserson, K. V. (1993) "Postmortem procedures in the emergency department: using the newly dead to practice and teach,"Journal of Medical Ethics 19:92-98.
Jones, D. G. (1991) "Fetal neural transplantation: placing the ethical debate within the context of society's use of human material," Bioethics 5:23-43.
Jones, D. G. and Fennell, S. (1991) "Bequests, cadavers and dissections: sketches from New Zealand history," New Zealand Medical Journal 104:210-212.
Jones, D. G. (1994) "Use of bequeathed and unclaimed bodies in the dissecting room," Clinical Anatomy 7:102-107.
Lassek, A. M. (1958) Human Dissection: Its Drama and Struggle, Charles C. Thomas, Springfield, Illinois.
May, W. F. (1985) "Religious justification for donating body parts," Hastings Center Report 15(2):38-42.
Orlowski, J. P., Kanoti, G. A. and Maxwell, M. J. (1988) "The ethics of using newly dead patients for teaching and practicing intubation techniques," The New England Journal of Medicine 319: 439-441.
Richardson, R. (1988) Death, Dissection and the Destitute, Penguin Books, London.
Teo, B. (1991) "Organs for transplantation: the Singapore experience," Hastings Center Report 21(6):10-13.
Teo, B. (1992) "Is the adoption of more efficient strategies of organ procurement the answer to persistent organ shortage in transplantation?" Bioethics 6:113-129.
Vawter, D. E., Kearney, W., Gervais, K. G., Caplan, A. L., Garry, D. and Tauer, C. (1990) The Use of Human Fetal Tissue: Scientific, Ethical and Policy Concerns, University of Minnesota, Minneapolis, Minnesota.
Wennberg, R. N. (1985) Life in the Balance, Eerdmans, Grand Rapids.