The world of anatomy has come a very long way since the dark days of grave robbing, the use of the unclaimed bodies of the derelict and neglected, let alone the horrors of the Nazi era. In the 19th century even well-known and publicly respected anatomists acted in ways that would not be tolerated today. This is because the anatomy profession is aware of the centrality of ethical values that inform every aspect of its functioning.
There are very high expectations of everyone having access to dead bodies, widespread acceptance of the privilege of having access to dead bodies for teaching and research, and awareness of the generosity of those who donate their bodies to anatomy departments.
The amount of ethical debate being undertaken in anatomy departments worldwide probably exceeds that of most other university disciplines. This is because staff who deal with dead bodies are conscious of the demanding and privileged territory in which they are working.
No longer is there any place for the use of unclaimed bodies, that is, those of the impoverished with no relatives to look after them in their final hours. These are being increasingly replaced world-wide by donations, where people have knowingly bequeathed their bodies to anatomy departments prior to the time of their death. In this country donations have been the sole source of bodies in medical schools since the 1960s. Staff of the Otago department have been at the forefront of arguing for this change for many years.
Students are introduced to the dissecting room through lectures and tutorials on ethical best practice, and ethical values are stressed throughout the course. Different cultural practices are acknowledged and respected. Before the dissecting course there are culturally appropriate ways of helping students approach the dead human body and the practice of dissection. Following the course the gift of the bodies is acknowledged with a farewell and a time of silence.
Students are also always reminded of the need to respect the bodies and body parts no matter how small some of the latter may be. Technical staff check all instruments and clean the bodies after each lab as a means of showing respect for them.
Experienced staff with clinical experience are always on hand to help students both technically and emotionally. Students are welcome to discuss concerns with staff. These procedures are important because the dissecting room experience is seen as part of the introduction to what it means to be a health professional. Staff also recognise the emotionally demanding nature of dissecting for some students.
Each year a thanksgiving service is held to mark the generosity of those who have donated their bodies and to thank their families for supporting them in this endeavour. The multicultural nature of the service reflects the broad cross section of the student population. Students themselves express their gratitude verbally and in writing.
Over many years the understanding of the ethical dimensions around body dissections has matured immensely. The world of anatomy is unrecognisable from the 1960s and 1970s when older doctors were trained. Practices then considered normal would now be unacceptable. This was not because the anatomists of that time set out to be unethical; everything they did was legal. But the legal expectations were inadequate.
‘Informed consent’ has replaced ‘lack of objection’. Bodies will only be accepted following the informed consent of the person donating their body prior to their death, and of their close family members. No longer will bodies be accepted simply because no one has objected to the donation. The ethical stakes are far higher than they used to be.
Unlike times in the past when anatomists were reluctant to initiate ethical debate about their practices, they are now the first to demand ethical discussion. Twenty years ago, it was difficult to get articles on ethical issues published in anatomy journals. That is no longer the case with some journals largely devoted to vigorous ethical debate on a wide range of issues. These range from public exhibitions of plastinated dissections of human bodies to the buying and selling of human body parts, and the availability of images of body parts on the internet.
Written by Gareth Jones, Emeritus Professor of Anatomy at the University of Otago