Maja I. Whitaker

Anatomy's Use of Unclaimed Bodies: Reasons Against Continued Dependence on an Ethically Dubious Practice

The use of unclaimed bodies has been one of the distinguishing features of the anatomy profession since the passing of nineteenth century legislation aimed at solving the problem of grave robbing. Only in more recent years has the use of bequeathed bodies supplanted dependence upon unclaimed bodies in many (but not all) countries. We argue that this dependence has opened the profession to a range of questionable ethical practices. Starting with contraventions of the early Anatomy Acts, we trace the manner in which the legitimacy of using unclaimed bodies has exposed vulnerable groups to dissection without their consent. These groups have included the impoverished, the mentally ill, African Americans, slaves, and stigmatized groups during the Nazi era. Unfortunately, ethical constraints have not been imposed on the use of unclaimed bodies. The major public plastination exhibitions of recent years invite us to revisit these issues, even though some like Body Worlds claim to use bequeathed bodies. The widespread use of unclaimed bodies in institutional settings has lent to these public exhibitions a modicum of legitimacy that is needed even when donated bodies are employed. This is because the notion of donation has changed as demonstrated by consideration of the principles of beneficence and non‐maleficence. We conclude that anatomists should cease using unclaimed bodies. Difficult as this will be in some cultures, the challenge for anatomists is to establish relationships of trust with their local communities and show how body donation can assist both the community and the profession. Clin. Anat. 25:246–254, 2012.

Engaging with plastination and the Body Worlds phenomenon: A cultural and intellectual challenge for anatomists

Body Worlds, the international plastination phenomenon, has proved immensely popular with audiences worldwide. Never before has the human body been exposed to public gaze in such an accessible and intriguing manner. Dissected body parts feature alongside whole‐body plastinates with their life‐like poses ranging from those with Renaissance motifs to others with highly contemporary themes. However, the exhibitions and their creator, Gunther von Hagens, have astounded many, including anatomists, some of whom find the unconventional display of human bodies unethical and offensive. The voyeuristic nature of Body Worlds and the uneasy balance between entertainment and education have proved problematic for anatomists. Von Hagens himself is a polarizing figure, pursuing his dream of “democratizing anatomy” with little regard for the conventions of academia. While valid ethical objections can be raised against some aspects of the exhibitions, we argue that wholesale rejection of them is unwarranted. In arriving at this conclusion we assess the ethical and educational issues involved. We divide the whole‐body plastinates into four categories, ranging from those illustrating structural and functional relationships to those with artistic and humanistic aspirations rather than anatomical ones. We conclude that anatomists need to face up to the opportunities and challenges posed by the Body Worlds phenomenon, utilizing what is being presented to the general public and adapting this in teaching and research. Clin. Anat. 22:770–776, 2009.

Speaking for the Dead : The Human Body in Biology and Medicine

Contents: Preface The dead body The dissected body The abused body The plastinated body The transplanted body The indigenous body The developing body The thinking body The modified body References Index.

I See Dead People: Insights From the Humanities Into the Nature of Plastinated Cadavers

Accounts from the humanities which focus on describing the nature of whole body plastinates are examined. We argue that this literature shows that plastinates do not clearly occupy standard cultural binary categories of interior or exterior, real or fake, dead or alive, bodies or persons, self or other and argue that Noël Carroll’s structural framework for horrific monsters unites the various accounts of the contradictory or ambiguous nature of plastinates while also showing how plastinates differ from horrific fictional monsters. In doing so, it offers an account of the varied reactions of those responding to exhibitions of plastinated whole bodies.

The tenuous world of plastinates

Gunther von Hagens stands in a long tradition of anatomy artists, and he has intentionally modeled himself after these. His aim to “democratize anatomy” is allied with the ethos of the Renaissance ...

Speculative Ethics: Valid Enterprise or Tragic Cul-De-Sac?

The excitement generated by major scientific advances almost inevitably leads to intense speculation concerning the uses to which these advances will be put. Since some of these will be accompanied by ethical challenges, it is appropriate for bioethicists to delve into their potential ethical implications. If the ethical dimensions of such advances can be outlined and analyzed in advance, this would appear to be a welcome contribution to any public debate that may ensue. However, the speculations range from those that could eventuate within the near future and would represent an incremental change to present practices, to those that are vastly less likely to come to pass and predict paradigmatic shifts of momentous proportions. The challenge for bioethicists is to determine whether they should devote their attention to such extreme speculative possibilities, or to more circumscribed speculations, or indeed whether it is better to focus on existing issues, rather than those that are merely possible. An illustration of more circumscribed speculation is provided by no less a scientific authority than Francis Collins in his 1999 Shattuck Lecture, in which he speculated on the medical and societal consequences of the Human Genome Project in 2010, just 11 years into the future. He described this as a hypothetical clinical encounter in which a 23-year-old undergoes a battery of genetic tests. This was because by 2010 Collins speculated that the field of pharmacogenetics would have blossomed to such an extent that a prophylactic drug regimen based on personal genetic data could be prescribed to reduce cholesterol level and the risk of coronary artery disease (Collins, 1999). As we look back at 2010 we can see that these goals have not as yet been realized at the level hypothesized by Collins. The question then is whether bioethical enquiry into the prospects opened up by genomic medicine has been weakened by this excessive optimism. Interestingly, at much the same time, Holtzman and Marteau (2000) contended that the new genetics would not revolutionize the way in which common diseases are identified or prevented. In wanting people to see beyond the genetic hype, they pointed to the importance of existing issues, such as social structures, lifestyle and environment, for much of disease. They also questioned how much interest would be shown in being tested genetically and even more in making appropriate lifestyle choices. These too are considerations calling for the attention of bioethicists. It is evident then that even relatively focused speculation has its problems. What about far more exploratory and aggressive speculation? Garreau (2005) considers that we are at a

Religious Traditions and Embryo Science

The surprisingly divergent ethical perspectives that emanate from Roman Catholicism and Judaism stem in large part from the extent to which they allow (and indeed welcome) scientific input. The greater openness of Judaism, as described by the authors (Zivotofsky and Jotkowitz 2009), allows an openness to contemporary scientific understanding of the embryo. However, a significant number of Roman Catholic ethicists also diverge from Dignitas Personae at this point, as do many Protestant ethicists. We suggest that this divergence stems less from the religious tradition within which theologians and theological ethicists are functioning, and more from the context within which the Bible is being interpreted and in particular on their dependence upon extra-biblical input, whether scientific input or Church tradition. Few problems will be encountered if there is consonance between the religious tradition in question and contemporary scientific viewpoints. This is not to argue that one or the other should occupy a dominant position in the relationship, rather that neither should ignore the contributions of the other. The issues outlined by Zivotofsky and Jotkowitz (2009) revolve around the dynamics of this relationship from the perspective of different religious traditions, with their varying emphases upon the earliest stages of embryonic life. This, in turn, raises the question of the extent to which these and other religious traditions make explicit their dependence upon scientific input, whether the latest insights of contemporary science or the outdated notions of premodern science. Underlying this statement lies a presupposition, namely, that it is impossible for religious traditions to ignore completely scientific notions when they wish to have input into any of the detailed facets of the ethical debate surrounding the reproductive technologies. There is no way in which a religious teacher like Jesus could have discussed the treatment of pre-implantation em-

Finding a Context for Discussing Human Life-Extension

Community input into ethical decision-making is fraught with problems, as demonstrated in one debate after another in the reproductive technology arena. Therefore, the attempt to avoid such problems in debates over the extension of human life span by Partridge and colleagues (2009) is to be welcomed. However, a number of assumptions underlying the target article need to be challenged. The first is that human life span extension is a new problem. This is not the case, since life expectancy at birth in Europe has dramatically increased over the past 150–160 years, a development that has proved revolutionary for social and ethical expectations and indeed for the ethos of medicine. This increase has been from as low as 25 years in the inner suburbs of industrial towns (Szreter and Mooney 1998) to around 75–80 years today. The decline in mortality in the nineteenth century stemmed from improvements in the external environment, particularly sanitation, with a consequent reduction in infectious diseases, and vaccination. This radical change in life expectancy means that we today are substantially enhanced in biomedical terms when compared with our nineteenth century forbears. The use of science and technology to overcome ill health and untimely or premature death has become embedded in our psyche, leading to ever increasing medical interventions to secure health and longevity. We do not, therefore, represent a neutral starting point for discussing the ethical implications of life span extending technologies, a perspective frequently omitted from public debate of contemporary technologies. Also ignored is the salutary consideration that the life expectancy of older people has changed comparatively little over the past 150 years. For instance, the increase in life expectancy for a child born in the United States between 1860 and 1960 was 31 years, but the comparable increase for a 60-year-old was 1 year (Omran 1977). In other words, most of the gains have been in childhood and young adulthood, through the control of infectious diseases and inadequate nutrition. This should serve as a warning for those with unrealistic expectations of the life extending powers of biomedical technology.

Brains and persons: an educational perspective.

The paper by Martyn et al. regarding medical students’ responses to the dissection of the heart and brain covers new ground in examining students’ views on the dissection of these two organs (Martyn et al., 2012). We are most grateful to the authors for following through with this research on the back of what was a most illuminating documentary concerning the dissection experiences of medical students. While a number of papers have appeared studying medical students’ experiences of dissection, we have been unable to find anything else addressing this topic in this particular manner. Of most immediate interest is the work of Hafferty (1991), which identified periods of anxiety for medical students associated with the dissection of certain regions—the hand and arm, the neck, the head and face, the abdomen, and the pelvic and perineal regions. For the most part these dissections elicited anxiety among students because the externally visible features (face, hands, and genitals) were obvious human referents, reminding students that it was a real human body they were dissecting. In contrast, Martyn et al. examined students’ reactions to dissecting internal organs with potential symbolic and/or personal connotations. In doing so they have revealed that students attach varying degrees of significance to the brain and heart, particularly in terms of their perceived association with what ‘‘made a person who they were.’’ The students were specifically asked various questions about the ‘‘seat of the soul,’’ with many locating it in the brain, some placing it in the heart, and others choosing not to locate it in either. The authors suggest that, for a number of students, their dissection of these organs proved troubling, eliciting emotional reactions of which faculty should be aware. Unfortunately, the retrospective nature of this study raises issues regarding the framing of the interviews and leaves unanswered questions about the students’ conception of the ‘‘soul.’’ For instance, one would like to have been provided with some insight into how the students conceptualized the soul, as in its relationship to personality, thought and reasoning, consciousness or memory, or perhaps other factors of significance to the students. Moreover, it is unclear whether the interviewers took any steps to distinguish between these distinctly different elements in their questions, or indeed whether the interviewers posed the existence of the soul as an open question. While it is not clear what exactly students meant when speaking of the ‘‘soul’’ or in identifying the ‘‘seat of the soul’’ in the heart or the brain, their responses as given are intriguing and disconcerting. We were surprised by the unconsidered and unsophisticated views the students presented. This was especially the case for those responses identifying the soul as being located in the heart. Some students appeared to endow this organ with the personal weight associated with it by metaphors and symbols prevalent in our culture and language. It is worrying that these students were not able to dissociate these cultural meanings from the reality of the heart’s biological function. Assuming that none of the teaching they had received had led to this conclusion, one wonders whether there should not be more specific teaching aimed at relating anatomical/ physiological knowledge with philosophical, cultural, and symbolic understandings in a critical and analytical way. In the absence of such input students will be left with a fragmented view of the human body. Our concern is that if this is indeed the case, students will lack the necessary foundation for tackling the many ethical issues they will encounter in clinical practice, and they may find aspects of their practice unnecessarily troubling on a personal level. It should be noted, however, that these were the responses of a small number of students who were ‘‘chosen to reflect a broad range of backgrounds and views,’’ and as such they may not be representative of the class as a whole. It was similarly disconcerting to read that very few students agreed with the statement that the ‘‘brain is what makes someone human/who they are.’’ Some students indicated that they believed brain dissection to be ‘‘cutting through somebody’s memories or consciousness.’’ This raises two issues. The general one is the students’ view of the cadaver.