Bodyworlds and the ethics of using human remains: a preliminary discussion

"I've got yer back": A community art and anatomy project

This article describes a community collaborative project, "I've got yer back," that utilized the craft of needle felting to raise awareness and develop understanding of the anatomy of the human spine. The project took place in 2023 and engaged with participants from across the United Kingdom and abroad and its completion was timed to coincide with National Back Health Awareness week in October 2023. We describe the process of creating a vertebra using needle felt and examine how the particularities of the process and the use of the sense of touch helped participants notice and understand the complex form of the human vertebra. We consider how the project encompassed creative processes of hands-on learning to enhance knowledge about this aspect of human anatomy. We discuss how the project evolved to include public and academic participation in a shared goal and argue for the effectiveness of seemingly simple and straightforward art or craft workshops in teaching relatively complex science. The article includes detailed feedback from participants who reflect on the process of learning through making and how it went on to affect individuals in very different, and sometimes very personal, ways.

Assessment of Ethical Compliance of Handling and Usage of the Human Body in Anatomical Facilities of Ethiopian Medical Schools

Background

Human anatomy has historically been a cornerstone in medical education and is special in that it uses human remains kept in various anatomical facilities like a morgue, gross anatomy laboratory, or museums for instruction and research. While serving knowledge advancement facilitating clinical practice and research, human cadaver handling, and usage at all levels, such as cadaver sourcing, transportation, storage, preservation, dissection, and final disposal deserves in return the utmost respect. In Ethiopia, even though there is not enough information on when, where, and by whom the first cadaver dissection was conducted, dissection is being conducted in many of its medical schools. Despite ethical necessity surrounding human body usage in every anatomical setting, there is still ethical and legal uncertainty due to several challenging barriers which is severe in developing nations including Ethiopia. The aim of this study is, therefore, to assess ethical practices of handling and usage of the human body to promote, in the near future, formulation and implementation of acceptable, respectful, and ethical guidelines for the anatomy dissection laboratories and related settings in Ethiopia.

Methods

A multicentered cross-sectional study was used at selected anatomy facilities of eight Ethiopian medical schools. The collected data through structured questionnaires and checklists were cleaned, preset and entered in to SPSS version 20 for analysis. Internal consistency and reliability were measured by using Cronbach’s alpha.

Results

The study result showed vivid human body ethical breaches that ranged from lack of power by anatomy unit to oversee the process during sourcing, transportation, embalming, caring, and dissection of cadavers in the anatomy laboratories to student’s mistreatment of cadavers.

Conclusion

In addition to lack of compliance due to lack of standard ethical guidelines or policies regarding human body usage, the compliance-based professional development is also nonexistent. The ethical way of body sourcing is through body donation; however, in Ethiopia, anatomy teaching exclusively depends on unclaimed bodies. Using a body for dissection that is solely sourced unethically may generate a negative emotional sense of life for anatomy instructors, technical assistants, morticians, and medical students. We inspire better provision of moral and ethical exercise with the good practice concerning the human body through recognizing the humanity and uniqueness of the deceased person. The results of this study serve as a serious condemnation of practices in Ethiopian anatomy facilities and we urge the Anatomical Society of Ethiopia to play its part in changing the present practices related to ethical and legal uncertainty of the human body usage.

Confucian Ethics on the Commercial Use of Human Bodies and Body Parts: Yi (Righteousness) or/and Li (Profit)?

In China as elsewhere in the world, human bodies and body parts have long been used for a wide range of medical and non-medical purposes. In recent decades, China has played a considerable role in some of the public exhibitions of plastinated bodies and body parts, and the commercial trade in organ donations. These contemporary developments have raised numerous challenging ethical and governance questions. In spite of the growing role of China in these, there have been few studies devoted to Chinese ethical thinking that might govern its policies on the use of human bodies and body parts, and in particular on the issue of commercialization. The present study is an attempt to bridge this gap, and concludes that Confucian thinking stresses the primacy of righteousness over profits and utilities. This conclusion is reached directly by drawing on Confucian ethical responses to the peculiar practice of using human body parts, such as placenta and flesh, as drugs in traditional Chinese medicine in imperial China and what has been called "yili zhibian," the major Confucian discourse on yi (righteousness or justice) and li (profit or interest) in its long history. The principle of prioritizing righteousness over profit leads to a general moral opposition to the commodification of human bodies and body parts. While Confucianism may not place an absolute prohibition on any such use, it does require that any commercial uses are made subject to the fundamental moral principles, such as righteousness, as well as adequate ethical governance procedures.

Three-dimensional Printing in Anatomy Education: Assessing Potential Ethical Dimensions

New technological developments have frequently had major consequences for anatomy education, and have raised ethical queries for anatomy educators. The advent of three-dimensional (3D) printing of human material is showing considerable promise as an educational tool that fits alongside cadaveric dissection, plastination, computer simulation, and anatomical models and images. At first glance its ethical implications appear minimal, and yet the more extensive ethical implications around clinical bioprinting suggest that a cautious approach to 3D printing in the dissecting room is in order. Following an overview of early groundbreaking studies into 3D printing of prosections, organs, and archived fetal material, it has become clear that their origin, using donated bodies or 3D files available on the Internet, has ethical overtones. The dynamic presented by digital technology raises questions about the nature of the consent provided by the body donor, reasons for 3D printing, the extent to which it will be commercialized, and its comparative advantages over other available teaching resources. In exploring questions like these, the place of 3D printing within a hierarchical sequence of value is outlined. Discussion centers on the significance of local usage of prints, the challenges created by regarding 3D prints as disposable property, the importance of retaining the human side to anatomy, and the unacceptability of obtaining 3D-printed material from unclaimed bodies. It is concluded that the scientific tenor of 3D processes represents a move away from the human person, so that efforts are required to prevent them accentuating depersonalization and commodification.

BODIES R US: Ethical Views on the Commercialization of the Dead in Medical Education and Research

With the ongoing and expanding use of willed bodies in medical education and research, there has been a concomitant rise in the need for willed bodies and an increase in the means of supplying these bodies. A relatively recent development to enlarge this supply has been the growth of for- profit willed body companies ("body brokers") in the United States. These companies advertise for donors, cover all cremation and other fees for the donor, distribute the bodies or body parts nationally and internationally, and charge their users for access to the body or body parts. In doing so, they generate substantial profits. This review examines the historical development of willed body programs, the legal and economic aspects of willed body programs, and then provides an ethical framework for the use of willed bodies. The ethical principles described include detailed informed consent from the donors, comprehensive and transparent information about the process from the body donation organizations, and societal input on the proper and legal handling of willed bodies. Based on the ethical principles outlined, it is recommended that there be no commercialization or commodification of willed bodies, and that programs that use willed bodies should not generate profit.

Art + Bioéthique : quand la recherche en bioéthique quitte les murs de l’université

Comment engager le public dans une réflexion sur les enjeux éthiques de notre époque? Guidés par cette question, nous avons développé une plateforme d’échange avec la communauté sur des questions bioéthiques à travers une exposition artistique ainsi qu’une série d’activités de médiation culturelle et scientifique pour les adultes et les enfants. Ce dossier thématique dresse le compte-rendu de ce projet. Art + Bioéthique repose sur une stratégie interdisciplinaire et collaborative qui a amené six jeunes chercheurs en bioéthique à être jumelés à six artistes de la relève afin d’échanger et d’apporter un nouvel éclairage sur une variété d’enjeux éthiques liés à la santé. Ces duos artistes-chercheurs ont chacun développé une oeuvre et un essai sur un thème commun. Notre objectif était de décloisonner l’art et la recherche académique en bioéthique afin de créer des formes hybrides et inédites de diffusion, d’éducation, d’expérimentation et de rencontre. L’expression de la bioéthique à travers l’art constitue une façon innovatrice de transmettre l’aspect sensible de tant de questions éthiques touchant à la santé et au bien-être. À travers ses divers volets, Art+Bioéthique a su rejoindre plusieurs centaines de personnes et les engager dans une réflexion éthique sur des enjeux au coeur de notre société.

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.

Anatomical practice at Göttingen University since the Age of Enlightenment and the fate of victims from Wolfenbüttel prison under Nazi rule

This report briefly summarises anatomical practice at Göttingen University from its founding in 1737 until the Nazi period and gives a detailed account of how Nazi death penalty legislation and execution practice at Wolfenbüttel prison influenced the decision-making of the anatomists in charge at that time. Problems in the procurement of corpses, encountered almost continuously throughout Europe since the broad introduction of dissection into medical training in the early 18th century, were absent in Göttingen during periods of overt progress in anatomical sciences, e.g. under Albrecht von Haller (in office 1736-1753) and Jacob Henle (1853-1885), and at times when existing regulations were rigorously enforced by the authorities (1814-1851). Ample availability of corpses in the wake of more than 600 executions in Wolfenbüttel between 1935 and 1945 was curtailed only by transportation fuel shortages and resulted in the dissection of more than 200 Nazi victim corpses in the Göttingen anatomy course. Apparently, neither individual offers of voluntary body donation (dating from 1932 to 1937 and published here as the earliest documents of this kind), nor the strong tradition of high-level anatomical research, nor even the awareness of the University's Age of Enlightenment origin, prevented the unethical use of corpses of Nazi victims for medical teaching. The Göttingen example may add "historical and moral detachment" under unusual political and wartime pressures to the "clinical and emotional detachment" thought to prevail amongst anatomy personnel (Hildebrandt, in this issue); together with the other reports it calls for all anatomists to bear in mind their ever present ethical obligations in respect to activities involving the use of corpses, both in medical schools and in the public domain.

Human body exhibitions: public opinion of young individuals and contemporary bioethics

PURPOSE

The exhibitions of plastinated cadavers and organs have attracted millions of visitors globally, while raising serious controversy about their content and purpose of implementation.

METHODS

We performed a survey based study on 500 randomly chosen individuals, aged 18- to 35-year old, in order to access their opinion regarding the conduction of such shows as well as body donation for scientific purposes.

RESULTS

We found that 46.3% of the participants had moral concerns, and 46.1% did not. Religious and philosophical beliefs concerned 21.8% of the sample, while 28% believed that the exhibits may affect visitors' mental health. Human dignity violation was stressed by 21.6%, whereas 26.6% disagreed with body donation to science.

CONCLUSIONS

The desire for qualitative-guided anatomy education is evident from the highly popular plastinated body and specimen exhibitions. Hence, additional focused effort could be provided to educate the public about normal and pathological anatomy in order to amend their life-style. This could be effected by certified anatomy demonstrators in graduated steps according to the cohort's age, education, occupation, and health status.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize.

Gunther von Hagens' BODY WORLDS: selling beautiful education

In the BODY WORLDS exhibitions currently touring the United States, Gunther von Hagens displays human cadavers preserved through plastination. Whole bodies are playfully posed and exposed to educate the public. However, the educational aims are ambiguous, and some aspects of the exhibit violate human dignity. In particular, the signature cards attached to the whole-body plastinates that bear the title, the signature of Gunther von Hagens, and the date of creation mark the plastinates as artwork and von Hagens as the artist in a gesture that strips the personal dignity from the donors. I conclude that the educational use of cadavers is compatible with respect for dignity if: 1) the utility of such use is great enough; 2) there are no other ways of achieving these ends; and 3) every effort is made to honor the dignity of the donors.

The story of the body and the story of the person: towards an ethics of representing human bodies and body-parts

Western culture has a few traditions of representing the human body - among them mortuary art (gisants), the freak show, the culture of the relics, renaissance art and pre-modern and modern anatomy. A historical analysis in the spirit of Norbert Elias is offered with regard to body - person relationship in anatomy. Modern anatomy is characterized by separating the story of the person from the story of the body, a strategy that is incompatible with the bio-psycho-social paradigm of clinical medicine. The paper discusses different aspects of the above traditions and how they might bear on this conflict and on contemporary bioethics and bedside practice.