Working with cadavers in the anatomy laboratory is often a humbling and monumental moment in a physician’s career. Students spend hours working on cadavers with gratitude and respect for the donation, which allows them to practice and learn about human anatomy on your way to the healers. Only sometimes these corpses are not actually donated – and the deceased never consented to the dismemberment of his body.
When the deceased’s next of kin cannot be found or their family cannot afford a funeral, the state or county is responsible for what to do with the remains. In these cases, unclaimed bodies are sometimes sent and received medical schoolsBut several experts in the field object to the practice, raising ethical concerns that these people never consented to dissection in their lives.
I am writing to New England Journal of Medicine In 2020, one medical student shared her experience of learning that her first patient was actually an unclaimed body after she had already cut it with a scalpel.
“I still don’t understand the guilt of dissecting a man who may have wanted to rest in peace,” she wrote.
“Using someone’s body, even after their death, without their consent is contrary to many of our generally accepted standards of ethical practice in medicine.”
There is no central database to calculate how many unclaimed corpses are reported nationally each year, and practices vary depending on the state or county in question. Some states, including Hawaii, Minnesota, Vermont, Rhode Island and New York, have banned the use of unclaimed bodies in medical education. But schools in other states continue to use them. The rate of unclaimed bodies accepted into medical schools increased from 2% to 14% between 2017 and 2021, according to a 2023 study in Texas. JAMA.
Eli Shupe, a medical ethicist at the University of Texas at Arlington and an author of the paper, said she was shocked to learn about the practice.
“Using someone’s body, even after their death, without their consent goes against many of our generally accepted standards of ethical practice in medicine,” Shupe told Salon in a phone interview.
Many experts are concerned that medical institutions using unclaimed bodies are violating the deceased’s fundamental right to consent. Additionally, without being able to identify any of their relatives, those performing autopsies have no way of knowing whether a person has a religious background or spiritual beliefs that directly contradict or prohibit body donation, said Joy Y. Balta, chair Committee on Human Body Donation of the American Anatomy Association (AAA).
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“Body donation is a noble, selfless gift, and the person makes this decision,” Balta told Salon in a telephone interview. “It’s not something someone else is forcing on them.”
In addition to the ethical issues that directly affect unclaimed individuals, the practice also harms families, Shupe said, citing a recent report. NBK The investigation that led to the discovery of the unclaimed bodies was not only sent to the North Texas Health Science Center without the family’s consent, but was also sold to various other institutions for training purposes. Some families were still searching for their deceased relatives when the publication contacted them to tell the story.
“In some cases, decedents have next of kin who could not be found, either because they were very difficult to find or because whoever was responsible for finding them did a poor job or was negligent,” Shupe said. “Sometimes relatives turn up later and find out that the remains of a loved one were donated without their knowledge, and this can and has caused really serious emotional distress.”
“It can and has caused really serious emotional distress.”
In recent years, many programs have restricted this practice. For example, in 2007 in Oregon stopped taking unclaimed bodies after the deceased’s sister and friends, who had not been notified of his death and never agreed to donate his body to the institution, tracked his body down to Oregon Health Sciences University. In Texas, a county under investigation by NBC has changed its policy provide burial or cremation of unclaimed bodies. North Texas Health Science Center did not respond to a request for comment before this story was published, but told NBC it would close its laboratory that received the bodies.
However, other evidence suggests that such practices continue to occur in various institutions throughout the country. In a 2018 study published in the journal Anatomical Sciences Education12% of the 146 medical schools that responded to the survey said they used unclaimed bodies in medical education, with many of the people who ran these programs reporting that they were neutral on the question of whether it was important to teach students about origin of the body, said study author Dr. Matthew DeCamp, a general internist at Johns Hopkins University.
“We certainly saw the whole spectrum in our study,” DeCamp told Salon in a phone interview. “Everything from institutions that knew they were using unclaimed bodies and chose not to tell students about it at all, to institutions that used it as a learning opportunity to help students develop what we would call their professional identity formation, etc. .. learn about social justice and inequality in our country.”
The use of unclaimed bodies in medical schools was legalized in the 1800s as an attempt to stop grave robberies, in which so-called “resurrectionists” dug up corpses and sold them to schools. However, some have argued it simply opened a new path for medical schools to continue to use bodies from disenfranchised communities.
There are not many studies on the demographics of the unclaimed, but one from 2020. study An analysis of trends in Los Angeles County found that they are disproportionately poor, unemployed, male and black. And yet people of color less likely to donate their body consensually to medical schools. Part of this may be because medical institutions have a long and dangerous history of exploiting black bodies to “advance” science, dating back to Tuskegee Syphilis Study doctor who was once known as the “Father of Gynecology”, practicing experimental medical procedures on enslaved black women.
“If we know that unclaimed bodies belong to the majority of people of color, and we know that very few people of color donate their bodies or want to donate their bodies, that is more of a reason for us not to send unclaimed bodies, especially from people of color, to be dissected.” , Balta told Salon in a telephone interview.
Many institutions justify the use of unclaimed bodies by saying they are needed to meet the need for a shortage of cadavers, according to brief on this topic from the American Medical Association, published in May.
However, although some localities reported lack of donors to meet needs their medical facilities, others reported more than enough. Commercial body brokers even collect enough bodies to We ship thousands of body parts all over the world every year.. The industry does require consent, although family members report they don’t know the vast distances the deceased will have to travel or what their bodies will have to go through. Some family members, for example, have reported donate the bodies of their loved ones to these body brokers, thinking that they will be used by medical institutions, and instead they are sent to the US Army for testing explosives.
“This is where the lack of oversight is an issue because if there was an organization that oversaw this, then there could be a donor bank and people could be sent from one county to another or from one state to another. rather than going beyond these ethical practices,” Balta said.
Apart from the Uniform Anatomical Gifts Act, passed in 1968, there is no federal legislation regulating what is done with unclaimed bodies, according to Thomas Champney, a professor of anatomy at the University of Miami Miller School of Medicine. In states that regulate unclaimed bodies, it is simply up to the agency and county to decide what to do with them.
“I would really like to see some kind of federal law passed that would say that all of people’s unclaimed data should be uploaded into a national database where families could search for their loved ones,” Champney told Salon in a phone interview. “But currently there is little regulation and virtually no laws.”
Other countries have more centralized mechanisms for regulating unclaimed persons, Balta said. In the UK, for example, His Majesty’s Surveyor of Anatomy has the power to close programs if they do not comply with federal body donation regulations.
AAA created task force to implement best practices in body donation in 2019, which Balta said should be published before the end of the year.
“We specifically say (in the guidelines) that body donation programs should not accept unclaimed or unidentified people into their programs for equity reasons,” Balta said.
Even immediate family members who choose to donate their deceased loved ones to medical schools may not be doing so out of a desire to advance science. One 2022 study found that the body donation registration process varies widely across the country, with many places that accept donors not informing families about everything the process entails. Unfortunately for some families, this may be the only available option for dealing with their relatives’ remains, says Lauren K. Bagian, a body donation researcher at Georgetown University School of Medicine.
“They can simply donate because most of the time, as part of a donation, institutions cover the cost of embalming, burial, preparing a death certificate or transporting the body, which can be thousands of dollars,” Bagyan told Salon in a phone interview. “This is another interesting ethical question: Do we accept these donations from next of kin, even though they may be financially motivated, when we do not require evidence that the person might have wanted it?”
It is cheaper for the county or state that handles the remains to donate the body to science. Each burial or cremation can cost thousands of dollars, and a new policy in one Texas county, for example, would cost $675,000 a year. That, Shupe said, is the price the district must pay for the support of its constituents in death—just as it did in life.
“These are unclaimed bodies, so they can be easily overlooked and forgotten,” Shupe said. “It’s good to see people finally paying attention to what’s going on and wondering if they have a greater obligation to these people after death.”