This is an excellent, if sad, example of a widespread historical phenomenon when the bodily remains collected by and used in anatomy departments were those of the poor and marginalised. These authors have helpfully drawn our attention to local examples of this phenomenon.
The use of unclaimed bodies stemmed from 1832 when the Human Tissue Act in the United Kingdom mandated this as the preferable manner in which bodies were to be obtained for anatomy departments, even though donations were recognised as an alternative source.
This was a tragic decision that had untold negative consequences for anatomy and pathology internationally for the next 130 years and even up to the present day in some countries and even in some American states.
It was not until the 1961 Human Tissue Act in the United Kingdom (1964 Act in New Zealand) that some semblance of ethical best practice emerged, with its reference to "lack of objection".
The trouble with this was families could not object if they were not informed that their relative had died. And unfortunately, this was frequently the case.
The significance of informed consent made a spectacular breakthrough around the year 2000. It was then that a number of major reports were produced in the United Kingdom putting forward core ethical principles for dealing with the dead.
These resulted from a number of scandals in which organs had been retained unnecessarily following postmortems and without the knowledge of the families. These spanned the 1960s to 1980s.
The result was the 2004 Human Tissue Act in the United Kingdom and the 2008 Act in New Zealand, both of which made informed consent central.
There had been an ethical trajectory since the 1960s cementing informed consent as a basic ethical value throughout medicine. In other words, treatment carried out on patients and investigations on the dead body are only to proceed in conjunction with the wishes of the patient and their family.
What this meant in practice was that decision-making powers were increasingly involving the families of the bereaved. They were being seen as integral to the decisions being taken about the body of their loved one.
In postmortems, families have interests in whether organs are retained and under what circumstances. Ethical reflection on these matters was becoming clearer as the role of informed consent moved perceptibly towards the epicentre of ethical practice.
Anatomy was no exception. I wrote my first article arguing for the use of donations in the early 1990s, as I reflected on these developments.
For me there was no place for use of the bodies of those unable to protect themselves against the ravages of anatomists, all too common many years ago. This is borne out in scrupulous detail by Halcrow’s study.
The world has changed but it is important to be reminded where we have come from. We learn from the past as we seek to establish a new and better way.
Central to these changes have been anatomists, bioethicists and social scientists working together. Scientists need the input of those from the humanities, just as the latter need scientists.
The authors also raise the very important question of how we can ethically use remains obtained under totally different circumstances many years ago, and in ways that we today would consider unethical.
This is found repeatedly in the history of anatomy, especially in the 16th and 17th centuries at the beginnings of modern anatomy when dissecting human bodies was seen as a strange and forbidding activity and was frequently frowned upon.
The founders of modern anatomy, such as Andreas Vesalius (1514-64), had to obtain the bodies they dissected from somewhere. As this was not a recognised activity the only avenues open to them were at the margins of legality and were questionable ethically.
Despite their accurate depictions of the human body, which set the scene for the anatomy of today and for so much of our understanding of human functioning in health and disease, they were obtained against a background that we would consider duplicitous and morally suspect.
There is no escape from this uneasy tension as we weigh up the immense benefits of scientific understanding when compared with what at the time were misleading traditional ideas of how the body ought to work.
This is an ethical enigma, as we assess what can be done (scientifically) against what should be done (ethically).
Scientists including anatomists need all the help they can get from the wisdom of bioethicists and from those expert in cultural obligations.
— Gareth Jones is Emeritus Professor of anatomy at the University of Otago.
