Ethics

LOVED ONE’S BODY IN THE ANATOMY LAB

MEDICAL STUDENTS RESPONSES TO DISSECTING THE HEART AND BRAIN: A

DIALOGUE SEAT OF THE SOUL

AIM OF THE ARTICLE

• To examine a case study in where recognition of the deceased by someone known to them in an anatomy class had occurred and the distress that ensued

• Recommendations for creating policies and procedures to minimize the risk of recognising the deceased by students, academic staff or professionals in order to prevent subsequent trauma

CASE STUDY

1998: A First Year Medical student contacted the Anatomy Dept. of the University she was attending in Australia to express her concerns that during her anatomy classes she may recognize her fathers body as he had bequeathed his remains to the university for the purposes of education. The Staff assured the student that the body would be removed. However, they retained parts of her fathers body believing that the student would not recognize them. The student did recognize the parts as belonging to her father and once again contacted the anatomy department and requested that they be removed as it had caused the student distress because she had seen her fathers body parts and she perceived the staff to be unsympathetic and antagonistic in their handling of the situation. The student found that the staff were very reluctant to act and the parts were only removed after external staff took action. As a result an investigation was carried out.

INVESTIGATION OUTCOME

The Anatomy Dept. acknowledged a number of failings:

• An Inadequate response to the initial request

• Failure to remove the body parts even after recognition

• Failure to sympathise lead to greater distress for the student involved which could have been eradicated early on had there been sufficient communication in addressing concerns

Recommendations

• Formation of Policies and Procedures to minimize recognition of the bequeathed and if it does occur how to manage it

SUGGESTIONS

Donors, Students & Maintaining Anonymity• When a donor expresses a wish in life to bequeath their remains the questionnaire

should ask if any friends, family or acquaintances are affiliated with the Life Sciences department. It should also be stated on the information sheet that in certain circumstances whereby they may be recognized it would warrant an untimely disregard of their remains to both maintain their anonymity and safeguard against distress to staff/students known to them.

• Consent must be given in life and permission attained to take photo’s or specimens of body parts and/or to disclose a donors clinical history.

• Students have a responsibility to be sympathetic and raise concerns to the department as soon as possible

SUGGESTIONS CONT.

Dealing with Bodies/Body Parts• If concerns have been raised or a donor has been recognized then the remains must be

disposed of immediately in accordance to the donors wishes unless there is a compelling reason not to do so e.g. On-going research that will be significantly affected/impeded by the disposal of the remains. In these exceptional circumstances the research should be expedited and all assistance required to do this should be provided

• Records should be checked to ensure that the body/body parts are not used in classes where a concern has been raised. If this is not feasible then other alternative learning methods should be provided e.g. DVD/CD-ROM etc.

• When a body/body parts have been removed this should be communicated asap to the person who expressed concern

SUGGESTIONS CONT.

Training & Education for Staff and Students

• To be aware of policy's and procedures in place

• To express their importance in maintaining the donors anonymity

• To be aware of the emotional impact that working on cadaveric remains can have and the support services available

• How to communicate in an effective and sensitive way should one become distressed or recognise a donor.

MEDICAL STUDENTS RESPONSES TO DISSECTING THE HEART AND BRAIN: A DIALOGUE SEAT OF THE SOUL

• Over the course of history there has been great discussions and debates about where the “Soul” resides in the body

• The Soul has been described as a person’s Life Force/ Consciousness / Essence of the person

• Beliefs: Can be religious/philosophical as opposed to scientific regardless of one’s background. Some believe

1. That the soul lives on after death

2. Others that it is a mortal life force that ends in death

Believed in the existence of 3 souls

1. Logos “The Head” – Immortal Mind

2. Thymos “The Heart” – Feelings- Bound in the Chest

3. Epithymetikon “Butterflies” Between the diaphragm and umbilicus -Passions and Desires

PHILOSOPHY

The Pythagoreans & Plato

• Studied the brain to establish the r/ship between body and soul and concluded that the “Seat of the Soul” was the brain

• Subsequent Scientific/Anatomical studies uncovered that the brain is responsible for our responses/personality/perceptions etc.

• The Heart is still viewed affectionately due to it’s affiliation with love “racing heart” which is, as we now know, a physiological response to neuro signally

SCIENCE Emanual Swedenborg (17th Century) Pioneer of Neuro-Anatomy

DISSECTION AND STUDENTS VIEWS

• 16 Students completed a questionnaire

• Very few found it difficult to dissect the thorax yet many found it difficult to dissect the brain because they seen it as the seat of consciousness where memories/personalities and perceptions were stored. Brain vs. Mind

• Religious beliefs did not affect the students views

DISCUSSION

• At what point does a person cease to be a person?

• Is it possible to separate the objective from the subjective?

• How important is it that there is anonymity in dealing with cadaveric remains to ensure that all donors are strangers to those who come into contact with them? Does this impact on Research and Education? i.e. Clinical History's/Background information