Of Discomfort and Disagreement: Unclaimed Bodies in Anatomy Laboratories at United States Medical Schools

Abstract

Use of unclaimed bodies for anatomy teaching in undergraduate medical education continues, but is ethically controversial. The purposes of this study were to estimate the proportion of United States (US) medical schools using unclaimed bodies in first‐year anatomy laboratories, to determine whether schools inform students of this use, and to explore anatomy course leaders’ attitudes toward unclaimed body use. Anatomy course leaders from 146 US medical schools that had independent preclinical programs including anatomy were surveyed. Survey results were analyzed with descriptive statistics and statistical tests of association. Free text responses were analyzed using a thematic editing style of qualitative content analysis. Of 89 responses (response rate, 61.0%), 11 schools (12.4%) reported possible use of unclaimed bodies. Course leaders from these schools reported greater comfort with using unclaimed bodies compared to leaders from other schools (P < 0.01). Although most course leaders (49/76, or 64.5%) believed it was important or very important to inform students about use of unclaimed bodies, respondents from schools where unclaimed bodies could be used were more neutral (P < 0.01). Qualitative findings revealed deep disagreement and contradictory views about how unclaimed body use relates to ethical principles of respect for persons and justice. Continued use of unclaimed bodies, varying levels of comfort with their use, and disagreement about the practices’ underlying morality suggest a need for greater ethical reflection about the permissibility of unclaimed body use in clinical anatomy and for educational interventions that teach students about its history, ethics, and contemporary practice.

The practice of ethics in the context of human dissection: Setting standards for future physicians

“…However the existing scenario is far from ideal as a recent study has documented that medical schools in major parts of Asia, Africa and South America till date depends on mostly unclaimed bodies or even exclusively unclaimed bodies for anatomical dissection ( Habicht et al, 2018 ). Unfortunately this trend is also prevalent in some pockets of Europe and North America ( Habicht et al, 2018 ; Caplan and DeCamp, 2019 ). However the silver lining is that at least a few of these medical schools have either transitioned to a bequest system or are in the midst of the ongoing process ( Habicht et al, 2018 ; Hutchinson et al, 2019 ).…”

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

“…Implementation of secure staffing levels for laboratory instructors. Facilitating obligatory faculty development sessions for anatomy educators, for example, through multiple scheduling options and online modules (Rizzolo et al, 2010). Collaboration with other groups throughout the Harvard Medical School system interested in creating an optimal environment for acquiring professional competencies in medicine. Expansion of those honored in the memorial service, to include not only body donors, but also unknown persons whose tissues, namely skulls and bones, are still used in the historical anatomical teaching collection (Kahn et al, 2017; Caplan and DeCamp, 2019). …”

“…• Collaboration with other groups throughout the Harvard Medical School system interested in creating an optimal environment for acquiring professional competencies in medicine. • Expansion of those honored in the memorial service, to include not only body donors, but also unknown persons whose tissues, namely skulls and bones, are still used in the historical anatomical teaching collection (Kahn et al, 2017;Caplan and DeCamp, 2019).…”

“…Evidence for the influence of the dissection course on medical students' perceptions of ethics has been documented in a recent longitudinal qualitative study (Stephens et al, 2019). Students themselves are conscious of and address the anatomy laboratory as a space of stressful experiences when a perceived lack of respect is exhibited by peers and faculty toward the bodies to be dissected (Terry, 2014; Caplan and DeCamp, 2019). Students have also demanded and outlined “ethical and policy considerations” for an improved anatomy education (Kahn and Gardin, 2016).…”

Anatomy, Education, and Ethics in a Changing World

“…In this special issue, one investigation from Australia presents findings from the largest and most comprehensive study of dissecting room experience on professionalism and ethical attitudes of medical students to donated bodies (Stephens et al, 2019), providing novel evidence for the impact of anatomy training on shaping the attitudes and perceptions of future medical professionals. There are also results from a qualitative study of emotion, ethics, and humanism in gross anatomy (Goss et al, 2019), and a first qualitative exploration of the use of unclaimed bodies and the impressions of the students that work with them (Caplan and DeCamp, 2019). The value of an educational intervention with a film about body donors (Iaconisi et al, 2019) and transformation and closure for donor families after meeting with students is explored (Halliday et al, 2019), while our understanding of donor populations is also enhanced through an exploration of registered Turkish body donors (Gürses et al, 2019) that provides a fascinating insight into how religion and culture influence body donation practice.…”