The evolution of medical practices, improvement of medical facilities and continuous research and development for the cure of diseases are aimed towards the perpetuation of a healthy and sound life. Nonetheless, no matter how much efforts and knowledge has been put into medical practices, every medical procedure (such as major operation) will always be a trial-and-error for the doctors or medical aides. This has been because human bodies react differently to a certain medication, hence no one can ascertain for sure if one will survive or not.The expectation that those who have sworn to medical professions are all knowledgeable and skilled in their craft would be an over-rating. Real training for them begins only during the time of hands-on experience.
In some experiments conducted for the continuous understanding of the complexity of human body or for lecture-demonstrations of medical procedures, a dead human body is being employed. This practice is among the medical practices that harbor criticisms, in relation to bio-ethical issues it poses.Although some procedures and experimentation may be carried out at the expense of animals like monkeys or rats, or using mannequins or imitations of the organ being studied, the use of a cadaver gives – more so a newly declared dead body -- a realistic approach and overview of the scenes in an operating room or medical procedure. Moreover, it would be easier for the medical practitioners to remember such procedure. For medical practitioners, access to dead bodies is not a problem.Some dead bodies, which are already overstaying in the hospitals or morgues or whose identification can not be ascertained, are being made available for studies, practice and other medical purposes.
However, since these cadavers were already dead for quite a long period and were subjected to different formulae for preservation, the quality of the body becomes affected. Furthermore, certain circumstances require for the immediate study of the body so as to understand the body condition while it is not yet preserved or rotten.Lastly, practicing of proper medical procedure (i. usually limited to endotracheal intubation, central line placement, skin incisions, thoracotomies, pericardiocentesis and biopsies)1 under such condition will help medical practitioners to gain experience should they encounter the same circumstance.
Hence, practicing on newly dead bodies is more convenient for medical purposes and educationally beneficial. Nonetheless, having involved the dead, the use of newly deceased bodies in medical practices harbors criticisms as attached with it is a bio-ethical and legal issue on respect for and how to treat dead bodies.More so, it is also a question if whether the permission of the family is to be seek first or not. In a case study related by Iserson, Sanders and Mathieu in their book Ethics in Emergency Medicine2, the question revolves around the issue on whether to seek the permission of the dead’s family prior a medical procedure or study is conducted on the body or should the medical practitioners proceed especially if the consent needed seems to be difficult or takes a longer period to secure.
In this case study, they related the case of a man who collapsed and eventually died due to cardiac arrest.Since the prolonged resuscitation had been unsuccessful, nothing had been done to revive the man. With the death of the man, the interns and resident medical practitioners present had all agreed to use the dead man’s body for practicing intubation and resuscitation to gain more experience. Furthermore, the team further requested to practice punctures of the central veins (a procedure, which requires the placing of a catheter on one of the major veins while several needle punctures on the lower neck and clavicles of the body is being executed).
The burden of allowing them has then fallen on the shoulders of the attending physician. With the family of the dead in the waiting room and the release of the dead body by the medical examiner, should the attending physician allow the staff to carry out their request? The intubation poses no further harm on the body of the dead as it will leave no mark or damage. More so, since the dead patient can no longer feel pain, such procedure will no longer pose threat to the patient’s well-being. Mastery of certain medical procedures requires constant practice.Certain procedures, if done negligently or with less knowledge may cause infection or death.
In other situation such as the one mentioned above – the central vein puncture -- practicing on newly dead bodies is an urgency. In this procedure the blood return to the catheter upon puncturing of the lower neck is being observed, hence this could not be done on embalmed or preserved bodies. In the United States, a constitutional rights to privacy exists, which protects a patient from “non-consensual invasion of the body”3. However, this ends once the patient is already dead.
Moreover, there is no law or stricter policy which prohibits or regulates hospitals or medical practitioner from employing dead bodies in their procedural demonstrations, practice or studies. In addition, specific state courts as in Michigan, Georgia and Florida, holds the constitutional rights to privacy as personal whereupon the next of kin has no claim unless otherwise as dictated in written. Without existing rules and regulations, practicing on newly dead bodies does not pose any grave legal implications on the end of the medical practitioners.On the other hand, the US Appeals Court for the Sixth Circuit held provisions regarding the ights of the next of kin to the dead’s remains. As stated, “.
. the next of kin had a constitutionally protected property interest in the patient's remains. Furthermore, the next of kin could have a legal claim against the hospital for negligent or intentional infliction of emotional distress if procedures were performed on the patient after death without the family's consent. ”4 In this light, it has become a dilemma to doctors or interns to proceed to studying and conducting medical examination and procedures on the dead body without having to think the reaction of the family.Apart from this, doctors are compelled to reflect on the ethical issue (i. e respect for the peaceful repose of the dead) and legal implication of such practice.
In order to justify the use of a recently dead body in the laboratory or hospital, the legal and ethical issues must be settled first. Common law defines death as the state of the body wherein vital functions, as in respiratory and cardiac functions ceased to work anymore. However, a more complex definition is being provided by the law and proposal to unify the definition of death for legal and medical purposes.In the Uniform Determination of Death Act, death is defined as (as per defined by different states and medical organizations) or is to be declared if (1) “…the entire brain (must) cease(d) to function, irreversibly”5, wherein the entire brain here is described as the brain stem and the neocortex, and if (2) the medical examiner announced his opinion that the person is already dead if under ordinary standards of medical practices, the body experienced irreversible and spontaneous cessation of the respiratory, circulatory and brain functions as caused by disease or condition.This does not include provision on how the body should be regarded upon declaration of death thus, medical practitioners has the freedom to do examination of the body or medical procedure practice.
Given this argument, medicine doctors or interns hold no legal liability on doing such. Moreover, there is not yet any policy prohibiting medical practitioners in conducting such test. What could have prevented them however, is the already mentioned constitutional rights of the kin of the dead to claim his remains and to authorize doctors from conducting studies on the dead member of the family.However, based on research, surveys show that there is a significant percentage of families who agreed to use their dead relative’s body in medical studies. According to this survey consent is 59% high “for invasive procedures in adults and 73% for endotracheal intubation in deceased infants”6. The wide-acceptability of the use of corpses among the kin implies that patients and their relatives are already learned and have support for continuous medical advancement and improvement.
As for the ethical issue, those questioning the ethical aspect of practicing on newly dead bodies argues that the dead should be given respect by allowing them to be at peace instead of making them a subject of medical experimentation or studies. The dead, being one of us who once walked the earth should at least be given a proper homage as a symbol to the body being the home of life and humanity.Nevertheless, practicing on dead bodies is rather more ethical than practicing on living human who could give his full consent. In addition, as argued by Iserson, keeping the living human alive by studying the body of the dead person is rather a respectful act for the life, which resided once in the body. In sum, practicing on newly dead bodies is neither disrespectful nor illegal as this act being done for the benefit of the living persons.
