Thursday, November 19, 2009

Would you donate your body for medical students to cut up?

I watched a fascinating and touching TV program last night about the people who have donated their bodies to the Dunedin School of Medicine for student doctors to dissect.

You would think, being a health professional, that I would have thought about how student doctors learn about anatomy and physiology, but I haven't. As a student nurse and midwife, I never did anything more exciting than inject an orange. So I sort of assumed that doctors learned about anatomy and physiology out of a book, the same way I did. I was once offered the chance to go to an autopsy as a student nurse but declined the offer.

The program was very sensitively filmed, I thought, and at the end I was in tears with the students as they watched the interviews of the people who they had cut up, and heard the reasons why they had donated their bodies.

I don't know if I would want to donate my body to science. On the one hand, I feel very squeamish about the idea. But on the other hand, a dead body has no soul...and if it benefited the learning of young doctors, then all to the good.

Would you donate your body to science?

41 comments:

KerryJ said...

That's my plan - just need to get the paperwork sorted.

The space that graveyeards take up could be used so much more effectively to improve the quality of life for the living -- public parks, affordable housing, etc.

My body is not me - when my brain dies, I'll be gone (or a fan of Neighbours). I say, let medical science learn what it can from what's left of me. As long as my head doesn't end up in a jar like Futurama. : >

Claire Thompson said...

Hmm, which would benefit society more--donating organs or donating your whole body? I wonder if you can put conditions--if my organs would not be helpful to transplant patients then please send me off to Anatomy 101? Right now science can have my organs if I kick off (must remember to remind loved ones of this), but I'll have to consider donating my whole body and how that fits in.

You've got me thinking!

Sarah Stewart said...

What interested me, KerryJ, was the reaction of the family - they would it very hard at the funeral that there was no body to say goodbye to at the funeral.

You have a point, Claire, that I was thinking about. I have said I want my organs to be donated to live people...would what's left be acceptable to the medical school? I'll have to find out. The only thing I have said I don't want anyone mucking about with is my eyes...weird eh?!

Sarah Stewart said...

I should have said 'they found it very hard' not 'would'

erika said...

I can sum up my philosophy with a comic (which tells you a lot about my philosophy)

To my mind, we're just meat. The rituals of socially acceptable passing can be conducted without the corpse, and it might be one last way to make a dent in my kharmic debt :D

But seriously, I can't help but wonder if such an expectation of revultion is a legacy from the Dark Ages and early Ren., when the overwhelmed (European) belief was in bodily resurrection on Judgement Day. You went into the ground whole so you could come back out. Now, unless I get to be one of the cool zombies that can run and doesn't stink too much, that doesn't really concern me - but it does make me wonder about the cultural impact of such long-held beliefs.

Because I'm weird and rambly like that. It can all be summed up in the cartoon.

Sarah Stewart said...

I have to say Erika, that what you have said has very strong resonance for me. I was brought up by parents who are Christians with a very strong belief of the second coming of Christ and resurrection of Christians. Subconsciously I have always thought that I need my body intact for the 'resurrection'...that is why up until recently I have told my family that I want to be buried, not cremated. This is a hidden belief that I am only just coming to terms with...It was only last weekend when I attended a cremation that I accepted that it could be an option for me...

erika said...

Exactly, Sarah. I come from a completely opposite tradition, where the idea of a body in a box, mouldering away for ever (no resurrections here) was anathema.

Which ties back into my earlier point, that the body itself (flesh and gristle, slowly cooling) is not so much central to our notions of a good or graceful death as is the values we attribute to it -- I think those values would be the strongers indicator of the potential for body being given to science or organ donation...

pondersome, man, pondersome!

Leigh Blackall said...

No, not with the present standard of education, teachers and students. I don't wont no rich kid doing to my body over half drunk and not even sure she wants to be a doc. See youtube for examples. When education is free again, and teachers even slightly more circumspect about their role, then maybe. Until then, fly me to Cambodia for the black market trade.

Deirdre said...

A massage therapy friend of mine recently did a dissection class and found it so important to her understanding of anatomy, she signed up as a donor.

Anne Marie said...

I went to a medical school where we dissected a body to learn anatomy, and I teach in a medical school which has the same. I did not enjoy dissection and am not sure that I learned very much from the process, but then I was vener going to be a surgeon.
Many medical schools do not have medical student dissection now, but still have 'pro-sections' for students to observe.
Although there are horrifying accounts of medical students being disrespectful of bodies, I would like to believe this is in the past. Some suggest that dissection is necessary in part to toughen up medical students. I think that is an equally disturbing thought.
If dissection is to remain in a curriculum there should be very good reasons why.

Sarah Stewart said...

@leighblackall I thought the students and teachers were very respectful in the program - they hold a memorial service for the people.

Merrolee said...

Our students attend the dissection labs at the University of Otago. This is also their first experience of ethical reasoning - thinking about who has donated, and why and being respectful of the 'body' they have in front of the. For kinesthetic and visual learners - the learning in these labs is hugely beneficial, and definitely not the same as using models or watching others. I believe that our students are well prepared to behave very appropriately in this situation.. and are well supervised as well!

Leigh Blackall said...

Y'll referencing undergrads as though its noble medical science makes me puke. When I was an art student we went to anatomy labs for drawing. Fck knows why, they still spend hours every day perving a naked people for $10 per he just to make crappy pencil drawings, never to learn how to draw clothing! But anyway, I witnessed students and profs being quite disrespectful. By I doesn't matter does it - they're only rotting corpses and there is no fcking God in heaven.

I'm with Anne Marie, come out of the noble science tree for just a minute, and have a think about why. Give me a specific reason why instead of generalized "science is great".

Anne Marie, what would illich say?

Leigh Blackall said...

Ive turned into a crouch haven't I! Please excuse my fun. Ive become an intollerant old man after my 4 yrs in Dunedin. And the typos are because I'm on a mobile.

Anne Marie said...

This paper contains seven arguments for the retention of dissection. doi:10.1016/j.aanat.2007.10.001

I don't doubt that students are respectful. I don't remember any dis-respect in my own year of dissection. I just look for objective evidence that it is the most effective and efficient way to teach anatomy.

Leigh Blackall said...

I wonder, could this argument we're not going to have extend to animals as well?

Sarah Stewart said...

OK...Leigh...this rich, middle class, drunk 'video on YouTube' student has become a doctor..and is now an obstetrician looking after your darling wife and baby. Things don't go normally and she requires emergency treatment etc. How can you guarantee that doctor has the requisite knowledge to carry out a c/s or whatever...is it better for that doctor to practice on your 'live' wife rather than a 'dead' body?

Leigh Blackall said...

You tell me?

I expect that they will have seen demos before, quite a few, and they may even have someone with experience on hand. So yes, they could learn by doing.

I'm not sure a dead person is good enough practice for all that would be involved anyway? But its not my area... I would trust someone with real experience (even if only observed) than rehersal on dead people..

Leigh Blackall said...

And animals? Should our undergrads and researchers continue their testing and foundational education on animals as much as they do? I heard in NZ that animal cutting is no longer the norm? what about gratuitous testing?

Sarah Stewart said...

But I can tell you now...there are some things that you just cannot learn by watching videos, practicing on models, or even watching others do it...you have to do it yourself. The feel of putting a needle through skin just cannot be replicated easily in other ways.

I have to say I'm arguing with you, Leigh, for the sake of it...because you've turned into such an old grouch. I actually haven't looked into this issue of teaching/learning by dissection because I have never had to think about it. Heath professionals have to learn some way...what's the difference between 'practicing' on you when you're alive to learning when you're dead?

I am interested to hear, Merrolee, that the OT students go to the dissection lab but nurses and midwives don't...what does that say about the way we educate nurses & midwives compared to OTs?

Leigh Blackall said...

yeah, I'm arguing for the sake of it too..

But just to be clear, I didn't say videos, simulations, and models replace.. I proposed that live observation to the point of guided live doing might suffice. Cutting on an as needed basis, with strong networks of support.

What about the military? Part of what they do is kill people. They need to know what does that effectivley. Should I donate my body so they can experiment with effective was to dismember it?

What about car safety research. Should I donate my body so they can know what a real body goes through on impact?

Why not clone semiconcious humans and practice on them live? They're nobody's child or parent, they have no conciousness.. lets do it!

Our ethics are to protect us, not the other.

Pam said...

ok,

Just to throw myself into the mix, I must say I am leaning towards Leigh on this one.

I am sorry to Annemarie but I do believe it is slightly naive to believe that being disrespectful is a thing of the past. Having been a scrub nurse and seen the behaviour of anaesthetists and Consultants towards unconscious patients let alone dead ones!

I have also been in the morge whilst a post mortem took place with medical students, training police officers present and anyone else that cared to learn 'real' anatomy.

I believe the need to donate your body to science is a thing of the past especially with the creation of 3D imaging and I am sure hollywood would be able to create something.
The program may have shown them being respectful but I am sure that was for the benefit of the cameras. I will keep all my body parts thank you and interestingly so will my Dr hubby!

Claire Thompson said...

Lots to think about here. I have no experience with human dissection, but as a teacher of high school biology I have thought about virtual vs real dissection a fair bit.

The benefits of virtual dissections are that they are cheaper, easier, less smelly, less confusing (as usually everyone is looking at the same animal so natural variation in internal structures doesn't complicate things), and avoids many of the ethical concerns associated with real dissections.

However, I've rarely seen a student get excited about a virtual dissection. There is sometimes a 'gee whiz' response to the cool flash animations, but not to the actual dissection itself. How are you going to learn that not every heart or spleen or... looks exactly the same? How are you going to find out if you have steady enough hands to make the delicate incisions required to cut through different tissues? Or the fact that different tissues feel very different? And as I think someone in this thread mentioned, dissections would seem to benefit kinesthetic learners.

Every year that I've done dissections and, particularly the fetal pig, I've allowed students to choose to do a virtual dissection if they are opposed to the real thing. Every year a small number of students make that choice. Every year a roughly equal number of students go into the dissection expecting to hate it and find out that they are fascinated by the process. The beauty of a tiny fetal pig heart, or the perfection of the tracheal cartilage is hard to replicate in a virtual setting. The students who choose the virtual route are still required to write the lab exam at the end of the dissection (using photo cards as the dissection animals are pretty ripe by then). Usually the students who have chosen the virtual path find the lab exam frustrating--they just don't know the parts as well as the students who did the real dissection.

I wonder how much of our hang ups with dissections, human and otherwise, are a reflection on our increased isolation from the nitty gritty of life and death? Most of us in western society do not slaughter and butcher our own food. Most of our children have no experience handling animal carcasses. If we eat meat most of us obtain it in a very sanitized form. I have never seen a dead human body other than in photos or images on TV.

Do all medical students need to learn anatomy by performing human dissections? I'm not sure. Perhaps for some it is the best way to learn, and for others it is not. As an educator I know that my students learn best when I can offer them multiple ways to access the information.

Pam said...

interestingly my husband says that all but two medical schools in the UK continued to do dissection until recently when the two who didn't found that the students weren't attaining high enough marks.

I am not againist it because I haven't seen my fair share of dead bodies rather that it plays to a natural human instinct to dehumanise the human body and I don't think it contributes to medical/human interface.

Take the doctors who worked in hitlers germany who took the opportunity to perform human experiments because they were in an environment that allowed them to do so and which positively encouraged them. They made great contributions to medical science yet as we all know it actually wasn't ethically acceptable.

In fact take the two Wellington consultants who decided to use women's smears as part of their research without consent or informing them they were part of research.
There are huge issues at play here and I suspect I have digressed somewhat but I just wanted to illustrate how unethically the medical profession can behave given the right set of circumstances.

erika said...

Oooh, interesting debate is interesting. Just to throw in another thought, we seem to be looking at the place of dissection in education without looking at what else goes along with it - should we perhaps also consider context? What ethical training do they have, what psycho-social preparation? How is dissection couched, how are the students introduced into it and what happens post-dissection not only in terms of the 'nuts and bolts' of anatomy, but also the thoughts and feelings of the student as a member of society and a human being (and not just a proto-doc)?

Deirdre said...

I called friend who recently did class and this is what my friend learned from cadaver anatomy class:

.Things aren't necessarily where they are supposed to be
.Appreciation of tissue densities and structures
. Texture of tissues
. Investigating cause of death
. Bodies response to previous surgeries

Deirdre said...

I think a key reason that my friend learned so much was her perceived need to learn more about tissue and nerve structure than previous anatomy classes provided and her instructor's role modeling of respect for human body.

starpath said...

As a student of Physical Education (decades ago), we were fortunate to be admitted to the "bod room" for anatomy instruction and observation of the dissection. It was all very respectful. Of course there were jokes about "do you want a hand?". Otago Medical School memorial service for relatives and friends was a clever way to enable people to remember the contribution of those who donated their bodies...a very good idea.

Sarah Stewart said...

Starpath: do you think the jokes were disrespectful or a way of coping with the reality of the experience?

Anne Marie said...

The comments which have been made about dissection showing the range of 'normal' fit with those in the paper I linked to. The authors also say that learning about different textures is important.

For the record I would like to state that I wouldn't have any concerns about giving my body over for dissection by students. My quandary is more over whether it is really is the most efficient way for students to learn. Research shows that different students have different experiences and spend more or less time in actual dissection as one might expect.

I grew up in a place in rural Northern Ireland. It is traditional for the dead to be waked in their own homes so I have seen and touched many people who had died before I studied medicine. It is actually a less familiar experience for me now that I live somewhere this is much less common.

Well, done on starting the conversation Sarah. There is actually a published paper from Dunedin about dissection quite recently. It documents the access of other professions to the process.

Has anyone been able to access the paper I linked to?

Claire said...

I would hope to donate my organs for transplant if possible, and then donate my body. I also come from the perspective that when you are gone, you are gone and I might as well be used for something constructive or buried for fertiliser!

I studied using cadavers at university and felt it was a hugely useful experience. Fellow students did make jokes, but I felt this was definitely a response to their anxiety and discomfort. Anatomy for me, was much more clear in the DR than in textbooks or animation. I absolutely agree that as long as the bodies keep on being donated, students should continue to be offered this useful method of learning. To be honest I am surprised this is a debate at all! If students are found to be disrespectful they should be subject to normal procedures for dealing with inappropriate and unethical conduct in relation to professional codes of practice.

Anne Marie said...

Absolutely Claire. I think the disrespect issue is a distraction. It certainly isn't a reason for stopping. I just wonder if it really is a useful way of learning.

Sarah Stewart said...

I have never thought about the issue until I watched the documentary and then only in terms of whether I would donate my body or not. We have never used dissection in the midwifery courses I have been involved with so I have never felt the need to do any reading or evaluation on the topic.

I wonder how much of the 'hands on' experience, including touch and smell, will be replicated one day using 3D etc.

Leigh Blackall said...

I'd say by then science will be using our bodies for methane power generation hooked up to crematoriums.

Anonymous said...

hi
I think peoples ideas and beliefs about eternal salvation probably influence their feelings on this.
What interested me was the lack of attention to the basic principles of of infection control 101 displayed by the students (it just looks wrong seeing long hair flapping and touching the exposed body - and gloved dirty hands - then scratching your face!). When the principles of clean and dirty are entrenched - you just don't ever do this - so that taught me something about med students and hygiene.

Also wondering what the relevance of dissection is to OT students??

Don't ever see this becoming part of midwifery education - as lets face it - its totally not relevant.

I think if med students are going to cut people up - then the content on considering the whole person id crucial - to make it holistc and healthy - and not just nutty.

I thought one of the tutors was a little too excited by the gratuity for my taste.

It gave me a bit to think about - initially I wasn't going to bother watching - but I couldn't be bothered going to bed and my partner loves the idea of donating himself - so I lost the which channel debate.

Rae

Sarah Stewart said...

I am wondering if we should be thinking more about donating our body parts for live transplant...would you donate for transplant, Leigh?

Leigh Blackall said...

Of course not! I try hard to follow Illich and his views on the medical institutions. Beside's I don't want to give the med any reason to put me down early because I have a good heart he'd like to dig out and use for the privately covered patient he has waiting.

Carol said...

I'm in grade 11 and I my biology class went to Queens university in Kingston ON and got the opportunity to the cadavers. I just wanted to say that I thought it was a very neat experience. We were allowed to touch the body and see how everything worked and how it was connected. Having a hands on experience really helped me understand the human anatomy better!
I will want my body donated to science if I die a natural death. I believe that once the person is dead the body is just a body and the person is not longer there. I think the bodies should be respected, and I think that used for science is a good cause after death. :)

Sarah Stewart said...

Hi Carol, great to hear from a younger person. As a matter of interest, what do you think you'll do as a job when you leave school? Will you do something in health like be a doctor or nurse?

EAMD said...

I'm a first-year medical student who just started Gross Anatomy, so here are a couple extraordinarily biased thoughts from the field...

1. I firmly believe dissection is a valuable part of the medical school experience. Bodies in books often look the same, both on the inside and on the outside. Bodies in books are neatly color-coded and diagrammed. It's vastly different to dig around for the internal thoracic artery, versus point to it on the page and say, "There it is. The blue one."

2. In my opinion, "human" applies to our cadavers as an adjective, not a noun. The soul, the essence, the spirit, whatever you want to call it--it's gone. Those perturbed by the barbarity of dissection would do well to recall the history of modern medicine. Far more ghastly techniques--on humans-- have been used to teach physicians about anatomy and physiology. Read up on J. Marion Sims, the "father of modern gynecology", for more detail on this.

3. In direct response to some of the commenters' concerns, it is my understanding that bodies for donation are donated after any desired funeral service is performed, i.e. the family has a funeral, THEN donates the body. Also, these particular bodies often have a variety of conditions--age being the most common one--which preclude organ donation. Finally, the eyes of our cadavers are already gone. They don't preserve well. :)

4. Finally, I am keeping track of disrespectful jokes/comments I hear. So far, it hasn't been egregious. But I have heard my classmates say ridiculous things outside the anatomy lab, so I am not holding my breath for a totally reverent atmosphere inside the lab.

Just some spectacularly biased thoughts from someone who is totally excited about gross anatomy. The great thing about body donation is that it's an opt-in procedure. I have friends who are all over donating their bodies to science. Other people, not so much. As excited as I am for this class, I think either choice is a valid one.

Sarah Stewart said...

Thank you very much for your comment EAMD - great to hear from a student's perspective