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Recent Ethical and Technical Issues Of ISRA MEDICAL JOURNAL Volume 4 Issue 2 Jun 2012 ORIGINAL ARTICLE RECENT ETHICAL AND TECHNICAL ISSUES OF CADAVERIC HUMAN BODIES AND TISSUES FOR EDUCATIONAL PURPOSES IN PAKISTAN: INITIATION OF A DISCUSSION FOR MAKING A POLICY Mansoor Ali Khan1 , Muhammad Ilyas Anjum2 , Afroz S Kazi3 ABSTRACT OBJECTIVE: To initiate a discussion, for devising a standardized nationwide policy for procurement and use of Cadaveric human bodies and tissues for educational purposes and then respectful disposition of the remains. DESIGN: Cohort design. PLACE: A Public Medical College DURATION: 2006 through 2011 METHODS: Available data was grouped into two chronological equal halves, Group–A 2006 to 2008, Group–B 2009 to 2011. The data was analyzed for age, sex, Known identity, Unknown Identity, later identified-claimed and remaining unidentified-unclaimed dead bodies. Studies related to policies for cadaveric procurement, transport, handling, utilization and disposal are presented. RESULTS: A total of 1605 records were analyzed. 54.9 % Cadavers were from 2nd and 3rd decade of life. The males in Group-A were 86.32% and in Group-B were 81.82%. DISCUSSION: About 41.55 % cadavers brought to Anatomy department were with Unknown Identity. But 34.93 % were later identified and claimed. Hence the police department of the region and the Anatomy Department of the institution with the help of print media are providing a great service to the society. The remaining unclaimed bodies are also utilized for dissection or in case of putrefied bodies bones were used for medical education. Even after exhaustive search no published data was available for cadavers brought to a public mortuary in Pakistan, as is presented here. CONCLUSION: Pakistan, being a developing nation, is quite vulnerable to many hazards of the increasing demands of cadavers in the medical education business. This is high time to start a discussion for making a comprehensive policy for caring and utilizing dead bodies for medical education. In this respect the anatomist, Islamic scholars and legal experts can collaborate with 'organ transplant' legislation bodies for devising policies. KEY WORDS: Ethics, cadaver, education INTRODUCTION cadavers for medical education has experienced various cycles of legalization and proscription in The human cadavers for educational purposes are different countries. During the 19th century, being used for long. In the past, anatomization of the anatomists largely finalized and systematized the body of a convicted person was sometimes ordered descriptive human anatomy of the previous century. as part of the punishment. It happened in 1805, in Extensive research was conducted in more areas of Massachusetts to James Halligan and Dominic Daley anatomy. Great Britain was particularly important in after their public hanging1 . this research: demand for cadavers grew so great Throughout history, the dissection of human there that body-snatching and even anatomy murder came into use as a means of obtaining them2 . In 1. Associate Prof and Head Department of response, the English Parliament passed the Anatomy, Nishtar Medical College, Multan. Anatomy Act 18323 , which finally provided for an 2. Assistant Prof Department of Anatomy, Nishtar adequate and legitimate supply of corpses by Medical College, Multan. 3. Prof Department of Anatomy, Isra University, allowing dissection of destitute. Hyderabad. Up till February 2012 PM&DC has recognized 87 Medical colleges for undergraduates and 38 Correspondence to: Postgraduate medical colleges4 . The number of Mansoor Ali Khan undergraduate medical colleges allowed by PM&DC Associate Prof and Head Department of Anatomy is has also increased. Fifteen years back the number Nishtar Medical College, Multan. of recognized undergraduate medical college was Email: [email protected] much less. This colossal increase in number of 100 Medical Institutions in the country both in public and once own cadaver helps him / her to attain a highly private sectors had put enormous demands on regarded status of “Ajarn Yai” great teacher14 . While virtually every resource and aspect of medical in our society organ donation is finding its place but education. It has also shaped the teaching of body donation after death seems to have no place as anatomy from dissection to mannequins but for vast yet. majority of students only anatomy models are available. But quite many researches still go in favor Technical Issues: 5 of dissection .It is emphasized that the cadaver must Technical issues in the management of mortuary are 6, 7 not be dismissed as obsolete since exposure to safe procurement of cadavers. At present cadavers dissection develops important cognitive skills and are received from the police department under police manual dexterity8 required by all medical rules 1934 or by another institute as a donation. practitioners. Lempp9 sums up dissection as an Storage of cadavers is very important and pains opportunity to reinforce familiarization and respect for taking. Storage includes embalming (with various the body and integration of theory into clinical techniques), un-interrupted adequate air practice. It would certainly be very unfortunate not to conditioning and security. take full advantage of the available technology to Justified allocation of cadavers for various purposes supplement revision of the learning objectives from is also important, like for dissection (cadaver to dissection classes10 . Tabinda Hassan11 a 'pro- student ratio), for display as specimens, for research, dissection' anatomist states, “this, gamble on for donation to other institute, etc. Staffing of the technology may be too risky in terms of patient safety mortuary is another problematic issue as general and well being which will lie solely in the hands of population does not like to work with the dead bodies. these future care takers of health”. Finally, the biggest technical issue at present is NOT To setup a stage and to encourage discussion on the to have any nation-wide policy or guidelines to be topic, following introductory notes are presented. adopted. Hence, this script Insha'Allah will lead to a healthy and positive initiation of a discussion in this Ethical Issues: respect. Even in the west, the guide lines on ethical issues for the care and use of cadavers in modern era face Legal Aspects: sacristy. Jones and Whitaker12 states “the lack of To the best of our knowledge, the legal guidelines for serious thinking about ethical issues surrounding use cadaveric care and use for medical education are of human body and remains anatomists and many almost negligible i.e. to say the only reference is other medical people peculiarly unprepared to meet Police Rules 1934 chapter XXV Para 25.38, the challenges of the very recent years”. In the “unidentified corpses should be handed over to any literature the ethical issues related to cadaveric care charitable society or to an institution for imparting and use for medical education are addressed in three instruction in Medical Science which is willing to main areas, namely, philosophical, practical, cultural accept them. If no such society or medical institution / religious. voluntaries to take such corpses, they should be A few questions will help delineate the philosophical buried in the normal manner”. Hence, detailed and aspects of ethical issues: Do the cadaver have same updated legal frame work is required. ethical status as living? Do the cadavers have same ethical status as animals? Ref (since they cannot give METHODS complete informed consent). Are cadavers no more than a property with associated legal rights but with A retrospective cohort study was carried out at the the limited ethical status inherent in property? 13 Department of Anatomy in a Public Medical College. Practical aspects of the ethics may include respect of It is providing mortuary and as well as morgue cadavers, usage of cadavers (dissection, display, services to surrounding districts and its attached experiment, research, donation / gift to other medical huge tertiary care Hospital. A large data (1605 institutions for medical education), disposition of cadavers) was collected from 03.05.2006 to cadavers, role of media, commercial aspects (like: 30.12.2011. The cadavers are brought to anatomy transport fees, handling fees, for-profit companies, department by police department. These cadavers donations or selling of cadavers). are brought by the police either as 'known (identified)- Cultural and religious considerations vary from cadavers' or as 'unknown (unidentified)-cadavers'. culture to culture, religion to religion and more so time These unknown cadavers may later be identified by to time in same culture and religion. For example, in close relatives through police or photographs in the Thailand the un-remunerated voluntary donation of news papers or directly by the relatives. Then they 101 ISRA MEDICAL JOURNAL Volume 4 Issue 2 Jun 2012 are claimed. Anatomy department returns the regard to this study and handling this large number of cadavers to the same police officials which brought cadavers and bones. the cadaver to the department. Then the police hand over the cadaver to the legitimate claimant. Thus, we RESULTS at anatomy department label these cadavers as 'known-identified', 'unknown identity' cadavers, A total of 1605 records were analyzed. The ages of 'later-identified' and after certain period of time the cadavers ranged from new born to 101 years. Each remaining cadavers as 'unclaimed'. The morgue and major group A and B was further divided into ten age mortuary service provided to the society in these six subgroups. years was calculated. The whole data was analyzed The age sub groups are presented in graphical forms in two major Groups A and B. Group – A is from 2006 in Graph A and Graph B with number mentioned in to 2008, while Group –B is from 2009 to 2011. The each subgroups. data was analyzed for age, sex, known (identified)- The male to female ratio of two groups is Group-A cadavers, unknown (unidentified)-cadavers, later 86.32% to 13.68% and in Group-B 81.82% to identified-claimed and un-claimed dead bodies in 18.18%.
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