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Religions and the Autopsy

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Religions and the Autopsy 8/18/2014 Religions and the Autopsy News & Perspective Drugs & Diseases CME & Education Log In Register Religions and the Autopsy Author: Elizabeth C Burton, MD; Chief Editor: Kim A Collins, MD, FCAP more... Updated: Mar 21, 2012 Overview Different traditions, beliefs, and practices surrounding death are common to all cultures and religions and have resulted in conflict regarding anatomic dissections and postmortem examinations. In addition, such views have been said to have hampered scientific and medical discovery in past years.[1] Persons from more westernized or diverse environments tend to have less cohesive connections with traditions, religion, and beliefs, and have a greater acceptance of autopsies. However, non-westernized, less diverse cultural groups have more unified traditions, beliefs, and practices surrounding death, and they more frequently have religious issues related to autopsies.[2] Although cultural or religious beliefs are often cited as a reason for opposition to autopsy, most religions and cultures find autopsies acceptable either based on the individual's beliefs or special circumstances.[3] Certain religions outright object (eg, Islam and Judaism) in that bodily intrusion violates beliefs about the sanctity of keeping the human body complete, although religious doctrine does not in of itself strictly forbid autopsies. Instead, it is a matter of interpretation of the doctrines which have changed over time. Christian Scientists do not outright object, but autopsies are not advocated. Buddhism, various Christian sects (eg, Anglican, Church of England, Church of Wales, Episcopal, Church of Scotland, Greek Orthodox, Roman Catholic, Baptist, Methodist), Church of Jesus Christ of Latter Day Saints, Free Church (Salvation Army, Quakers), and Jehovah Witness doctrines do not state an intrinsic objection to autopsies.[4] Shinto, Taoism, and Confucianism do not prohibit autopsies. In addition, Hindus have no intrinsic objection to autopsies, but their belief is that all organs must be returned to the body, and those who practice Sikhism believe that the funeral must not be delayed. Not surprisingly, views about autopsies often parallel views about organ and tissue donation. Religious objections to autopsy occur in both medicolegal- and hospital (clinical)-based autopsies. For clinical autopsies the purpose is generally to investigate the cause of death and extent of natural disease, and consent must be granted by the next-of-kin in order for an autopsy to occur. When permission for an autopsy is declined for any reason, including religious objections, the autopsy is not done. The process is different in cases that fall under medicolegal jurisdiction. The purpose of the medicolegal autopsy, which may or may not be part of a death inquest, can be to identify the deceased, document the nature and distribution of injuries, correlate whether the nature and distribution of injuries is consistent with a history or eyewitness account, reconstruct events related to the death, determine other diseases or injuries that may have contributed to the death, and collect trace materials that may help ascertain the manner and cause of death as well as solve crimes.[5] In medicolegal cases, a death inquest and/or autopsy is ordered by a legal authority (most commonly a medical examiner or coroner), and permission from the next-of kin is not sought although expressed opposition from the next-of-kin is viewed and dealt with on a case-by-case basis. A number of cases in which an autopsy was protested on religious grounds have been shown to have hampered or obstructed investigation of deaths, including http://emedicine.medscape.com/article/1705993-overview#aw2aab6b3 1/14 8/18/2014 Religions and the Autopsy those of a suspicious nature.[1, 6] Such challenges result in inconsistencies between the autonomy for an individual (patient or family) and that of an authority (justice and law enforcement). These have resulted in public policy and legislation restricting autopsies to cases in which there is a compelling public necessity and often require a court order to proceed in the least intrusive way possible.[1] See also Autopsy Request Process. Islam Islamic religious practices are most prevalent in the Middle East, Northern and Western Africa, Central and South Asia, Indian subcontinent, and Malay Archipelago, and centered in Eastern Africa, the Balkan Peninsula, Russia, Europe, and China. Although the Qur'an (Koran) does not directly discuss autopsies or postmortem examinations, Islam contains many important doctrines which do. When contemporary situations challenge Islamic law, scholars known as hadith are sought out to publish a fatwa, or legal opinion. The fatwa are not binding, and several can exist regarding one issue. These interpretations, therefore, can range from more literal views of the laws to liberal, modern interpretations.[7] The main issues in Islam involving autopsies are not different from other religions: autopsies delay burials, cause harm to the body, and remove body parts. The benefits are the same also: autopsies can lead to scientific advances, important medical diagnoses and enhance education, among many others.[8] Muslims undergo several rigid traditions following death. The eyes and mouth should be closed and the limbs should be straightened. The body should be faced toward Mecca, if not already. The body is washed and draped in a specific manner. Several family and community members travel to the deceased and participate in the mourning process. Muslims are always buried without embalming and are never cremated. The deceased should be buried as soon as possible, usually within 24 hours, and the burial should be as close to the site of death as possible, preferably within 1-2 miles. Family members do not eat until the deceased has been buried. Females never attend funerals.[8] It is therefore clear why autopsies are not encouraged in Islam tradition. First, a postmortem examination would inevitably delay the burial. The Sharia, the book of Islamic law, states that the importance is "in order to bring the dead person closer to what God has prepared for him/her," and to bring God's servant closer to Him.[7] A decayed body is considered repulsive to others.[8] Finally, a rapid burial is beneficial to the community: if the deceased was a good person, then it will be a good deed to hasten his or her journey to God; alternatively, it would behoove the community to free themselves of a bad person as quickly as possible.[7] There are a few reasons that are reasonable to delay the burial. Egyptian Rashid Rida's fatwa of 1910, entitled "Postmortem Examinations and the Postponement of Burial" was published in al-Manar, a weekly, and then monthly, journal. Rida was a well known scholar and politician at the time. He described that a risk of a hasty burial is that the person may not truly be dead. This, he realized, was especially true in the setting of drowning or being struck down during a storm. Therefore, it is beneficial to wait on an official medical examination. Finally, it may take time to obtain camphor (kafur), which is the special turpenoid solution used to clean the body. Hence, Rida had determined that there are reasons to postpone burial, and this has led to expansion of his ideas to include medical examination for various reasons.[7, 9] The Sharia encourages retaining the body in its original form and keeping it as close to the site of death as possible, both of which would be violated by performing an autopsy. Transporting the body to the laboratory may cause physical damage and move the body far from the site of death. The scholar Abd al-Fattah stated that a body that has lost its human form has lost its dignity, which is a serious sin.[7] However, the Sharia contains a few exceptions to this as well. It explains that if a person had swallowed money which belongs to someone else, it is acceptable to retrieve that money out of the deceased person's abdomen in order to pay his debt, thereby preventing harm to his heirs. Additionally, if a woman dies during pregnancy and the fetus is believed to be alive, some sects of Islam believe that it is proper to remove the fetus with an incision.[9] The Prophet Muhammad stated that "to break the bone of a dead person is like breaking the bone of a living person" (Sunan of Abu Dawood) which has been extensively interpreted in the fields of autopsy and organ transplantation. Some believe that this means that the deceased can still feel pain.[10] http://emedicine.medscape.com/article/1705993-overview#aw2aab6b3 2/14 8/18/2014 Religions and the Autopsy Maslaha is the Islamic principle of "public benefit." It states that when the benefits outweigh the damages, the beneficial approach should be taken. This has wide interpretations and definitely has been used to support the practice of autopsies. H. M. Makhluf's landmark fatwa was published in 1952 and represents the Sunni school of thought regarding postmortem examinations. He explained that a doctor is only fully educated when he understands the body inside and out, thereby making human dissection necessary for thorough medical education.[9] He also stated that advances in medicine are supported by the themes of the Sharia. This is an interpretation of the Sharia's ideas about not performing religious duties if health will suffer. According to the Sharia, people are encouraged to seek medical help when needed and not to exhaust their bodies by performing religious duties. Makhluf even went so far to legitimize voluntary donation of bodies to science. Contemporary Islamic society is sensitive to criticism regarding lack of medical advancement and falling behind Western medicine; therefore, these arguments are taken seriously by the public.[7] However, some believe that animal autopsies should be sufficient.
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