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CLINICAL ANATOMY Volume 29, Number 1, 2016 Special Issue on Ethics in Anatomy

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CLINICAL ANATOMY Volume 29, Number 1, 2016 Special Issue on Ethics in Anatomy The Official Journal of the American Association of Clinical Anatomists, the British Association of Clinical Anatomists, the Australian and New Zealand Association of Clinical Anatomists, & the Anatomical Society of Southern Africa CLINICAL ANATOMY Volume 29, Number 1, 2016 Special Issue on Ethics in Anatomy http://wileyonlinelibrary.com/journal/ca ISSN 0897–3806 Clinical Anatomy 29:1 (2016) EDITORIAL Gentlemen, damn the sphenoid bone! R. SHANE TUBBS* Editor-in-Chief Seattle, WA Welcome to our first issue of 2016. This year, Clinical Anatomy will provide our readership with cutting edge publications that can be used for improved patient care as well as in the teaching of anatomy to future practi- tioners of medicine and the health related professions. Oliver Wendell Homes (1809-1894) (Fig. 1), a true Renaissance man, is known for his famous opening line (and the title of this editorial) for his anatomy course at Harvard Medical School. This whimsical comment not only applies to the complexity of this single bone but to the deeper aspects of anatomy as well. Oliver Wendell Holmes, Sr. was a physician, dean of the Harvard Medi- cal School, one of the best regarded American poets of the 19th century, father of a future United States Supreme Court Justice, inventor and — unknown to many — an anatomist. His friends included Ralph Waldo Emerson, Henry Wadsworth Longfellow, and Louis Pasteur. He trained with some of the most influential Fig. 1. Oliver Wendell Holmes, Sr. (1809–1894) anatomists/surgeons of his day including Lisfranc, Larrey, Velpeau, Bigelow, and Dupuytren. As a teacher of anatomy, he had strong feelings regarding medical Jones from the University of Otago has aptly put curricular reform and to some, was considered one of together an international group of authors who are the best lecturers in the discipline. As dean, he pio- expert in this field. Although conclusions cannot be neered social reform by admitting both white women drawn, bringing these topics to the light is an important and free black men to Harvard Medical School (Tubbs first step in conversation and debate and one that we et al., 2012). The cover of this issue of our Journal takes believe the readers of Clinical Anatomy will enjoy. one back to times when segregation was the norm between trainees of medicine. Since these earlier controversial times, anatomical REFERENCES knowledge and teaching have come a long way. How- ever, controversies are still around. For example, the Tubbs RS, Shoja MM, Loukas M, Carmichael SW. 2012. Oliver Wendell ethics of anatomy is a timely topic and one that we are Holmes, Sr. (1809-1894): physician, jurist, poet, inventor, pioneer, happy to bring to you in this Special Issue. Dr. Gareth and anatomist. Clin Anat 25:992–997. *Correspondence to: R. Shane Tubbs, Children’s Hospital, Pediatric, Neurosurgery, 1600 7th Avenue South, Lowder 400, Birmingham, Alabama 35233. E-mail: [email protected] Published online in Wiley Online Library (wileyonlinelibrary. com). DOI: 10.1002/ca.22670 VC 2015 Wiley Periodicals, Inc. Clinical Anatomy 29:2–3 (2016) EDITORIAL Anatomy in Ethical Review DAVID GARETH JONES* Department of Anatomy, University of Otago, Dunedin, New Zealand When I became Head of my present Anatomy been ongoing debate over the public display of whole Department in the early 1980s, it was considered dissected plastinated bodies (Hildebrandt, 2009a,b; very strange to encounter someone who had an inter- Jones and Whitaker, 2009; King et al., 2014). While est in anatomy and ethics. At best the two were seen different ethical issues are raised in these two areas, as occupying quite separate intellectual compart- they hone in on fundamental ethical considerations— ments; at worst the two were incompatible. In prac- informed consent on the part of all involved, treating tice, their separation was little more than an the person who has died and their families with dig- indication that the discipline of anatomy had no need nity and respect, and working toward a gift relation- of ethics. Obtaining the bodies of the dead was carried ship with its emphasis on donation rather than out in accordance with existing legislation (the then retention (Department of Health, 2001). extant Anatomy Act), and as it happened the only Much of the debate in the anatomical literature has bodies used in the Department had been bequeathed centered on the ethical thrust away from using for the purposes of teaching and research. All proce- unclaimed bodies toward a model based on donation dures were legal (Jones and Fennell, 1991). What and bequest (Jones, 1994; Jones and Whitaker, 2012). more could be asked of anatomists? While this is not the only ethical issue of significance in The Department also housed the skeletal remains of relation to dead bodies and body parts, it encapsulates indigenous peoples, histology slides of human tissue, them since a willingness to override the interests of the and a Museum containing human embryos and fetuses, deceased and their families in this way suggests that as well as an impressive collection of preserved human they will also be overridden in others. There is perhaps parts. While many of these items had been in the Depart- a parallel between this and the retention of organs ment for many years, they represented important teach- without consent following post mortem. Both suggest a ing tools and raised significant ethical challenges (Jones professional paternalism whereby that which is and Telfer, 1995; Jones and Harris, 1998). regarded as benefiting the profession overrides the Responses such as these reflected the ethical climate welfare of the dead person and their family. of the time, and should not be unduly harshly con- Valuable as these debates have been, they are demned. They were not intended to conceal notorious exposed to the danger that they reflect the situation activities, and I have no reason to suspect that any such in Western countries and ignore the realities found in activities were taking place. However,they failed to pre- other societies (Winkelmann and Guldner,€ 2004; Lin pare the anatomists in the Department (or anywhere et al., 2009; Subrasinghe and Jones, 2015). Unless for that matter) for activities elsewhere with the poten- great care is exercised the result is cultural and reli- tial for mistreating dead bodies. Neither these nor other gious myopia, resulting in ethical generalizations that anatomists were being trained to think critically about are unworkable in some societies and may actually their practices, and were not being provided with appro- stifle constructive ethical debate. As has been evident priate analytical ethical tools (Jones, 1998). in Western societies, the development of ethical The organ scandals that came to light in the 1990s awareness has occurred gradually, so that ethical in the UK were the result of the activities of patholo- standards today differ substantially from what was gists and clinicians, rather than of anatomists, and yet regarded as ethical practice 50 let alone 200 years they brought into the open a welter of ethical consid- ago. Against this background those societies lacking a erations as to what can and cannot be done to and history of ethical debate, especially where there are with the dead human body, body parts, and organs. long-standing cultural and religious considerations These scandals led to one commission of inquiry after that have not been rigorously assessed, may well fol- another, with the subsequent formulation of crucial low their own trajectories. This is not to suggest that ethical values governing treatment of the bodies of the recently deceased, plus ways of approaching the bereaved family (Bristol Royal Infirmary Inquiry, *Correspondence to: D Gareth Jones, Department of Anatomy, University of Otago, PO Box 913, Dunedin 9054, New Zealand. 2001; The Royal Liverpool Children’s Inquiry, 2001; E-mail: [email protected] Retained Organs Commission, 2002). However, anatomists were directly implicated in Received 7 September 2015; Accepted 9 October 2015 unethical practices during the Nazi era in Germany Published online in Wiley Online Library (wileyonlinelibrary. and occupied territories, and more recently there has com). DOI: 10.1002/ca.22646 VC 2015 Wiley Periodicals, Inc. EDITORIAL 3 they will end up with radically different ethical values REFERENCES from those in the West, but that the manner in which they manifest themselves will be different. It also fol- Bristol Royal Infirmary Inquiry. 2001. Learning from Bristol: The lows that the West may have much to learn from Report of the Public Inquiry into Children’s Heart Surgery at the these other experiences. Bristol Royal Infirmary 1984–1995. Bristol: Crown Copyright. Cambon-Thomsen A. 2004. The social and ethical issues of post- The one underlying message that emerges from genomic human biobanks. Nat Rev Gen 5:866–873. tracing the history of anatomy (especially the donation Department of Health. 2001. The Removal, Retention and Use of of bodies for dissection) is that anatomists have to win Human Organs and Tissue from Postmortem Examination. Lon- the confidence of the population in which they are func- don: Her Majesty’s Stationary Office. tioning. This has been hard won over many years in the Hildebrandt S. 2009a. Anatomy in the Third Reich: An outline. I. West, and it could still be lost. For instance, the organ National socialist politics, anatomical institutions, and anato- scandals, even though the province of pathology, could mists. Clin Anat 22:883–893. Hildebrandt S. 2009b. Anatomy in the Third Reich: An outline. II. have had dire repercussions for anatomy. This does not Bodies for anatomy and related medical disciplines. Clin Anat 22: appear to be the case, and yet it demonstrates the 894–905. inevitable tension between science and ethics; what is Jones DG. 1994. Use of bequeathed and unclaimed bodies in the best for scientific investigation may not be best for pro- dissecting room.
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