EDITORIALS 125 Cadaver organ donation considering the human being—is finite; ................................................................................... senescence starts with the zygote, and J Med Ethics: first published as 10.1136/jme.29.3.130 on 1 June 2003. Downloaded from corporeal death is its inevitable end. After death the human body decays, a It is immoral to require consent for process with which few are familiar and which excites revulsion which is both cadaver organ donation instinctive and learned. The instinctive part of this revulsion I think is easily H E Emson explained, as an inherited reflex ac- quired by ancestral experience that ................................................................................... rotten meat is not good to eat. Embedded very deeply in the nature of humanity No one has the right to say what should be done to their body there is another element to this, a belief after death that death is not the end of the soul and that the life of the body can somehow persist or be restored. This was expressed n my opinion any concept of property them have ever viewed and touched a in the burial practices of the earliest in the human body either during life or human cadaver, or seen a decomposing humans, in the staining of bones of the Iafter death is biologically inaccurate body. deceased with red pigment as a symbol and morally wrong. The body should be Out of all this I have become what I of continuing or resurgent life. Such regarded as on loan to the individual understand is termed a dichotomist, one practices have been elaborated by many from the biomass, to which the cadaver who believes that the body and soul are different cultures, as in preservation and will inevitably return. Development of separate, different entities. I use the term veneration of the bones of ancestors; immunosuppressive drugs has resulted “soul” for want of a better, not knowing burial with grave goods, food, slaugh- in the cadaver becoming a unique and a word which does not in some way carry tered animals, and slaves, and mummifi- invaluable resource to those who will implications of the soul’s origin, nature, cation and embalming, to retain a simu- benefit from organ donation. Faced with value, and destination. I wish to imply lacrum of continuing life, the last a the biological reality, the moral error of none of these, nor to intrude here my common practice in many contemporary societies including our own. All these any concept of property in the body, and own religious beliefs. For the purposes of seek in some manner to deny the fact of the quantitative failure of voluntary this discussion, the soul to me is a death, or at the very least to delay its organ donation, I believe that the right of non-physical, immaterial entity which acceptance, to spread this as a process control over the cadaver should be vested animates the body and gives it what we know as life. In knowing and experienc- over a period of time, and to come to in the state as representative of those ing a person, we cannot separate body admit it gradually rather than as an who may benefit from organ donation. and soul, because we always know them instant blow at a single temporal point. How one regards the dead human together. From the moment of birth until Such practices often contrast oddly an body, the cadaver, is in part governed by that of death they are inseparable and expressed belief in an afterlife in a better one’s familiarity with it. At the present intertwined to form the person, the world, with profound reluctance to leave time, very few people ever see a cadaver human being. At death the soul departs this one. Many religions express belief in http://jme.bmj.com/ which has not in some way been altered from the body—I have watched this some form of “the resurrection of the after death, and even fewer touch, occur—and here I express no beliefs body” but so far as I am aware, at the handle, deal in any way with the dead whatsoever as to what happens to it at present time, this is only rarely inter- human body. In developed countries, that point; where it goes, if anywhere, preted as a strict physical reconstitution death itself most frequently occurs away what its future is, if any. What is clear to of its elements as at the moment of from the home, in an institution, under me is, that without the soul, the body is death. There is too much practical the supervision of professional care- not and can never again be a part of the human experience for this, and however on September 27, 2021 by guest. Protected copyright. givers. For most people, ideas concerning person. The cadaver is not, what the body belief in a resurrection is interpreted, an the cadaver, its nature, the proper way to has been. element of symbolism is for most people deal with it, are formed under these con- The body, on the other hand, is more inescapable. ditions. easily defined and described. This, the However acceptance of death is denied As a pathologist specialising in foren- physical entity animated by the soul, is or delayed, the human body is inexorably sic pathology, for 50 years I have been at formed of chemical elements and com- destined to decay as the beginning of a the other end of the spectrum of experi- pounds, organised into tissues and or- recycling process. Its constituent compo- ence. In my daily work I have been privi- gans, combined in a marvellous com- nents are broken down by various means leged to examine the cadaver in all its plexity and with the soul, it is the human into simpler forms, and these in turn are stages after death from the immediate person. In this combined state, the recycled into the bodies of later genera- postmortem moments through all the person is alive; without the soul, the tions of living things. We die and stages of decomposition to bare bones. body is dead, with all that implies. From decay—or are burned—to come up again Working in a relatively small community, the moment of conception the compo- as wheat or roses, which in turn may I have sometimes been charged with nent parts of the body are formed from form the bodies of future generations of examining the body of someone I have material drawn from the external physi- people. Were this not so I would not be known in life, which is never an easy cal world, in active interchange and alive to write this, nor you to read it; the task. These experiences have moulded dynamic equilibrium with the biomass, elements which might have formed us my ideas as to what the cadaver is, what the sum total of living organisms on the would all have been locked up in the it represents, and how it should be planet, and with some of its inorganic indestructible physical remains of the treated. My beliefs are by no means matter. We study the human person from first generation of living organisms. unique, but I believe the experience its earliest beginnings, through growth, Decay is the inevitable and necesssary which has formed them is unusual and differentiation, maturity, decline, dis- consequence of finite corporeal mortal because of this, important. Reading the ease, and death. The life of the metazoan life. works of ethicists who pronounce upon animal Homo sapiens, as we know Viewed from this point, the human these matters, I wonder how many of it—and this is only one of the ways of body can only legitimately be regarded www.jmedethics.com 126 EDITORIALS as on extended loan from the biomass, to that their loved one’s body, maintained and the individual is incapable of recon- the individual of which it forms a part, in a semblence of life by artificial stitution. The person no longer exists, J Med Ethics: first published as 10.1136/jme.29.3.130 on 1 June 2003. Downloaded from and any view of it as property which can respiration, is in fact dead and will obvi- the soul has departed, and the individual be owned and disposed of must be ously be so when the respirator is turned who was but is no longer has no further examined very seriously, questioned, and off. Added to this, there is acceptance of use for the body which has been part of modified. Our culture accepts as a death as a process, not as an event; a fact him or her during life. The concept of the fundamental principle that while the which those close to the deceased come right of a person to determine before body is animated by the soul, the person to accept gradually and which in its full- death, the disposal of their body after resulting from this union has a right to ness may take years. Some progress death, made sense only when there was the preserved integrity of the body which towards reconciling these facts—for no continuing use for that body; it makes is a necessary part of his or her total human emotions are facts with which neither practical nor moral sense now, being. This is expressed in law, in our we must deal—and resolving this di- when the body for which the dead society, by prohibitions against killing, lemma, can be made when the death of person no longer has any use, is quite lit- wounding, or even such minimal assault an individual is known to be inevitable erally a vital resource, a potential source as threatening to touch the body without but can be postponed for a short time of life for others.