Respect for the dead

Human remains: dissection and its histories Helen MacDonald; Yale University Press; 2006 (Melbourne University Press; 2005) 224 pp US$35.00 ISBN 0–300–11699–3

At first glance, a history of dissection may appear morbid with little relevance for present-day health practitioners. However, Helen MacDonald has written a thought-provoking and readable book that raises important ethical considerations regarding the use and abuse of human remains, both in the past and in the present.

Figure. Photo by: Yale University Press

Most, if not all, physicians practising medicine in Canada, and around the world, have dissected a cadaver during their undergraduate medical training. The anatomy class has become a rite of passage, but few are aware of the important history regarding the procurement and use of dead bodies for the purpose of medical education. Stories of “resurectionists” and “body-snatchers,” who at one time ensured the supply of cadavers for dissection, are not simply anecdotal relics of the past. Learning about the history of dissection can help students and physicians reflect upon the use of human remains and foster a greater respect for the dead.

In the introduction to the book, MacDonald engages the reader with a graphic account of a human dissection carried out in 2002 as a form of performance art in the East End of London (also known as “Jack the Ripper” territory). She recounts, for instance, how the audience cheered when the artist–anatomist “pulled at the sternum with both hands and plunged into [the] thorax [of the deceased] to lift out his heart and lungs.” Using this rather gruesome event as a starting point, MacDonald weaves a complex narrative linking morally questionable historical practices, such as grave robbing and dissecting the dead bodies of poor and vulnerable people (e.g., prisoners, Aboriginal peoples, women, persons with mental illness), with controversial practices carried out in a modern context (e.g., harvesting organs without explicit consent to be used for transplant or research, human dissection as performance art).

The main focus of this book is 19th-century Tasmania, then known as Van Diemen's Land, an island off the southern coast of Australia that served as a penal colony during the British colonial era. MacDonald uses this setting to explore how the dead bodies of prisoners and Aboriginal peoples were used for medical dissection in the interest of advancing science, and how their remains were then sold for display in Victorian museums of natural history.

By describing in detail specific dissections documented in historical records, MacDonald provides a vivid account of how the bodies of individuals were used after death. Such accounts are at times unpleasant to read, particularly when they reveal a lack of professionalism and when human remains are treated with disrespect: “The dissecting room was a place in which gross indecencies were performed and not only by medical men. A porter at St. Bartholomew's was said to have raped the corpse of an attractive fifteen-year old girl in front of medical students.”

Through the examination of archival material, MacDonald seeks to demonstrate the relationships of power surrounding dissection and, in particular, how 19th-century anatomists developed a proprietary attitude toward human remains. MacDonald shows how these insights are useful in better understanding many of the unethical practices that occurred in relation to the dead, and how they can shed light on current-day abuses (such as the unauthorized collection of children's organs at Alder Hey Hospital in Liverpool during the 1980s and 1990s).

MacDonald does not argue for abolishing anatomy classes, organ transplantation or medical research on autopsy specimens and suggests that “there are, indeed, compelling reasons to dissect the dead.” She wants, however, to draw attention to the important ethical questions and concerns regarding the use of dead bodies. The main thesis of the book, for which MacDonald makes a strong case, is that “human remains matter” and should not be treated as mere objects or tools for the acquisition of medical knowledge, or for any other purposes, even if such activities may benefit humankind. Transparency, professionalism and respect for the dead (and their loved ones) should therefore guide our approach to the procurement and use of human remains.