Corpses provide a precious resource for humankind. Thousands of people are on waiting lists for transplants: roughly, around 60 000 people are waiting for a transplant in the USA, 100 000 in India, 8000 in Italy1 and 5800 in the UK.2 The life of many of these people currently depends upon the recruitment of organs.
Cadavers are important for the advancement of science and for medical training. Anatomy would have not developed without the study of corpses.3 Leonardo da Vinci, who is regarded as the father of anatomy and physiology, is thought to have dissected at least 30 bodies of various ages. He meticulously studied organs and their functioning and compared them with the organs of other animals. The importance of his work for modern anatomy and physiology is universally recognised. Some examples of Leonardo’s studies and drawings of dissections are shown in figs 1
–5.
Through his study of corpses, Leonardo offered remarkable insight into the anatomy and physiology of the digestive, reproductive, nervous, and cardiovascular systems.4 More recently, the study of human tissue archives has—for example, allowed advancements in the understanding of psychiatric disorders and of the effects of neuroleptic drugs on the brain, and dissection and study of cadavers has enhanced our knowledge of atherosclerotic cardiovascular diseases.5
From the point of view of benefits for humankind, it could be claimed that cadavers are a public good. However, the use of cadavers is surrounded by a clash of opposing principles and arguments. Most people would probably not accept the idea that once they die the remaining body automatically becomes a public good or a public thing (a res-publica, a republic). In this paper we shall see whether cadavers should be regarded as a republic. In order to do so, I will examine in detail the ethical issues surrounding organ and tissue retention. The principal aim of this paper is to identify the real nature of the ethical problems at stake.
THE PRACTICE ADOPTED IN THE UK
The ethics of organ and tissue retention has been animatedly debated in various European countries, especially over the past 10 years. In the UK the most acute polemics arose after a number of scandals relating to organs and tissues retained by pathology services.6
One of most infamous is the case of Alder Hey Hospital,7 concerning doctors who asked parents of deceased children to sign forms or formulas of consent for retention and use of tissues from their children’s bodies (although many cases involved adults).8 Parents were told that this would help doctors understand the cause of their child’s death. The request was generally made very soon after the death of the child. The parents believed that "tissues" amounted to small samples of material, but later they found out that entire organs, such as the heart and brain, had been removed. They complained that they had not been adequately informed; that unknowingly they had buried "an empty shell"; that often these organs were left in storage and not used; that in many cases these were later put in the waste along with rubbish.9
Public inquiry into organ retention resulted in a number of public reports, the first of which was the Bristol Interim Inquiry.10 For other reports see references 11–18. I will not go into the merit of the inquiry that followed the case. I shall instead examine the ethical issues that this case raises. I will start my analysis by considering the social practice adopted in the UK but the ethical issues analysed here have a broad scope.
In the UK, the Human Tissue Act 1961 requires that:
- the deceased’s wishes, when they are known, should be respected.
- when the deceased’s wishes are unknown, the family (spouse or surviving relatives) has the right to object to organ and tissue retention and use. (A coroner or the courts can order post-mortem examination, regardless of the wishes of the deceased or of the family.)
A Human Tissue Bill is now before Parliament. It will replace the Human Tissue Act 1961 and the Human Organs Transplant Act 1989, which currently represent the relevant legislation. Scotland proposes to introduce separate legislation (M Brazier, The Human Tissue Bill, unpublished).19,20 I will now discuss the rationale for respecting a person’s post-mortem decisions. Later I shall discuss the rationale for respecting the family’s wishes. Both cases present important ethical issues that need to be clarified.
Answers to all your Biology Questions
