Death and remembrance: Addressing the costs of learning anatomy through the memorialization of donors

Journal of Clinical Ethics

Volumn 10, Issue 4, 1999, Pages 300-308

  Dixon, Kathleen Marie ^a  

^a BOWLING GREEN STATE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANATOMY; ARTICLE; CADAVER; DEATH AND EUTHANASIA; DEHUMANIZATION; DONOR; EDUCATION; HEALTH CARE AND PUBLIC HEALTH; HUMAN; MEDICAL COLLEGE OF OHIO; MEDICAL EDUCATION; PERSONHOOD; TRANSPLANTATION;

DEATH AND EUTHANASIA; HEALTH CARE AND PUBLIC HEALTH; MEDICAL COLLEGE OF OHIO;

ANATOMY; CADAVER; DEHUMANIZATION; EDUCATION, MEDICAL; HUMANS; PERSONHOOD; TISSUE AND ORGAN PROCUREMENT; TISSUE DONORS;

EID: 0033290737     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (62)

1. K.V. Iserson describes this transition saying, "The anatomy lab . . . introduces medical students into medicine's guild. Dissecting a human body is a rite-of-passage that the rest of the world knows of, wonders at, and fears." K.V. Iserson, Death to Dust: What Happens to Dead Bodies? (Tucson, Ariz.: Galen Press, 1994), 92. F.W. Hafferty provides evidentiary support for this claim and links it with students' own perceptions: "While enveloped by their training experiences, medical students are prone to characterize their training as a rite of passage. Some accounts depicted medical training as a gauntlet of trials, emotional as well as academic. Others emphasized the ceremonial and ritualistic nature of either the educational process or the students' responses to it." F.W. Hafferty, Into the Valley: Death and the Socialization of Medical Students (New Haven, Conn.: Yale University Press, 1991), 187. Hafferty argues that the "basic-science years" could be interpreted as a liminal phase. In this stage, [1]nitiates move more completely into a world marked by "uncommon sense" . . . ambiguity, and a release from what had once been normal interpretive constraints. Individuals are asked to reinterpret and construct reality in new ways - thus becoming, in Turner's construction, "liminal monsters," involved in a "time outside time" where factors of everyday social construction are subverted, distorted, and denormalized (p. 187). Students at City Medical School confirmed that Gross Anatomy laboratory separated them from laypersons and other professionals. One observed, "Anatomy is the subject that says you're in medical school" (p. 53). Another student explained: The cadaver represents a unique figure in your life . . . . It's impressive, so that when you talk to other people about it they are taken aback. They can't understand how you can do it. Having done it, it sets you apart. It's one of the biggest symbols of medical school. It distinguishes us as medical students unlike a course in biochemistry could ever do. Anatomy is the one thing that medical students do that other people don't (p. 53). City medical students also recognized Gross Anatomy as a testing or proving ground for their ability to identify and either implement or constructively modify "feelings rules" associated with the professional culture of medicine (pp. 14-18, 66-67, 188-90).
2. K.V. Iserson describes this transition saying, "The anatomy lab . . . introduces medical students into medicine's guild. Dissecting a human body is a rite-of-passage that the rest of the world knows of, wonders at, and fears." K.V. Iserson, Death to Dust: What Happens to Dead Bodies? (Tucson, Ariz.: Galen Press, 1994), 92. F.W. Hafferty provides evidentiary support for this claim and links it with students' own perceptions: "While enveloped by their training experiences, medical students are prone to characterize their training as a rite of passage. Some accounts depicted medical training as a gauntlet of trials, emotional as well as academic. Others emphasized the ceremonial and ritualistic nature of either the educational process or the students' responses to it." F.W. Hafferty, Into the Valley: Death and the Socialization of Medical Students (New Haven, Conn.: Yale University Press, 1991), 187. Hafferty argues that the "basic-science years" could be interpreted as a liminal phase. In this stage, [1]nitiates move more completely into a world marked by "uncommon sense" . . . ambiguity, and a release from what had once been normal interpretive constraints. Individuals are asked to reinterpret and construct reality in new ways - thus becoming, in Turner's construction, "liminal monsters," involved in a "time outside time" where factors of everyday social construction are subverted, distorted, and denormalized (p. 187). Students at City Medical School confirmed that Gross Anatomy laboratory separated them from laypersons and other professionals. One observed, "Anatomy is the subject that says you're in medical school" (p. 53). Another student explained: The cadaver represents a unique figure in your life . . . . It's impressive, so that when you talk to other people about it they are taken aback. They can't understand how you can do it. Having done it, it sets you apart. It's one of the biggest symbols of medical school. It distinguishes us as medical students unlike a course in biochemistry could ever do. Anatomy is the one thing that medical students do that other people don't (p. 53). City medical students also recognized Gross Anatomy as a testing or proving ground for their ability to identify and either implement or constructively modify "feelings rules" associated with the professional culture of medicine (pp. 14-18, 66-67, 188-90).
3. F. Gonzalez-Crussi, Notes of an Anatomist (San Diego: Harcourt, Brace, Jovanovich, 1985), 65-66.
4. Hafferty, Into the Valley, see note 1 above, p. 146.
5. Ibid. It is interesting to note that students themselves often remain unconvinced of the educational value of their human dissections. Hafferty describes high rates of absenteeism at "City's" Gross Anatomy laboratory. "Aside from peaks in attendance during prosections and thorax dissections, attendance dropped rapidly and consistently over the initial month of lab to about 50 percent and then, over the next two months, continued to decline less rapidly until the end of lab" (p. 144). Students at "City" were not required to attend lab and offered a variety of explanations for their absences. These included "in order of frequency, (1) the quality of the cadavers, (2) the quality of the lab instructors, and (3) labmate relations" (p. 145). Students also believed that attendance in lab and participation in dissection were unnecessary as "City" had no practical, lab-based exams and dissection did not affect their performance on the multiple choice exams which determined their grades in the course (p. 145).
6. S. Russell quoted in N. Schoenberg, "Anatomy of Compassion," Toledo Blade, 2 November 1991: 27.
7. Hafferty defines this term: Prosections are anatomical parts that have been previously dissected, often by faculty members, for use as teaching tools (for example, one arm dissected to show muscle and tendon structure, another to highlight the vascular system), thereby allowing students to view, in context, structures they might well destroy if they were allowed to attempt identification by dissecting on their own. Hafferty, Into the Valley, see note 1 above, p. 90.
8. S.A. Hoffman, Under the Ether Dome: A Physician's Apprenticeship at Massachusetts General Hospital (New York: Charles Scribner's Sons, 1986), 11.
9. See note 5 above.
10. Hafferty, Into the Valley, see note 1 above, p. 83. Hafferty also records students' worries about the adequacy of donors' understanding of the processes of medical dissection. If donors "really had no idea what was going to happen," the moral value of their consent was impeached (p. 84).
11. See note 5 above.
12. Hafferty, Into the Valley, see note 1 above, p. 119.
13. See note 5 above.
14. P. MacPherson, "Remembering the Donation: Memorial Service Honors Those Who Gave their Bodies to Science," American Medical News 33 (9 February 1990): 9.
15. Ibid.
16. See note 5 above.
17. Hafferty, Into the Valley, see note 1 above, p. 82.
18. Ibid., 99-102, 106-8.
19. Ibid., 94.
20. Ibid., 90.
21. Ibid., 136.
22. Ibid., 102.
23. Ibid., 103.
24. W. Hunter as quoted in Iserson, Death to Dust, see note 1 above, p. 91.
25. Hafferty, Into the Valley, see note 1 above, p. 104.
26. Ibid., 84.
27. Ibid., 127.
28. Ibid.
29. Ibid., 120.
30. Ibid., 119.
31. Ibid., 101.
32. Ibid., 107.
33. R. Zussman, Intensive Care: Medical Ethics and the Medical Profession (Chicago: University of Chicago Press, 1992), 52.
34. Ibid., 58-9
35. Ibid., 59.
36. Ibid.
37. Iserson, Death to Dust, see note 1 above, pp. 93-4.
38. S. Freud, "Humor," International Journal of Psychoanalysis 9 (1928): 1-6 as quoted in M.N. Hall and P.T. Rappe, "Humor and Critical Incident Stress," The Path Ahead: Readings in Death and Dying, L.A. DeSpelder and A.L. Strickland, ed. (Mountain View, Calif.: Mayfield, 1995), 290.
39. S. Freud, "Humor," International Journal of Psychoanalysis 9 (1928): 1-6 as quoted in M.N. Hall and P.T. Rappe, "Humor and Critical Incident Stress," The Path Ahead: Readings in Death and Dying, L.A. DeSpelder and A.L. Strickland, ed. (Mountain View, Calif.: Mayfield, 1995), 290.
40. Hall and Rappe, "Humor," see note 37 above, p. 290.
41. Hafferty, Into the Valley, see note 1 above, p. 85.
42. Hall and Rappe, "Humor," see note 37 above, p. 291.
43. See note 7 above, p. 11-2.
44. Iserson, Death to Dust, see note 1 above, p. 96.
45. Describing the ceremonies at the Medical College of Virginia, MacPherson writes, "Never were the cadavers' names mentioned, though they are recorded in a register at the cemetery office. There was no reference to the ways the donors had lived and died, or to the reasons for the gift they had made." Donors' contributions and sacrifices are simply recognized enmasse. See note 13 above.
46. M. Stroebe et al., "Broken Hearts or Broken Bonds: Love and Death in Historical Perspective," in The Path Ahead: Readings in Death and Dying, L.A. DeSpelder and A.L. Strickland, ed. (Mountain View, Calif.: Mayfield, 1995), 230-41.
47. E.J. Cassell, The Nature of Suffering and the Goals of Medicine (New York: Oxford, 1991), 33.
48. See note 7 above, p. 12.
49. See note 45 above, p. 232.
50. Ibid., 234.
51. These images are reproduced and an interesting critical discussion can be found in T. Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge, Mass.: Harvard University Press, 1990), 76-7.
52. Ibid., 76.
53. Ibid., 77.
54. Hafferty, Into the Valley, see note 1 above, p. 81.
55. Ibid., 99 and 119.
56. Ibid., 94.
57. Ibid., 84.
58. Ibid., 123.
59. Ibid.
60. Ibid., 122.
61. Ibid., 104.
62. Ibid., 118.