37. postmortem

Procurement

The human bodies and body parts that are used for teaching and training in the United States come from 3 primary sources:

1. Donors via academic body donation programs or state anatomical boards

2. Donors via private "body brokers"

3. Unclaimed bodies

What (who) is an unclaimed body?

Unclaimed bodies are human remains that have been positively identified but for whom no one has stepped forward to arrange for burial or cremation.

Demographics of the unclaimed

Large-scale research on demographics is limited. From what we do know, the unclaimed dead are more likely to have been...

• Male

• Black or otherwise non-white

• Low income

• Isolated or estranged from family

Responsibility for disposition

The county in which an unclaimed person dies is typically responsible for the disposition of their body.

Legality of "donation"

In most parts of the United States*, it is legal for unclaimed bodies to be offered medical schools, mortuary colleges, or other institutions that might have in interest in using them for teaching or research.

*Some exceptions are Hawaii, Vermont, and Minnesota. New York has also

banned the practice in cities with populations of greater than one million.

Legal without NOK permission

In essentially all the jurisdictions where the 'donation' of unclaimed bodies is legal, it is permitted even without the prior consent of the deceased or permission from their next of kin.

How common is this practice in the US?

2019 survey of anatomy course leaders at US medical schools (Caplan & DeCamp): 12.4% indicated the possible use of unclaimed bodies at their institution.

Response rate was 61%; self-selection is likely.

No shortage of willing donors

70% of programs receive enough bodies

17% receive a surplus

13% receive too few.

As Tom Champney (UMiami) puts it, scarcity is a "red herring".

What's the incentive?

Cost-savings for the counties and, in some cases, profit for the institutions

The unconsented use of the unclaimed needs to end.

At a moral minimum, medical schools should refuse to accept unclaimed bodies in the absence of either the prior consent of the deceased or explicit permission from their next of kin.

Argument 1: Consent

The unclaimed dead have not consented to dissection, nor can we justify the use of their bodies on the basis of presumed consent.

Argument 2: Direct harm

Harm to the deceased? Maybe.

Harm to the living? Assuredly.

• Loved ones

• Communities

• Medical students

Argument 3: Justice

The people whose bodies go unclaimed are disproportionately those that have faced marginalization, discrimination, and economic hardship in life.

The injustice here is racial as well as economic.

Argument 4: Public trust

As the systematic use of unclaimed bodies comes to light, public trust in health care and medical professionals may be damaged.

This has foreseeable downstream consequences, e.g.,

• The exacerbation of existing health inequalities

• Decreased compliance with emergency public health measures

• Lower rates of participation in medical research

• Lower rates of voluntary organ donation

Counterargument: The Stewardship Argument

1. Access to bodies is importantly beneficial to medical education.

2. There is currently more demand for bodies than there is supply.

3. Accordingly, bodies are a scarce (not scarce) and valuable resource.

4. Therefore, the procurement and use of unclaimed bodies in teaching is permissible (not permissable) on the basis of responsible resource stewardship.

Counterargument: The Uncertainty Argument

1. The donation of unclaimed bodies to medical science is ethically permissible in cases where the preferences of the

deceased are unknown.

2. If we do not know what the deceased would have wanted, then any mode of disposition might violate their preferences.

3. So why not donate them?

This is sloppy and lazy decision theory, falling well short of best practices for both proxy decision-making and reasoning under uncertainty.

(For one, it inaccurately assigns all possible preferences the same credence.

It also treats all possible preference violations as equally serious.)

Take-home message

The use of unclaimed bodies in medical teaching and research is morally unacceptable.

At a minimum, body donation programs

should insist on the prior consent of the deceased or the explicit permission of their next of kin.

There's nothing special about Texas.

Unclaimed bodies are still in use all over the country.

This is a national issue.

A need for regulation

State and even federal legislation should be put in place to prohibit the use of unclaimed bodies in medical teaching and research. In the absence of these regulations, counties can adopt policies against the practice.

In the meantime, institutions of higher learning should divest.

Institutional divestment

1. A commitment to transparency

2. Removal of unclaimed bodies currently in use

3. Dignified cremation or burial of the above

4. Adoption of policies specifying minimum ethical standards for whole body procurement and establishment of an anatomical oversight committee.

(...But note that the perfect is the enemy of the good - institutions can

still make moral progress even while, situationally, deferring to pragmatics on particular action items.)