Overcoming the tension between scientific and religious views in teaching anatomical dissection: the Israeli experience

More than three thousand years of Jewish historical and scholarly writings have addressed the problematic relationship between anatomical dissection for the purpose of medical education and Judaism, which values the wholeness and sanctity of the human body. The Department of Anatomy at Tel Aviv University's Sackler Faculty of Medicine has sought to bridge the gap between science and Jewish religious-cultural values. The Department requires students to conduct laboratory dissections on cadavers in an ethical and respectful manner. Student emotions are also addressed by the Department as students are encouraged to share their apprehensions and concerns about participating in dissections in discussion groups. At the same time, the high academic standards of the medical school are strictly upheld, ensuring that each student has a thorough knowledge of human anatomy. Teaching anatomy in Israeli medical school involves reconciling two conflicting approaches to dissection: (1) The scientific-medical approach, which views the human body as inert material and anatomical dissection as a means of studying anatomy and gaining medical knowledge. (2) A Jewish religious point of view, which perceives anatomical dissection as a threat to the sanctity of a human body and leads to the defilement of those participating in the dissection. In this article, the views of major Jewish scholars regarding dissection are presented and discussed in relation to their implementation in the dissection theater. These views are examined in an anthropological light based on observations in the dissection room and interviews with students and faculty members. The findings reflect the emotions and concerns of Israeli medical students at the Sackler Faculty of Medicine in particular as well as those of the Israeli-Jewish population as a whole. In the dissection theater, medical students must gain a comprehensive understanding of human anatomy while dealing with their own personal ethical, cultural, and religious views on death and dying. Confronting these issues enhances both personal growth as individuals and professional behavior as future physicians.     

Capital punishment and anatomy: history and ethics of an ongoing association

Anatomical science has used the bodies of the executed for dissection over many centuries. As anatomy has developed into a vehicle of not only scientific but also moral and ethical education, it is important to consider the source of human bodies for dissection and the manner of their acquisition. From the thirteenth to the early seventeenth century, the bodies of the executed were the only legal source of bodies for dissection. Starting in the late seventeenth century, the bodies of unclaimed persons were also made legally available. With the developing movement to abolish the death penalty in many countries around the world and with the renunciation of the use of the bodies of the executed by the British legal system in the nineteenth century, two different practices have developed in that there are Anatomy Departments who use the bodies of the executed for dissection or research and those who do not. The history of the use of bodies of the executed in German Anatomy Departments during the National Socialist regime is an example for the insidious slide from an ethical use of human bodies in dissection to an unethical one. There are cases of contemporary use of unclaimed or donated bodies of the executed, but they are rarely well documented. The intention of this review is to initiate an ethical discourse about the use of the bodies of the executed in contemporary anatomy.     

The evolution of epistemological methodologies in anatomy: From antiquity to modern times

Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.     

Books,bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first “clinical discipline.” By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.     

Anatomical practice at Göttingen University since the Age of Enlightenment and the fate of victims from Wolfenbüttel prison under Nazi rule

This report briefly summarises anatomical practice at G?ttingen University from its founding in 1737 until the Nazi period and gives a detailed account of how Nazi death penalty legislation and execution practice at Wolfenbüttel prison influenced the decision-making of the anatomists in charge at that time. Problems in the procurement of corpses, encountered almost continuously throughout Europe since the broad introduction of dissection into medical training in the early 18th century, were absent in G?ttingen during periods of overt progress in anatomical sciences, e.g. under Albrecht von Haller (in office 1736-1753) and Jacob Henle (1853-1885), and at times when existing regulations were rigorously enforced by the authorities (1814-1851). Ample availability of corpses in the wake of more than 600 executions in Wolfenbüttel between 1935 and 1945 was curtailed only by transportation fuel shortages and resulted in the dissection of more than 200 Nazi victim corpses in the G?ttingen anatomy course. Apparently, neither individual offers of voluntary body donation (dating from 1932 to 1937 and published here as the earliest documents of this kind), nor the strong tradition of high-level anatomical research, nor even the awareness of the University's Age of Enlightenment origin, prevented the unethical use of corpses of Nazi victims for medical teaching. The G?ttingen example may add "historical and moral detachment" under unusual political and wartime pressures to the "clinical and emotional detachment" thought to prevail amongst anatomy personnel (Hildebrandt, in this issue); together with the other reports it calls for all anatomists to bear in mind their ever present ethical obligations in respect to activities involving the use of corpses, both in medical schools and in the public domain.     

Plastination and its importance in teaching anatomy. Critical points for long-term preservation of human tissue

Most medical curricula rely on human bodies for teaching macroscopic anatomy. Over the past 20 years, plastination has become an important means of preservation of organs, for well dissected specimens or for body slices. Here, several critical points regarding body donation with legal and ethical considerations for long-term preservation, the use of cadavers in teaching and the preparation of plastinates as an additional teaching tool will be discussed. Silicone S10 is the gold standard in the preparation of plastinates. An important point to respect is the preparation of specimens, since only very well dissected body parts or excellent tissue sections should be plastinated to show the extraordinary aspects of the human anatomy. The preparation of thin and transparent sections and preservation with P40 polyester provides an additional technique to prepare resistant body slices. A selection of samples prepared by S10 and P40 are shown and compared. In addition, Prussian or Berlin blue staining of brain slices is shown to discriminate better between gray and white matter and demonstrate neuroanatomical structures. These plastinates have been used for many years in teaching first-and second-year medical students and have not lost their appeal. Students and staff appreciate the use of such plastinates. One of the advantages is that their use is not restricted to the dissection hall; slices and body parts can be used in any lecture room or in small group teaching. Therefore, ethical and legal questions need to be addressed regarding their specific use. Plastinates do not replace the traditional dissection courses, since students learn best the anatomical features of a given region by hands-on dissection and by exploratory anatomy. Furthermore, plastinates are more rigid and do not allow demonstration of hidden structures; they also become more cumbersome for endoscopy or are too rigid for demonstrating mechanical features of joints. However, although not a replacement for traditional dissections, plastination provides an additional tool for long-term preservation and for teaching human anatomy.     

Let the dead teach the living: the rise of body bequeathal in 20th-century America.

America's medical schools have long used human cadavers to teach anatomy, but acquiring adequate numbers of bodies for dissection has always been a challenge. Physicians and medical students of the 18th and 19th centuries often resorted to robbing graves, and this history has been extensively examined. Less studied, however, is the history of body acquisition in the 20th century, and this article evaluates the factors that coalesced to transition American society from body theft to body donation. First, it describes the legislation that released the unclaimed bodies of those dying in public institutions to medical schools for dissection, thereby effectively ending grave robbery. Then it discusses midcentury journalistic exposés of excesses in the funeral industry-works that were instrumental in bringing alternatives, including the previously unpopular option of body donation, to public consciousness. Finally, it examines the rise of body transplantation, the Uniform Anatomical Gifts Act of 1968, and the subsequent state of willed-body programs at the turn of the 21st century. Body-donation programs have gradually stabilized since and currently provide most of the bodies used for dissection in American medical schools. Relying as they do on public trust, however, these programs remain potentially precarious and threatened by public scandals. Whether American medical schools will receive enough bodies to properly educate students in the future remains to be seen.     

A Glimpse into the process of gaining permission for the educational dissection of human cadavers in the Ottoman empire

Dissection of the human body for educational purposes became officially permitted in the Ottoman Empire only after a long, difficult process. In the West, studies based on the findings of Galen had been taboo during a long period in which dissection of human bodies had been prohibited. Although the first dissection studies since ancient times began to appear in the Western literature in the late 13th and early 14th centuries, the post‐Galen taboo against dissection was broken only in the 16th century by the studies of Vesalius. However, in the Eastern World, it was only fairly recently that the idea of the “sanctity of the human body” could be challenged. In the medieval Islamic world, as during the Middle Ages in the West, prohibitions against the dissection of human cadavers continued for social and religious reasons, although the Koran does not specifically ban such dissection. This prohibition also continued through the Ottoman era, which began in the 14th century. The first efforts to end the prohibition on dissection in the Ottoman Empire were made at the beginning of the 19th century during the reign of Sultan Selim III but official permission for dissection was given only in 1841 during the reign of Sultan Abdulmecid. Educational dissections in the Ottoman Empire officially began at the Istanbul Medical School following the granting of this permission. This article will discuss the attempts to end the prohibition of dissection in Ottomans within the scope of the history of anatomical study in Turkey. Clin. Anat. 27:964–971, 2014. © 2014 Wiley Periodicals, Inc.     

Bygone theatres of events: A history of human anatomy and dissection

Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.     

The dissection experience as a laboratory for self-discovery about death and dying: Another side of clinical anatomy

Dissection of the human body raises questions for medical students about the source of bodies, bodily trespass, invasion of privacy, death, dying, and their own mortality. Facing and expressing the aversions, fears, and fantasies associated with human dissection help prepare the student both for academic work in the anatomy laboratory and for the emotional work implicit in patient care. With little additional curricular time within the longitudinal continuity of the dissection course we have developed a program in medical humanities that fosters both skills. This program, heavily dependent upon the arts, uses exposure to painting, film, and literature coupled with reflection, writing, and small group discussions to explore and express students' attitudes toward death and dissection as they experience the first year of medical school. The final session, a service of memoriam and thanksgiving planned and produced by the students, provides an appropriate personal closure of the dissection experience. Our students affirm that such a program, evolving over the past 12 years, has provided a foundation early in medical education for development of caring physician-patient relationships and for continued exploration of humanistic and ethical issues in medicine. These experiences illustrate that clinical anatomy has the potential to contribute to both the art and science of medicine.     

The dissection course – necessary and indispensable for teaching anatomy to medical students

Anatomy is a major basic subject in medicine and related biomedical sciences. A central tool most universities use for teaching anatomy is the “dissection course”, in which medical students learn the basic constructional principles of the human body by dissecting a cadaver. In recent years, the relevance and value of the dissection laboratory have been under discussion at different universities due to high costs and problems of shortness in time in some medical curricula. Indeed, during the last 10 years, several universities in the US and the UK have abandoned dissection and have moved from a cadaver-oriented to a cadaverless anatomy. This development results in a fundamental discussion on the role of the “dissection course” in the medical curriculum, ultimately raising the question as to whether we should continue teaching anatomy by dissection. This article presents nine arguments for the dissection course as a central tool for teaching macroscopic anatomy and is an attestment to the continuation of the use of cadaver material in anatomical laboratories within the auspices of scholastic and university order for the benefit of future physicians with due respect and honour guaranteed for every donor.     

Anatomy and ethics: An exploration of some ethical dimensions of contemporary anatomy

Anatomy and ethics have traditionally been viewed as inhabiting different conceptual worlds on the assumption that the practice of anatomy is ethically neutral. This assumption is challenged by critiquing the nature of anatomy and by demonstrating that ethical issues pervade anatomical study. This should come as no surprise since anatomy deals with the structure of the human body, and it is the human body and human tissues that are central to bioethical questions concerning human life in both health and disease, at its beginning and end and in research and clinical practice. Furthermore, many issues of interest to anatomists, such as the mechanisms of organ and fetal tissue transplantation, the neurological bases of aging and dementia, and definitions of brain death, are best tackled by venturing into questions usually dealt with in a clinical context. By the same token, a number of clinical issues can be approached helpfully from starting points provided by anatomy, although they too have ethical dimensions. To illustrate the close interrelationship between anatomical and ethical issues, two topic areas are discussed: research on archeological human remains and the notion of the pre-embryo. Clin. Anat. 11:100–105, 1998. © 1998 Wiley-Liss, Inc.     

Anatomical knowledge among medieval folk artists: osteological interpretation of two Dance of Death motifs

Anatomy has a long history that started with dissection of animals and then expanded and flourished thanks to dissections performed on human bodies. Artists had a crucial role in uncovering the secrets of human anatomy. While most studies have focused on the influence of famous Renaissance artists on human anatomy studies, the anatomical drawings by pre‐Renaissance artists and local craftsmen have remained in their shadow. One of the most popular artistic genres in which complete or parts of human skeletons appear is the Dance of Death (Danse Macabre). This article is an anthropological study of two medieval Dance of Death frescoes that are unusual in being relatively early as well as accurately datable. A comparative morphological analysis of the two late 15th century works present in Istria has been conducted. The two works were painted by two local masters and show how the artists filled the gaps in their knowledge of human anatomy mostly with insights into animal bones and imagination. Their artworks, even though only 16 years apart, demonstrate substantial differences in the representation of the skeletons. The article argues that the history of medicine and of art could make good use of osteology and physical anthropology in attempts to define and understand how anatomical knowledge developed among pre‐Renaissance and post‐Renaissance artists and local people.     

History of collecting cadavers in Japan

This study investigated how and from where medical students had acquired cadavers for research throughout Japanese history. At the beginning of dissection in the mid Edo era, they cut up executed prisoners granted by the Tokugawa Shyogunate to study internal body parts. After the Meiji Restoration, the social mechanism of delivering cadavers underwent a complete transformation and they began to utilize 1) dead bodies of inpatients who had received free medical treatment and 2) unclaimed bodies mainly from homes for the aged and prisons. It was quite recently that "kentai", voluntary body donation, became common practice of collecting cadavers. Consequently the history of cadavers submitted to dissection faithfully reflects the relation between medical science and society.     

Process of development of body donation law in Japan

In the world, throughout history it has been difficult to obtain bodies for cadaveric dissection practice and research. In Japan, the difficulties were enhanced by the unique social culture and understanding surrounding the deceased and family responsibility. Further, from the 1970's onward, there was a large influx of new medical schools. In order to provide such a large number of medical students with anatomical study materials which are not merely obtained from unknowing deceased, but rather willfully donated by the deceased, a means by which to officially donate bodies was necessary. From the mid-1970's anatomy professors and leaders of volunteer body donation organizations realized that there was a need to formulate a procedure for the wholesome development of a body donation law. Together, they proposed this concept to senators and then on to the Ministry of Education. Their efforts bore two fruits: creation (1982) of an Official Certificate of Appreciation from the Ministry of Education (addressed to the deceased and given to the family) and also the Body Donation Law (1983). For society, such a law ensures the cultural acceptance of the concept of body donation, because it proves verification by the government. Also, such a law resolves possible later disputes between family members. Further, this law can facilitate the true wishes of the deceased, not that of the family members. In 1995, the Crown Prince and Princess participated in the Ceremony of the Centenary of the Japanese Association of Anatomists. In his address, the Prince congratulated the Association for their leadership in the development of Japanese modern medicine. He noted that body donation has been a key point to facilitate excellent medical education. As a result of the body donation law, presently there is a sufficient number of donated bodies for student dissection practice at the medical schools throughout Japan. Certainly it is pleasing to all to know that the will of the deceased has been carried out. For the family as well as the schools, this process is undertaken in an official and socially acceptable manner. In this review, we describe the process toward the development of the body donation law and the influences of this law by quoting the official journal of the Japan Union of Voluntary Body Donation, "Tokushi Kentai" (Voluntary Body Donation).     

Improved dissection efficiency in the human gross anatomy laboratory by the integration of computers and modern technology

The need to increase the efficiency of dissection in the gross anatomy laboratory has been the driving force behind the technologic changes we have recently implemented. With the introduction of an integrated systems-based medical curriculum and a reduction in laboratory teaching hours, anatomy faculty at the University of North Texas Health Science Center (UNTHSC) developed a computer-based dissection manual to adjust to these curricular changes and time constraints. At each cadaver workstation, Apple iMac computers were added and a new dissection manual, running in a browser-based format, was installed. Within the text of the manual, anatomical structures required for dissection were linked to digital images from prosected materials; in addition, for each body system, the dissection manual included images from cross sections, radiographs, CT scans, and histology. Although we have placed a high priority on computerization of the anatomy laboratory, we remain strong advocates of the importance of cadaver dissection. It is our belief that the utilization of computers for dissection is a natural evolution of technology and fosters creative teaching strategies adapted for anatomy laboratories in the 21st century. Our strategy has significantly enhanced the independence and proficiency of our students, the efficiency of their dissection time, and the quality of laboratory instruction by the faculty.     

Quidne mortui vivos docent? The evolving purpose of human dissection in medical education.

The dissection experience has evolved over the past 500 years, following broader cutural trends in science and medicine. Through this time each period has recruited human gross anatomic dissection for characteristic purposes. Key variables have been: (1) the motivating philosophies of medicine and science, (2) how well clinical medicine and basic science have been integrated by anatomy, and (3) how explicity thoughts or feelings about death and dying have been addressed in the context of anatomy. The authors are especially interested in the third variable, and suggest that although anatomy is scientifically in decline, dissection is currently enjoying a revival as a vehicle for teaching humanist values in medical school. Changes in the culture of medicine have carried anatomy from a research science, to a training tool, nearly to a hazing ritual, to a vehicle for ethical and moral education. Physicians, scientists, and medical students, as well as observers such as sociologists and writers, have been only intermittently aware of these cultural shifts. Yet anatomic dissection has been remarkably persistent as a feature of medical education-indeed it stands out as the most universal and universally recognizable step in becoming a doctor. This paper attempts to explore and interpret in detail the history of anatomy education, drawing on both subjective commentary and objective data from each period.     

Pathological analysis of cadavers for educational dissection by using postmortem imaging

This study was performed primarily to clarify whether pathological analysis of cadavers for anatomical dissection is possible using postmortem imaging (PMI), and whether this is worthwhile. A total of 33 cadavers that underwent systematic anatomical dissection at our medical school also underwent PMI. Fixative solution was injected into the corpus 3–4 days after death. PMI was then performed using an 8‐slice multi‐detector CT scanner 3 months before dissection. Before dissection, a conference was held to discuss the findings of the PMI. First, two radiologists read the postmortem images without any medical information and deduced the immediate cause of death. Then, the anatomy instructor revealed the medical information available. Based on this information, the radiologist, anatomy instructor, and pathologists suggested candidate sampling sites for pathological examination. On the last day of the dissection period, the pathologists resected the sample tissues and processed them for pathological examination. In 12 of 33 cases, the presumed causes of death could be determined based on PMI alone, and revision of the cause of death described in the death certificate was considered in five (15.2%) cases, based on PMI and pathological analysis. This article presents a novel method of pathological analysis of cadavers for anatomical dissection using PMI without disturbing the anatomy education of medical students.