Commemorations and Memorials

The following sections are included:

• DEDICATION
• PREFACE
• CONTENTS

For a considerable number of students studying human anatomy today, the educational journey of exploring the human body might not begin with a tutorial or a dissection session, or even with a customary introductory lecture. In an increasing number of institutions, it commences with a commemoration of the body donors — the people whose dead bodies, now embalmed cadavers, are to be dissected and studied during the anatomy course. Whereas these ceremonies are most often conducted in teaching spaces, they can also take place around specially created memorial objects (monuments) and in memorial spaces (memorial halls and parks). While both memorial ceremonies and objects/spaces are not new in the discipline of anatomy, they were in the past presented and carried out only sporadically and in an isolated manner. Since the mid-20th century, they have become more common and have been adopted by anatomy departments around the world, with a significantly increased frequency in the last few decades…

In considering the ethical dimensions of commemorations, the altruism of the donors emerges as predominant, coupled with which is their informed consent. However, these values will only be expressed if there is trust on the part of the community that anatomists will act with integrity. This is because all involved in the donation process are part of a network of relationships — a community of learning about death and the dead body. Within this community, there needs to be recognition of the crucial input and equal value of each participant — from donors and families to staff, students and researchers. It is values such as these that give to thanksgiving ceremonies their rationale, since they are integral to communities of donation. Since anatomists are part of this community, they have obligations towards the communities from which the donors come as well as responsibility for the bodies they study. It is this common humanity that can be celebrated publicly as anatomists thank their donors and families for their precious gift, acknowledging their dependence upon the goodwill and understanding that lies behind it. This is also a time for families to enter into the drama of death and donation in whatever manner is culturally appropriate for them and their community.

Like other human focused disciplines, medicine benefits from a robust account of human flourishing. Aristotle’s eudaemonistic view, which seeks to describe the telos of human life objectively, is a better basis for medical care than a hedonic approach. The chapter reviews several reasons why a eudaemonistic view is preferable, some general and others specific to medical care. It notes Nussbaum’s “capability approach” as a more rounded account than Aristotle. The chapter then explores several important elements of an account of human flourishing: religious and spirit engagement, taking moral responsibility, physical health, social relationships, verbal communication, and sharing stories and telling history. These are all relevant to medical care. The conclusion relates the account of flourishing to practices of commemorating those who have donated their bodies for anatomy study.

In the United States, the majority of university-based or state-based willed body programs provide a memorial service for the users of the bodies and / or for the families of those individuals who donated their bodies. On the other hand, for-profit and non-profit willed body companies rarely provide any type of service. The differences between the various types of willed body organizations in the United States are examined and a discussion comparing these organizations is highlighted. These differences are especially apparent when examining issues such as the availability of memorial services.

Since the late 1980s, investigations into the history of medicine practiced in Germany from 1933 to 1945 have revealed the deep involvement of clinicians and biomedical researchers in the atrocities of the National Socialist (NS) regime. However, only recently has the role of anatomists in the physical destruction of the bodies of perceived enemies of the NS government been studied.

The bodies of victims of NS persecution, that became available within the traditional sources of anatomical body procurement, were used extensively and eagerly by anatomists for teaching and research purposes. The remains — or ashes after cremation — were interred in anatomy cemetery plots, which were usually anonymous. A current focus of research is the identification and restoration of the biographies of these victims, who have remained un-named over many decades. Several different ways of memorialization have been chosen so far, including the publication of names and biographies in scientific journals, books and on websites. Another option could be a memorial service at medical schools for victims of abusive practices in medicine and anatomy.

The National Socialists’ attempt to not only physically annihilate these human beings, but also erase their existence from the memory of mankind, shall be revoked by the restoration of the victims’ names and biographies.

Unknown-provenance osteology is the rule rather than the exception at most well-established university anatomy laboratories. This circumstance results from the difficulties associated with processing skeletons and consequent historical reliance on external skeleton supply — one common source is the Calcutta bone trade that operated at its peak from 1930 to 1985. This trade shipped tens-of-thousands of skeletons across the globe each year (notably without accompanying consents), potentially exceeding 2 million skeletons in total, dwarfing numbers associated with body-snatching that gave rise to the Anatomy Act in Britain. These events are extraordinary in anatomy’s history, yet it receives next to no acknowledgement in the scientific literature and countermeasures to address this situation have drawn little attention. Herein, we review articles from the popular press to provide an overarching account of the Calcutta bone trade and supplement this review with osteology from The University of Queensland’s (UQ) anatomy rooms. We outline novel and positive steps taken at The School of Biomedical Sciences to recognize and decommission unknown-provenance osteology (in all probability derived from the Calcutta bone trade) to a memorial assemblage — an action made possible via the simultaneous establishment of a new osteological collection of indefinite body donors. While the memorial assemblage cannot undo events of the past, this action awards these unknown and potentially misappropriated individuals levels of respect not previously afforded. This approach is not only favourable from an ethical standpoint, but it also offers substantially improved osteological morphologies to benefit student learning.

Physician training typically begins with dissection of anatomical donors, which is commonly used to teach structure and function. However, cadaveric dissection also provides opportunities for multifaceted educational experiences that build other skills and competencies critical to patient care. This chapter discusses a teaching paradigm in which students interact with families of the deceased persons whom they are dissecting. This novel approach represents a shift from the traditional paradigm, which emphasizes students’ clinical detachment, and restores identity to anatomical donors by treating them as “first patients.” This practice establishes the patient as the primary focus of medicine early in the curriculum. From patients’ arrival in the laboratory, through donor memorial services and even after the return of cremains, the “student-patient-family relationship” evolves, building connections and developing skills that directly affect future patient care. Learning anatomy and medicine through the first patient is achieved according to five guiding principles: First Patient; Knowledge; Reflection and Reflective Practice; Treating the Total Patient; and Professionalism. Here, these principles and their implementation are described, and their impact on student doctors and learning outcomes are discussed. Results suggest that mastery of basic science knowledge and competencies, including professionalism, compassion, and leadership skills, are enhanced by this protocol.

New Zealand is a bicultural country with the Treaty of Waitangi ensuring equal rights for Māori (the indigenous people) and Pākehā (non-Māori). The commemorations practised at the University of Otago reflect the cultural beliefs of Māori and the increasingly multicultural nature of New Zealand society.

In Māori culture, the dead body is recognized as tapu (sacred or restricted) and it is necessary for Māori students to take part in a ritual to allow them to enter and work in the dissecting room safely. The Department of Anatomy holds a clearing of the way ceremony (whakawātea) at the beginning of each academic year to meet this need. Initially, the whakawātea was held only for Māori students but it is now offered to all students studying Anatomy.

Interestingly, most students attend the ceremony, and this chapter explores the reasons why students choose to come to the whakawātea. Another commemoration is held towards the end of the academic year to remember the lives of those who have bequeathed their bodies. This student-led, thanksgiving service brings together the families of the donors and provides them with some closure. Families also have the opportunity to meet with students and understand the value of their family member’s gift. Further commemoration processes occur following the completion of dissection.

The fundamental basis of teaching and learning human anatomy is the dissection of the human body. However, the first encounter with a cadaver will affect many Health Sciences students emotionally. The emotional progression of students as they face dissection is well documented. The question is how to deal with those feelings; how the approach to anatomy may help or hinder a student’s ability to empathize with patients. The solution may be in a formal introduction to the cadaver, treating her/him as if she/he is the first patient, and further, by developing relationships with donors and the family of the donor.

In the 21^st Century, it has become necessary to de-ritualize the dissection process in order to smooth the way for scholars to have access to positive knowledge. We discuss here ceremonies which have been designed to assist Health Sciences students in coping with the transition from life to death and in accepting the donor as a bountiful gift. In addition, we explore information which is provided to the students at their first encounter with the cadaver.

Over the last 20 years, body donation programs have been initiated in a few large cities in China. Most of these while successful, have also met with difficulties. A major issue is that the number of donated bodies is far below what is needed for medical education in China. The reasons for the low number of bequests is multifactorial and due in part to the influence of traditional spiritual beliefs, poor legislation, low social recognition, poor collaboration between donor organisations, and the lack of effective processes for donation. Overcoming these obstacles will require that all sectors of the Chinese society cooperate. Various ways to commemorate cadaver donors have emerged and evolved in the regions where donation is successful. These are now being promoted gradually throughout the country. Donors are commemorated via body donation monuments, memorial parks, public memorial activities, online memorial platforms and memorial activities included as part of delivering anatomy teaching. These commemorations and memorials will actively help change traditional Chinese ideas, improve social recognition, forge a powerful bond of trust between the anatomists and medical students with the general community. It is envisaged that in the long term these practices will result in a greater awareness of humanistic side of medicine in students, reduce the tensions between doctors and patients and promote body donation programs in China.

In 2008, the Body Donation Program was established at the Federal University of Health Sciences of Porto Alegre (UFCSPA) due to an increasing demand for bodies for teaching anatomy. Pioneer in Brazil, the Program aims to inform the population about the possibility of donating one’s body in life and its establishment allowed other interconnected activities to be developed by the Discipline of Human Anatomy, which are organized as an Anatomy Outreach Program. First among these activities, the Dissection Workshop is a 40-hour course that allows undergraduate students to enhance their knowledge of Anatomy and produce high quality prosections for gross anatomy classes. Once the Dissection Workshop ends, the best specimens are selected for annual temporary exhibition entitled Museum of Anatomy. The Museum is open to the community and organized by volunteer undergraduate students from preparing the rooms to acting as volunteer guides during visits. Lastly, an Ecumenical Ceremony to Honor the Body Donor is organized every year by first year medical students. In the presence of other students, professors and the donors’ families, these students sing, play music and thank the families for their altruistic attitude, thus providing an emotional experience for everyone in attendance.

At the University of New South Wales, Australia, a Thanksgiving Service for the families of donors was initiated in 2002. This ceremony has grown to include students performing musical tributes, readings, prayers of thanksgiving and the laying of flowers and refreshments. This chapter describes this ceremony and its value and impact on families, students and staff.

The use of social media in anatomy education has increased in recent years. Among the other possible areas of application, social media can be seen as an instrument to facilitate the push to imbibe anatomy and anatomy education with humanistic values and make practices in these disciplines more humane. This paper reviewed the presentation of anatomy memorial ceremonies on YouTube, one of the most utilized forms of social media. The review, which included only English language uploads, revealed 66 relevant videos. These videos showed ceremonies (full or in part), reflections and news reports, and were posted by either individuals or institutions, most of which were from North America. The ceremonies that were featured varied markedly with regards to timing, participation, terminology, and format. YouTube seems to function as an easily accessible platform for sharing experiences and ideas on anatomy memorials, and importantly the ways in which anatomy practices can be made more humane. It is suggested that YouTube and social media in general could be utilized even more resourcefully as a medium for the exchange of information relating to best practice in anatomy education.

The emerging practice of commemorating donors may well represent a shift in anatomy education with far-reaching ramifications that include instilling a deeper appreciation for the need to embed humanistic values in medical and science students, adding dignity to the work of staff working with cadavers, and changing attitudes towards donors and donation…

The following section is included:

• INDEX