Health: This business takes guts - somebody else's

Click to follow
We buried my Granddad in November. He was a very funny man, irreligious and careful with his money, too. When he died he wanted to be "chucked in the ground in a bin-liner without any fuss." None of this expensive respect for the autonomy of the dead. Alas, when my aunt communicated this wish to the undertaker, he said: "We couldn't possibly do that - it's unethical." So he ended up shelling out for a coffin and all the trimmings. Is there any other way?

Well yes - you can leave your body to medical dissection. As a student, the first patient I ever met was a dead one. Without any attempt at moral guidance, we were encouraged to cut it into increasingly smaller pieces. Some fainted, a few juggled with the kidneys or skipped with the intestines. One amusing man stuck a hose in one end of the gut and blasted the contents out of the other.

And then there were apocryphal stories of bits smuggled out. A student was said to have stolen an arm and hidden it at the bottom of his girlfriend's bed. Others favoured an aberrant penis, on a key ring or dropped between tube doors or in a rugby scrum. Simon Fenn got off lightly.

Most students didn't exhibit such callous disregard for human death. The pair dissecting opposite me were scholars. They took it all very seriously and meticulously dissected out every tiny root of the autonomic nervous system running alongside the spine. It must have taken hours and was truly a beauty to behold, until I mistook it for fat and ripped the whole lot out. It was the only time I ever saw anyone cry in the dissection room - but then I wasn't there when a student pulled back his sheet and discovered a cadaverous Auntie Beryl. Allegedly.

Dissection was generally regarded as a rites of passage thing - part of the historical dehumanisation of medics that turns us into anti-holistic emotional cripples fit only to work a hundred hours a week in the NHS.

There was no preparation for what lay behind the dissection room door - the God-awful smell, the sound of the saw slicing off the top of the skull or the sight of unfeasibly large genitals swollen in the preservation process. It was sink or swim, survival of the cruellest.

Indeed, the only reference to the grisly business came in an aside in a pathology lecture. "One man wanted to be a doctor but repeatedly failed his exams. When he died, he left us his body because it was the only way he'd ever get into medical school." It was meant as a joke, but it inadvertently reminded us that this poor sod had never achieved his aspirations and was trying to do us a favour in death. How would he feel about our laissez faire attitude to his dismembered remains? The skipping stopped soon after.

That was 1981, and medical education has moved on. Now students get introductory lectures on the ethics of cadaver use and a chance to discuss their feelings about meeting their first corpse. And the scope for abuse is far less - instead of getting a scalpel, a DIY guide book and half a body each, they get to watch someone else do it properly from a distance. Any kidney juggling is done with plastic replicas.

Some students feel they're missing out on their initiation ceremony, and some consultants agree. "We had to do it and so should they" is still a pervading attitude in medicine.

Medical dissection started in Britain with 16th-century criminals executed for murder. This was seen as a further punishment, worse than gibbeting, and volunteers were thin on the ground. So doctors looked under it. Raiding paupers' graves to get "resurrected corpses" was endemic in the 18th century - 2,000 snatches a year for medical schools until the Anatomy Act tried to stop it in 1832. Dissection, however, carried on apace using "unclaimed bodies".

Of the 57,000 cadavers used in London medical schools until the 1930s, virtually all were from workhouses of asylums - people who never consented to be dissected but had no-one willing or able to afford a coffin.

Nowadays, we rely on supposedly informed bequests, but even when dissection is done with dignity, the ethics are questionable in the absence of evidence that it makes better doctors, The anatomical knowledge is quickly forgotten and for me at least, there was no mature reflection on death and dying.

That said, I'd be quite happy to leave my body to the nearest anatomy department and, given the chance, I'm sure Gramps would have, too. Just so long as they pay for the burial.

Comments