The Case For and
Against Cadavers
Over the centuries, dissecting the human body
has evolved from a criminal offence to a vehicle of mass entertainment to an
initiation rite.
In the Middle Ages, human dissections were
forbidden. In 17th-century
By the 20th century,
dissection had become the exclusive purview of scientists and a mandatory rite
of passage for all doctors.
The scandals reported this month involving the
sale of donated cadavers at the
In 18th- and early 19th-century
Now, though, the place
of dissection in medical education is changing in ways that have not been seen
before.
The hours devoted to formal anatomy training
are sharply down in
Computerized scans and 3-D re-creations of the
human body provide cleaner, more colourful teaching tools than the time-consuming
dissections of the past.
Some educators say that dissection, as taught
to medical students since the Renaissance, is on its way out. Others maintain
it is becoming more important than ever, not only for teaching the structure of
the human body but also for the more subtle lessons it can impart on the
meaning of being a doctor.
"It is always difficult to decide how much
anatomy should be learned by a doctor," says Dr. Frank Gonzalez-Crussi, a
retired pathologist in
Much of the traditional anatomy curriculum is
irrelevant to medical practice and might easily be eliminated, Gonzalez-Crussi says,
but there is still no substitute for dissection, which forces the student,
willy-nilly, to confront human mortality.
Through the mid-20th century, medical students
typically spent hundreds of hours dissecting. Working in small groups with scalpels
and scissors, they would tease out every major structure in the body, including
tendons, arteries and nerves, memorizing dozens of tortuous pathways and
hundreds of Latin names in the process.
But as the focus of medical science continues
shifting from whole organs to cells and molecules, more and more teaching hours
are consumed by molecular biology and genetics.
Surveys show that today's medical students may
spend more than 80 per cent less time in dissections than did students in the 1950s.
Anatomy faculty members are aging, professors say, and fewer classically trained
graduate students are available to replace them.
A shortage of donated cadavers is not the big
problem: Most medical schools receive enough to meet their teaching needs. But startling
new discoveries in anatomy are uncommon and money for research is sparse.
Still, anatomical research continues to have
practical applications — in the design of new implants or prosthetic devices,
for example.
To supplement dissections, medical schools now
routinely use computer-based tools, most often CT and MRI scans of living patients.
Some programs take advantage of the National Library of Medicine's Visible
Human Project, which provides radiological scans and actual digitalized
photographs of cross-sections of a male and female cadaver.
Computer-generated models — like one program
that gives the viewer the illusion of flying through the nooks and crannies of
a human skull — can clarify tiny, convoluted anatomical structures in a way
that actual preserved specimens cannot.
Some schools now pare down anatomy courses by
sparing students all hands-on contact with a cadaver. Students learn anatomy by
inspecting structures in cadavers that have already been dissected by an
instructor.
Studies have shown that students who learn
anatomy from professionally prepared dissections, called prosections, perform about
as well on standardized tests as those who do the dissection themselves.
But anatomists bristle
at any suggestion that either prosections or computer models will make them
obsolete.
"There are some excellent computer-based
resources, but they are not a replacement for the cadaver," says Dr. Todd
Olson, a professor of anatomy at Albert Einstein College of Medicine in
Dr. Carol Scott-Conner, a professor of surgery
at the
While she won't say that every medical student
"needs an intensive anatomy course," she insists that "everybody
needs to learn anatomy."
Even when the details of anatomy and the Latin
names fade from a doctor's memory, memories of the experience remain vivid, she
says.
Further, drawings and models ignore the huge
variability in human anatomy, in which duplicated, misshapen or aberrant structures
are common.
Students who spend time searching for an
important nerve or a blood vessel that surfaces nowhere near where it is
supposed to be learn a hands-on lesson about the huge range of "normal"
in medicine.
Anatomists also
emphasize that working with a cadaver elicits a sense of reverence that
pictures and models do not.
Medical attitudes toward
human specimens have varied over the years.
Apocryphal stories from the 19th and early 20th
centuries describe medical students jumping rope with the intestines of cadavers
and playing lewd practical jokes with cadavers' genitalia.
As recently as 30 years ago, medical students
who expressed any fear or squeamishness about human dissection were often told
they were "weak" and in the wrong field, Olson notes.
But now, he says, schools uniformly encourage
students to work through their emotions and appreciate the gravity of the proceedings.
At
"In medicine now, there's a big emphasis
on teaching students professionalism," says Dr. Lawrence Rizzolo, director
of the Yale course.
"In anatomy, we begin the discussion — how
the student will function as a professional, learning how to react to an uncomfortable
situation, facing death and dying.
"We get them in
touch with their feelings."
When the course ends, the Yale students thank
their donors, as they call the cadavers, in a ceremony that includes original poems
and musical compositions.
Every first-year student attends, Rizzolo says,
and the service has come to celebrate not only the rite of passage of the anatomy
course but also the students' immersion in medicine.