Is it ethical to take advantage of vulnerable people to get their bodies?
The legalization of euthanasia – called medical assistance in dying (MAID) — in Canada has resulted in some people choosing to donate their bodies to anatomy programs, but it has raised profound ethical issues.
Bruce Wainman, of McMaster University, said the anatomical scientist community needs to establish guidelines around these donations. There are issues about the appropriateness of accepting or using MAID body donations; communication with donors, informed consent, and the transparency surrounding MAID donation with staff, faculty and students.
His article on the topic, co-authored with medical ethicist Jon Cornwall of the University of Otago in New Zealand, was published in the journal Anatomical Sciences Education.
“At this point, it is unclear how many anatomical programs have accepted or are accepting bodies of persons who end their life using MAID, as no reliable information exists on this topic,” said Wainman, professor of pathology and molecular medicine at McMaster.
The McMaster University body donation program has accepted six MAID bodies between the time the legislation was enacted in June 2016 and November 2018.
“Right after the law was passed in Canada, the bodies began to arrive,” Wainman said. “MAID makes up 5% of our body donations now, but I can see it easily going to 10% before the end of the year. That makes it five to 10 bodies a year.”
Wainman said the process of receiving and using bodies from donors who undertake MAID poses ethical challenges. “We have a tremendous relationship with many people in the palliative care field, so it comes up as a discussion point: 'Are you interested in donating your body to anatomic study?'” he said.
“An ethical question I face is that for these people who are so vulnerable, who are at that moment trying to decide if theirs is a life worth living, are we somehow inducing them to want to donate? Are we providing them with additional impetus to donate? It's a serious issue as the last thing we want to do is to bring about any pressure at this difficult point in their lives.”
“We are having discussions — important discussions — in our anatomy lab on what it means to receive a body that has not died of natural causes,” he said. “On the death certificate it lists the cause which compelled them to seek MAID, not from medical assistance in death, but we are aware of the circumstances beyond that. It's important in every possible way to be transparent. … Human health is not just about the function of your lungs and kidneys, it's also about the person who lives in that body.”
There are guidelines around body donation to anatomy facilities, such as those from the International Federation of Associations of Anatomists (2012) and the American Association of Anatomists (2009). However, these guidelines do not refer directly to the acceptance of euthanasia bodies, probably due to the newness of euthanasia laws.
Michael Cook is editor of BioEdge
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