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Ethical and legal:
Rights of dead body vs. Medical practices

By Shireen Lalani

Mr. Ellsworth, who was 87 years old, was brought into the emergency room by the local rescue squad in a complete cardiac arrest. All emergency procedures were performed, including the establishment of an airway, peripheral intravenous lines, urinary catheterization, and more. After resuscitation attempts had been performed for 45 minutes, the patient was pronounced dead by attending physician and family members were notified. At that time the family arrived at the emergency room. Mary Pope, the evening staff nurse, found the attending physician teaching incubation techniques to five medical students and they were using Mr. Ellsworth’ corpse for practice. She quietly notified the attending physician that the family had arrived and wanted to talk to physician. They also wanted to see their loved one’s body. The attending physician, however, said that he would be busy teaching the medical students for another 15 to 20 minutes. When Ms. Pope asked weather Mr. Ellsworth had given permission for his body to use to teaching purpose, the attending physician ignored Miss Pope and asked her to tell the family that he would be busy with another patient for few more minutes. In the above scenario we have seen that the attending physician is teaching an invasive procedure using a deceased body and ignoring the respect and dignity of it. I was shocked with the doctor’s attitude towards Mr. Ellsworth’s corpse, his family members and the nurse as well. While reflecting on this incident, I was thinking about the rights of dead body. Is this legally and ethically right? Being Muslim what about the rights of human body after death explained in the Holy Quran and other religions. I felt very upset for this incident. What about the family, who did not know that what happened to Mr. Ellsworth and what, is going on now? They wanted to see the doctor and the doctor was replying them to wait outside with disrespect to the family members. This incident has great significance towards the family members, and for all paramedical practitioners.

Evaluation
This incident stood out for me because first of all it was an ethical issue. Physician showed disrespect towards the corpse of Mr. Ellsworth by not following the rights of dead body. Secondly physician should have consent from the family. Thirdly, physician should respect family members as they wanted to talk to the attending physician and he asked nurse to give excuse to them. Fourthly what about the religion does clients or any other religion allowed this kind of practice. Finally what was the role of nurse, why she did not firmly stop the physician from practicing such heartless behavior?

Analysis
When I reflect back the situation many questions start revolving around my mind. Such as, why doctor was practicing on the dead body? Is it ethically or legally right to practice on a dead body? Why he did not take permission from the family first and then uses the corpse of Mr. Ellsworth? Why he asked family members to wait and did not gave respect to them? What about religion is it allowing us to use dead body for our own practice purpose? Moreover why nurse in that situation was mute and did not advocate for patient’s body right? She could stop the physician if she feels that what is going on is not legally or ethically right. I was thinking if there was my family instead of Mr. Ellsworth then how do I feel or what could be my reactions? While analyzing critically many assumptions appear on the screen of my mind. Such as, for physician might be the importance of educational value of practicing procedure for medical students are more important than the dignity and respect for the deceased patient. Although is it ethically and legally not right but this practice could safe many other patient from death. The physician did not ask for consent because he might think that the family will refuse him to use Mr. Ellsworth’s corpse for practicing purpose. The physician did not answer the family members because he did not want to waste his time because if the process of rigor mortis starts he could not teach or practice with his students.

If we talk about religion, it never allows us to perform such practices. Every religion explicitly bans any manipulation of dead body. If we put our self in the physician’s shoes and think that intubation is one of the essential procedures one needs to perform before putting a patient on ventilation. If physician is not expert in this procedure he might fail to safe others as well. The physician who worked to safe Mr. Ellsworth’s life (and failed) now is using the patient’s shell to horn his skills which might benefit to other critical patient. Marry Pope; the evening shift nurse was not able to stop the physician firmly as she had knowledge that what is happening is not right. Might be she do not have enough guts to stop a physician after all having enough knowledge. If we assess the practice of other hospitals in Karachi, it is more wore than this situation. In newspaper we daily read some news about the mal practicing on dead body or abusing it without known to family members.

Synthesis
After critical analysis I start wondering that what literature says to have better solution of this situation. According to the American Medical Association it is recommended that practicing on deseeded body is important for the medical student and should perform with dignity; with permission of family and within the supervised environment (AMA, 2002). If we review from the religious point of view it is there in Quran and Bible as well that after death the body should buried as soon as possible with all its dignity and full parts. Whereas, according to Iserson 1995, if respect means paying homage and bestowing owner, this procedure is more respectful than many of the other procedures performed in our society after death. After reviewing the literature I came to know that religion is absolutely not allowing us to practice on dead body. Whereas practicing of the invasive procedure is important for physician to work in critical care area but for this permission from the family is essential. Now day’s different manikins are available in the market which can utilize for practicing purpose. After critically analyzing and have literature knowledge, in future if I came across the same scenario I could act differently. I know that I have to advocate for the patient’s right, if I will see any physician practicing on the dead body I should find out that he has taken the permission from the family or not. If not then I could stop the physician firmly in order to maintain the dignity and respect of the dead body. In order to know that what the thinking of general population is I interviewed some of my neighbors. The question was if any of your family members die and a doctor comes to you and asks if we can teach a procedure on the dead body what will be your response. I came to know that 6 out of 10 families answered that if we have proper explanation that why medical staff is using the body we might offer them to practice.

In conclusion, first of all paramedical persons should know that without family’s consent they could not perform any practice on a dead body. Secondly they should keep respect and dignity of family decision and their religion as well. Thirdly as a professional nurse we need to adapt the role of an advocator in order to maintain patient’s autonomy. For this purpose I will educate other nursing staff by discussing ethical concepts with them. In addition ongoing sessions could arrange to discuss how to become assertive for patient’s right.