Donation of the body to medicine: how to prevent dissection from rhyme with transgression?

On November 26, the weekly L'Express suddenly exposed malfunctions of the body donation center of the Faculty of Medicine of the University of Paris-Descartes. Dilapidated premises, rotten remains gnawed by mice ... The terrible conditions of conservation of thousands of bodies donated to medicine led to the administrative closure of the center, then to the opening of an investigation for "attacking the integrity of" un cadavre ”by the Paris prosecutor's office on November 29.

Lhe silence agreed upon for years, the embarrassment of many doctors or institutional officials to explain this indignity at the heart of a prestigious university are indicative of a strange and disturbing state of mind, the corollary of which is the significant lack of studies. devoted to the ethical aspects of dissection.

Would the superior interests of biomedicine justify the concealment or concealment of practices incompatible with medical ethics and the good practices of dignified research? While since the beginning of 2018 our country has been debating the revision of the law on bioethics, that the question of the end of life comes back regularly on the public scene, how can we explain this lack of consideration and this indifference with regard to unjustifiable and sordid behavior? ?

Of course, we must not generalize the criticism and cast shame on all the centers for donating bodies. But we can legitimately ask certain questions: did the absence of binding rules aimed at avoiding the abuses denounced exonerate the institutions concerned from all responsibility, even if only of a moral nature? And what about the vigilance of national ethics bodies?

The respect due to the person does not cease to be imposed after death

In his decision n ° 94-343 / 344 DC of July 27, 1994, the Constitutional Council affirms that: “[…] the safeguard of the dignity of the human person against any form of enslavement and degradation is a principle of constitutional value. The intervention on the deceased seems to me to come under this principle, the scope of which is essential including concerning the donation of the body to science.

One could oppose the legal distinction between the person and the corpse. From an ethical point of view, however, this cannot justify the unworthy use of a human remains, its instrumentalization. Our obligations towards him derive from values ​​rooted in our traditions and our culture through duties and rites of separation and funeral, if only out of respect for the memory of the deceased.

The deposit of an anonymous body in a cold room for medico-scientific purposes, its dismemberment and the various experiments carried out do not make it an undifferentiated material delivered without the slightest consideration to the investigations. As soon as it is considered to be part of a biomedical activity, strict ethical rules are enacted to regulate the dissection. As the code of medical ethics underlines, “The respect due to the person does not cease to be imposed after death. "

The rules in force mark a line which separates good medical practice from what is an acceptable transgression or not. So thesection 16-1 of the Civil Code states: “Everyone has the right to respect for their body. The human body is inviolable. " Article 16-3 complete: “The integrity of the human body can only be violated in the event of therapeutic necessity for the person. "

Is this notion of integrity still relevant when it comes to human remains? Should we explore its meaning and scope when the body is dismembered as part of dissection and anatomical experimentation? When the person has consented during his lifetime to donate his body for the benefit of society, is this admitting that he frees us from any obligation with regard to his remains, the fate of which he knows may be in store for him?

We note that the legislator was more invested in taking into account the ashes of the deceased than in that of the medical-scientific study of the corpse. Article 11 of the Law n ° 2008-1350 of December 19, 2008 relating to funeral legislation adds after article 16-1 of the civil code, an article 16-1-1 as follows: “The respect due to the human body does not cease with death. The remains of those who have died, including the ashes of those whose bodies have given rise to cremation, must be treated with respect, dignity and decency. "

This means that respecting intangible values ​​and considerations of an anthropological nature makes it possible, in uncertain circumstances which justify setting out benchmarks, to protect us from any possible drift. In particular, those that we see today.

Gaps in dissection

If the lack of explicit texts concerning the dissection is indicative of a lack of specific reflection, it is either because the use of the anonymous corpse for research purposes would exempt it from any moral obligation towards it, if only of the order of decency, or because a demanding ethical reflection would run the risk of hampering the scientific process and subjecting it to philosophical or metaphysical objections which are hardly compatible with the spirit of "modern science".

An interesting semantic distinction can be noted in this regard, following a surgical intervention, between “operative waste and“ anatomical part ”. Would we consider the corpse used for science as "anatomical waste", thus deprived of its attachment to humanity, to human history, to a human and social environment which nevertheless remains after its death?

It does not seem out of place to explore the meaning of resolutions which, while not directly concerning experimentation on the corpse, have however to do with the ethics of the researcher.

Our conception of the dignity recognized unconditionally to the human person is based on an order which should inform our approach to the use of dissection. The Declaration of Helsinki evokes the right balance to be struck between the objectives of the experiment and human rights.

In the case of a corpse, this balance could be understood between a scientific objective and the concern to preserve the dignity of the corpse, both during the intervention and in the conditions of its conservation and then of its cremation.

“If the primary objective of medical research is to generate new knowledge, this objective should never take precedence over the rights and interests of those involved in the research. "

The notion of kindness, like that of non-maleficence, can contribute to sufficiently responsible and caring practices not to admit acts of avoidable mutilation, attacks on the dignity and integrity of the corpse assimilated to unbearable violence and an attitude of contempt for the person who gave his body to science.

Preserve trust

The act of donating one's body after death, as well as the non-refusal of a post-mortem organ harvesting for transplants, are the expression of solidarity and trust shown to humanity, society, science and medicine. It therefore commits, reciprocally, to be guarantors of irreproachable practices, up to the moral value of this gift.

In the absence of transparency where modesty and decency justify discretion and restraint, perfect loyalty is required. And this even if dissections and other interventions on the corpse take place in the confined context of medical schools or laboratories, for the purposes of training and explorations of advances in surgical techniques. An examination of what would be, in these circumstances, an ethics of respect and decency would be appropriate.

The suspicion generated by episodic revelations, including regarding what is going on behind the walls forensic institutes contributes to a mistrust that is spreading today, in so many areas, at all levels of the public sphere. The interests of justice, like those of science, do not justify everything, in this case the unnamable. Where human vulnerabilities, suffering and social miseries are the strongest, consideration, attention and respect for rigorous, incontestable and appropriate measures cannot be discussed.

Sacrilege, a lasting notion

The requirement and the effectiveness of intangible principles indeed condition the acceptability of practices which, as we know, challenge our ancestral representations of the sacredness of the body, and our attachments to the obligations that we owe to the dead in the preparations and the organization of funerals, including in a secular context.

In addition to its dismemberment, the body given to science is only rarely returned before its collective cremation and the dispersion of the ashes in a “garden of memories” is not accompanied by a ceremony, with some exceptions. Some faculties of medicine organized an annual moment of meditation in homage to the deceased who gave their bodies to science, and some funeral monuments attest to this form of memory.

Chateaubriand testifies in his Memories from beyond the grave resolute opposition to the autopsy

"If I die outside France, I would like my body not to be returned to its part until after fifty years of a first burial, that my remains be saved from a sacrilege autopsy, that they spare themselves the care to seek in my frozen brain and in my extinguished heart the mystery of my being. Death does not reveal the secrets of life. "

This notion of sacrilege seems perennial in the current context of a secularized society. Evidenced by the scandalized reactions to the news of the center for the donation of bodies of the University of Paris-Descartes.

Ethical continuity

We need to better understand why and how such medico-scientific practices have not aroused the vigilance that could have prevented such abuses. We also need to better prioritize the order of our concerns in matters of ethics and bioethics, the order of our implications, including in fields as delicate to investigate as death, autopsies and dissections. As far as I am concerned, I have always considered these issues to be in the order of our higher obligations.

So that, according to the expression in force in the philosophy of the gift of the body - "death in the service of life" - is not just a slogan that covers unjustifiable behavior, it would still be appropriate that the ideology of certain scientists does not distort the moral significance attributed by the donor to his donation.

In addition, it is important to reflect on scientific practices that are indifferent to the requirement to think, from an ethical point of view, the meaning of action and its consequences. As such, interventions that are sometimes intrusive on living organisms, in the name of advances in biomedicine and an aim of improving human capacities, deserve attention, vigilance, even circumspection, the inadequacies of which, here too, are noted. , not to say the deficiencies. Claude Bernard could he still, in the current context, argue that

“In science, it is the idea that gives facts their value and meaning. It is the same in morality ... The surgeon, the physiologist and Nero also engage in mutilations on living beings. What still distinguishes them, if not the idea? ... The physiologist is not a man of the world, he is a scientist, he is a man who is seized and absorbed by an idea scientist that he pursues: he no longer hears the cries of animals, he no longer sees the blood flowing, he sees only his idea and sees only organisms which hide from him problems that he wants to discover. "?

Between the instrumentalisation of bodies on the one hand and the digitization of bodies on the other, what about our conception of human dignity?

To answer this question, a political reflection associating multidisciplinary skills within the framework of an open dialogue is urgent. Our values ​​of humanity, that of our democracy, are committed to it. From now on, we must not limit the consequences of the behavior and serious negligence observed in recent days to administrative measures and legal proceedings.The Conversation

Emmanuel Hirsch, Professor of medical ethics, Paris-Saclay University

This article is republished from The Conversation under Creative Commons license. Read theoriginal article.

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