April 1982 III/8
AUTOPSY: ETHICAL AND RELIGIOUS CONSIDERATIONS
At times people are reluctant to release the body of a loved one for autopsy. Are there good reasons for this reluctance? Is it a violation of propriety, ethics or religion to release the body of a spouse, parent, or child for medical examination? If not, why the continued reluctance?
When a human being dies, the body is no longer unified by the life-giving principle or soul by which it is a constituted human person. The cadaver of a person, then, is not a human body in the proper sense of the word. Insofar as possible, we should avoid referring to the physical remains of a person as though the person existed in a human body or was, so to speak, limited by the human body. While existing in this life, the human person is a substantial unity of spirit (form) and body (matter), not an accidental juxtaposition of two distinct entities. Though the remains of a human body may resemble the body of a living person, and though this resemblance may be prolonged through embalming, the remains are not a human body, but a mass of organic matter, decomposing into constitutive organic elements. If the corpse of a human person is not a human body, then why are people so concerned about proper care for the remains of the deceased person? Why treat it with the respect and reverence which it usually receives? Respect and reverence are due the remains of a human being because of the value of human life which once informed the now inert mass still bearing the image of the deceased person. In order to mourn and express sorrow for the fact that the person will no longer be present in the same manner as before, certain reverential actions are performed which express the love of the people who remain. Respect for the dead body, then, signifies respect for human life, respect for the Author of life, and respect for the person who once subsisted with this now corrupting corpse, and who now exists in a different modality. Hence the actions, the ritual that people follow when caring for the body of a deceased person, have a meaning beyond their apparent signification.
Autopsyis the examination of a cadaver after death performed in order to provide greater medical knowledge concerning the cause of death. Historically, the first major impetus for autopsies was provided when Frederick II, emperor of the Holy Roman Empire, instructed physicians studying at Salerno and Naples to spend at least one year in the study of anatomy. Theologians expressed the belief that such dissection of the human cadaver could be done with proper respect for the dead so long as the organs were restored to the body prior to burial.
In accord with the respect due the remains of a human person then, in an autopsy, no organ should be removed from a corpse nor should the body be dismembered in any way unless there is a sufficient reason which would justify such an action. Usually the next of kin or the person to whom the corpse is committed for care has the legal right to determine if organs may be removed from the body and if an autopsy may be performed (Pierce v. Swan Point, 1872). However, the right of the next of kin in regard to caring for the human body is not absolute. It may be superseded by statements made by the person while still alive; for example a statement that a person wanted to donate his body for scientific study, or by the needs of society, for example, when an autopsy might help improve medical knowledge.
Today, the benefit of an autopsy occasionally will be to provide knowledge about a rare or contagious disease. In such cases autopsies should be performed because the good of the community demands it and because increased medical knowledge is needed. If the next of kin were not willing to approve the autopsy, the court could order that the autopsy be performed. In cases of violent death or unattended death an autopsy is required by law, no matter what wishes were expressed by the next of kin.
Usually, however, the purpose of an autopsy is not to trace the etiology of a rare disease nor to discover unknown or violent causes of death. More frequently, autopsies are performed mainly to help health care professionals achieve a higher level of effectiveness in the care of the living. Autopsies are especially useful for the common good when performed in teaching hospitals. The autopsy rate of a hospital is usually a sign of concern for excellence and offers a gauge of professional integrity and interest in scientific advancement. Through autopsies, the diagnosis and treatment a person received can be evaluated and staff members encouraged to observe a high level of proficiency.
From a Christian point of view, the practice of allowing autopsies and one's body for scientific research is acceptable and even to be encouraged if a true need exists. Pope Pius XII, for example, exhibited approval of autopsies when he said:
The public must be educated. It must be explained with intelligence and respect that to consent explicitly or tacitly to serious damage to the integrity of the corpse in the interest of those who are suffering, is no violation of the reverence due to the dead. (2)
According to the prevailing opinion of Jewish scholars, autopsies can be condoned only when there are indications that the information accruing from them may be of value in saving the life of another individual. Thus postmortem dissections are indicated when an experimental drug or surgical procedure was utilized and the autopsy is likely to shed some light on the merits of the treatment. Similarly, when death was caused by contagious disease or genetic disorder, autopsies are warranted for the purpose of instituting prophylactic treatment or helping with genetic counseling. Most rabbinic authorities also permit postmortem dissection for forensic purposes when mandated by law. But in all cases where autopsies are indicated, they must be limited to the special areas where relevant information may be obtained. Following the examination, all organs must be returned for burial.(3)
The teaching of Islam does not allow for voluntary autopsy because it is considered a desecration of a human person who was associated with the body. If the law requires it, however, then the next of kin may acquiesce to it. Unless some law would be broken or public health endangered, it seems the religious beliefs of people who disapprove of autopsies should be respected. However, it is worthwhile to point out that one reason why medicine in the Islamic world failed to progress after a promising beginning was due to a lack of clinical information which could have been garnered through autopsies. (4)
Because of what it represents, the remains of a human person should be shown respect and reverence. But such respect and reverence is consistent with autopsies which are designed to promote public health and improve medical knowledge, provided proper respect is shown for the cadavers. When people are faced with decision concerning autopsy, they should be encouraged to approve such procedure because of the help that will be offered to others.
Kevin O'Rourke, OP
1. E.Cassell,"The Nature of Suffering and the Goals of Medicine," NEJM, v.306; 3/18/81; p.639-645.
2. The Human Body, St. Paul Press, 1960; p.382.
3. "Cadavers," Encycl. of Bioethics, I; p.14.
4. "Islam," Enclycl. of Bioethics, II; p.788.
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