Bioethics Forum Essay
Say Their Names: Unclaimed Bodies and Untrustworthiness in Medical Science
A recent NBC investigative series titled “Dealing the Dead” revealed that thousands of unclaimed bodies were used by the University of North Texas Health Science Center for scientific research and medical education, and to generate profit. The human body donation program, known as the Willed Body Program, was developed to educate future physicians, scientists, and other health professionals.
While some unclaimed bodies were selected to train future health care providers in anatomy labs at UNTHSC, others were dismembered and leased out to organizations, including medical schools, the U.S. Army, and for-profit medical technology companies. Advertising the bodies as “the highest quality found anywhere in the U.S.,” UNTHSC distributed approximately 2,350 unclaimed bodies to at least 12 organizations from 2021 to 2023, with $2.5 million in profits, according to financial records.
In response to these allegations, many of the participating organizations and recipients of the unclaimed bodies released statements that said that they were not aware that the remains were donated without consent. UNTHSC has suspended operation of the Willed Body Program.
UNTHSC officials deemed the bodies unclaimed if they were unable to identify or reach next of kin to obtain consent, stating, “If a relative is not located or does not claim the remains, a decision must still be made.” But the NBC investigation uncovered “repeated failures by death investigators in Dallas and Tarrant counties — and by the Health Sciences Center — to contact family members who were reachable before declaring a body unclaimed.”
This story comes to light in the wake of ongoing debates about medical trainees conducting pelvic and prostate exams on patients, many of whom were anesthetized, who did not explicitly consent to the procedures. “Informed consent includes the right to refuse consent for sensitive examinations conducted for teaching purposes and the right to refuse to consent to any previously unagreed examinations to treatment while under anesthesia,” stated the Department of Health and Human Services earlier this year. A growing body of evidence indicates that pelvic and prostate exams performed without patients’ consent happen more frequently among patients of color. Similar trends exist in anatomy labs across the country, where cadavers are disproportionately from minoritized communities.
These findings raise important ethical questions around the need for ongoing transparency and accountability concerning the use of the deceased in medical research and education. Why are institutions and state anatomical boards not certifying the rigorous evaluation of the consent process of the remains intended for medical education and scientific research? Should medical students and staff be informed about the origins of the remains they are handling? How are medical educators and bioethicists discussing cadaveric donation with trainees, and are they doing so in an ethical and respectful manner that acknowledges historical and contemporary contexts? What processes and procedures are in place to require informed consent for the use of the deceased in medical research and education?
The medical community has a long and sordid history of experimenting on Black, Indigenous, poor, disabled, mentally ill, and incarcerated bodies. In the ethics discourse, these individuals are often characterized as vulnerable populations, at elevated risk for harm or exploitation. Expanded research ethics frameworks emphasize that vulnerability must be understood in the context of overlapping structures of oppression, including anti-Black racism, classism, and sexism, and the unique ways that these structures intersect and are perpetuated in the research process.
Historical and present-day exploitive practices, including the recent unethical use of unclaimed bodies for medical research and education, diminish the public’s trust in research and health care establishments. Simply put, the failure to be truthful and transparent about the consent obtained for use of the deceased in medical science erodes these organizations’ ability to be relied on as honest and truthful, core tenets of trustworthiness. In response, we must move beyond the discourse that places an undue burden on individuals and communities to be more trustful of research and medical institutions; rather, we ought to shift our thinking and actions towards cultivating and adapting a culture of trustworthiness at the organizational level. As stated by the AAMC Center for Health Justice: “A long, ongoing history of mistreatment and abuse has fostered logical distrust of the health care system and other institutions across diverse communities. Trust is the foundation of the community-driven, multisector partnerships necessary to create lasting health equity for all.”
There is an extensive body of literature that names and documents medical abuse and exploitation. However, there remains a dearth of research focused on operationalizing and measuring institutional distrust and trustworthiness, and even fewer efforts to address these systemic issues. Developing measures of trustworthiness, especially measures that assess the relationship of trustworthiness and organizational trust to engage in the research process, represents a much-needed shift towards holding institutions and organizations accountable for acknowledging, rectifying and repairing severed trust.
The Covid-19 pandemic taught us that medical, research, and public health institutions must demonstrate that they are worthy of the public’s trust. Stated plainly, trustworthiness must precede trust, and the time to rebuild is now.
In conclusion, the harm, exploitation, and injury sustained among countless human beings in medical research and education cannot be ignored. As a community of bioethicists, we must have the moral courage to confront and dismantle the inhumane and unjust policies and practices within our own institutions. We must remember to honor and recognize the lives and legacies of those extracted for use in UNTHSC Willed Body Program.
#Say their names.
Barbara Adams. Victor Honey. Carl Yenner. Michael Dewayne Coleman. Oscar Fitzgerald. Elsa Cordero
Faith E. Fletcher, PhD, MA, is an associate professor in the Center for Medical Ethics at Baylor College of Medicine, a senior bioethics advisor to The Hastings Center and a Hastings Center fellow of The Hastings Center. @FaithEFletcher
Olive Pertuit, MPH, is a clinical research associate in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. @OliveRPertuit
Sophie L. Schott, BA, is a clinical research coordinator in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a first-year medical student at the McGovern Medical School at UT Health. @MyBestSchott
Virginia A. Brown, PhD, MA is a research scholar in Health Equity and Population Health at The Hastings Center. @VirginiaABrown
[Blair L Sadler JD and Alfred M. Sadler, Jr, MD served as the chief consultants to the Commissioners on Uniform State Laws (now the Uniform Law Commission) in drafting the Uniform Anatomical Gift Act. They are Founding Fellows of The Hastings Center.]
In drafting the original Uniform Anatomical Gift Act in 1968, it was very clear that the core principle of voluntary informed consent applied to donations of tissue and whole bodies for medical research and teaching, as well as organs for transplantation. The abuses described here are flagrant violations of the law and serve to undermine public trust in medicine and science. Individual states and CMS must be much more pro-active and aggressive in bringing these practices to an end. The authors are to be commended on an excellent discussion of a serious problem that demands attention.
These articles provide a comprehensive picture of what has transpired in this complex and evolving field:
1 Sadler, A.M. Jr. and Sadler, B.L.: “Transplantation and the Law: The Need for Organized Sensitivity” 57 Georgetown Law Journal, 5-54 (1968).
2 Sadler, B.L. and Sadler, A.M. Jr.: Organ Transplantation and the Uniform Anatomical Gift Act: fifty-year perspective”, Hastings Center Report, 48:14-18 (2018).
Thank you so much for your important leadership in this area. I will be sure to add this to my list of resources.
Also, the Sadler Scholars program is an important training mechanism that expands the bioethics workforce and diversity of thought in the field to amplify issues like the one we raise here. Thank you!
In Chapter 2 of my book, STRUCTURE OF MORAL REVOLUTIONS, I describe the origins of voluntary donation and use of unclaimed bodies programs. They were initiated by Benthamites and by Jeremy Bentham himself as a way of preventing body snatching and grave robbing and the subsequent purchase of these bodies by anatomy theaters and medical schools. As I note on p. 71, African American graveyards were routinely plundered by grave robbers. The Benthamite reforms required anatomy theaters and medical schools to use voluntarily donated bodies and to use unclaimed bodies only if efforts were made to contact the next of kin. Bentham role modeled voluntary contributions by donating his body and inviting influencers to attend its public dissection (p.73, 74). Unclaimed bodies were used for dissection in anatomy theaters and medical schools and the supply of free bodies undermined any incentive for grave robbing with soon ceased to be a phenomenon. Massachusetts was the first US state to introduce these reforms and grave robbing in that state soon came to an end. The use and sale of unclaimed bodies is an artifact of sources of supply. Monitored consent to donation works but only supplies sufficiently to meet the demand.
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Thank you, Dr. Baker for the resource and additional insight around this topic!