Speaking for the dead: The human body in biology and medicine
D Gareth Jones, Maja I Whitaker
ISBN: 978-0-754674-52-8; 2009; 296 pages; Ashgate Publishing Company;
Rebecca Scott Bray
School of Social and Political Sciences, The University of Sydney
When the first edition of D. Gareth Jones's Speaking for the Dead was published in 2000, its aim was to address the silences around the proliferate use of the human cadaver and its parts in laboratories, anatomy departments, museums, dissecting rooms and mortuaries. That book was a significant attempt to contextualise anatomy within the social world and to concomitantly expose practices of anatomy to 'ethical assessment' (2000:x). To do this the first edition assembled a broad range of issues that, discussed in one book, collected the diverse ethical strands involved in dealing with the human cadaver in biology and medicine.
That first edition discussed dissection, research on the clinically dead, indigenous remains in museum collections, organ and tissues transplantation, brain death and human embryos; the spectrum of life and death from pre-embryo to the nearly dead through to historical remains. This focus has been recapitulated and expanded in the second edition; but contemporary issues, which rent the scenes of biology and medicine in the 21st century, have focused both the contents and its structure, including a shift in terminology that encompasses 'the body' as opposed to strictly 'cadavers'. The first volume was a prescient collection; at that time the world of medicine was quite literally on the brink of very public discussions about how the dead body was managed. Since 2000, numerous scandals in the United Kingdom, Australia, New Zealand and the USA have reshaped social and legal dialogue about the dead body and its parts. These events include revelations about organ and tissue retention at Bristol and Alder Hey in the UK which reverberated in Australia and New Zealand, leading to government audits, autopsy and organ retention protocols and changes to legislation; and the illicit trade in human tissue and body parts in the USA.
These developments alone testify to the relevance of a revised edition, and this makes for a larger and more comprehensive collection with co-author Maja I. Whitaker. New material is subtly integrated into the book, which is structured into chapters each discussing the diverse bodies with which anatomists engage (dead, dissected, abused, plastinated, transplanted, indigenous, developing, thinking, modified). The early chapters build on the historical narrative of anatomy and incorporate a discussion of contemporary scandals, ensuring that the burking controversies in the UK are no longer the only reference point when making ethical assessments about troubling practices; that is, we are also firmly located in the 21st century. The range of practices that demand such assessments leads steadily to Chapter 3 and its focus on 'The Abused Body', which takes account of research and experimentation on clinically dead bodies, and also delves into histories of experimentation in the Nazi era with their contemporary implications. This is an interesting chapter that details aspects of medical and scientific research of relevance to broader disciplines such as criminology.
Around the same time that contemporary scandals were erupting around organ and tissue retention in the late twentieth and early twenty first centuries, concurrent developments have allowed a different public face of dissection and medicine to emerge. One key example discussed in the book is the work of Gunther von Hagens. Not without its controversy, the plastination work of von Hagens and his 'Body Worlds' exhibition requires attention; he is part of a lineage of anatomists who conjoin art and anatomy and he moves the anatomical specimen out of medical education contexts to an interested public. This chapter explores issues which have vexed 'Body Worlds' and which echo throughout much of the book - questions of voluntary donation, informed consent and how we treat bodies - and ultimately highlights the 'multidimensional nature' of the exhibition which witnesses the presentation of dead bodies outside strict medical-scientific frameworks (2009:105). In this way the book extends its analysis beyond clinical fields, recognising the important and expanding social territory of the body at the interface of medicine and biology, and as such is of broad disciplinary value.
Chapters 5 through 9 increase the ambit of the 'body'; Chapter 5 considers 'The Transplanted Body' and attendant issues of consent. Detailing ethical viewpoints in the literature, Jones and Whitaker discuss matters that push ethical limits such as the use of fetuses, xenotransplantation and refract their discussion through case examples, a useful and informative feature of the book. This allows them to cover a range of case material, and leads to an extensive bibliography which is a particularly valuable resource. Chapter 6 is an updated chapter detailing the collection of indigenous remains in museums throughout the world and the development of policy and legislation to aid repatriation of remains to communities. This chapter threads legal and policy developments through a discussion of ethical issues where scientific interest and indigenous concerns collide and suggests guidelines to ameliorate tension. Chapter 7 shifts the discussion to 'The Developing Body' and the human embryo and stem cells; Chapter 8 focuses on 'The Thinking Body' and questions surrounding the brain, such as brain death definitions, implications of definitions for the treatment of persons, and issues of neuroimaging which take the reader into diverse areas as disease prediction and lie detection in forensic contexts. Chapter 9 concludes the collection by further examining the promise of the body. This chapter engages with numerous issues around 'The Modified Body', such as surgical modifications, gene therapy, psychopharmaceuticals and examines the debates around therapy and enhancement.
With such a comprehensive focus, Speaking for the Dead is a rich resource for information and analysis of key ethical debates connecting a range of issues, relevant case studies and, in many examples, their policy and legislative contexts. This awareness of jurisdictional developments is important, as recent human tissue and organ retention scandals tell us (see chapter 2 for a discussion of dissection which incorporates comments on the Human Tissue Act 2004 [UK] as one example). Correspondingly, these legal changes continue in a climate of increased discussion around the appropriate management of the dead body, even in situations where 'consent' becomes tricky (such as coronial autopsies). Recent reforms to coronial law in Australia have engaged with issues around the body which have a definite historical life, such as concepts of dignity, and have done so in league with contemporary concerns including the management of the deceased in a growing technological age, the importance of families and respect for cultural and religious diversity. These ongoing concerns ensure that this book has a long life.