Erik Larsen // “Open up a few corpses: you will dissipate at once the darkness that observation alone could not…” (Qtd. in Foucault 146). Xavier Bichat’s maxim, written in his Anatomie générale of 1801, described a new medical epistemology—one that informs medical practice and training to this day. Along with his Parisian colleagues, Bichat attempted to demonstrate that symptoms reflected specific and observable anatomical changes in the body (Sappol 52). By dissecting the cadavers of former patients, physicians might formulate links between physiological alterations in organs and the symptoms observed in vivo. One can little doubt the continuing positive influence of the empirically minded anatomists of Bichat’s age on medical knowledge, practice, and education. Indeed, today, many students begin their medical educations by opening up a corpse in order to understand how specific changes in structure and function will affect living patients. But dissection’s immense success often obfuscates its human costs. Historians have revealed much about body snatching and other insidious practices that darken anatomy’s history. First-year medical students bear another cost for their knowledge, and one we rarely recognize: many students struggle profoundly with the ethical complexities of dissecting dead bodies.
Bichat’s blithe injunction to “open up a few corpses” belies the tensions, if not trauma, some students experience while doing so. I recently learned of these difficulties while assisting with an ongoing research project at the University of Rochester School of Medicine and Dentistry. Faculty from the Division of Medical Humanities and Bioethics interviewed several first-year medical students about their experiences in the Anatomy Lab (students at Rochester perform full-body dissections). While many students reported positive experiences, several grappled with emotional turmoil throughout the class. Understandably, many students struggled emotionally and ethically to dissociate cadavers from living bodies. The instructors may have compounded this confusion by describing the cadaver as the student’s “first patient.” Although these attempts to personify the dead body stem from a need to teach students appropriate respect for patients and anatomical donors, the relationship of student and cadaver differs greatly from that of doctor and patient. Students disassemble the cadaver, often applying considerable force to remove organs and bones, and without any expectation that their actions will heal the “patient.” Responding perhaps to the cadaver’s ambiguous status, several students reported a nagging concern in our interviews: they wondered if potential donors understood what students would do to their bodies. Rather than interpreting this response as a critique of the consent process, I recognized in the students’ fears a more basic question: had they committed violence against the dead?
What rights should we grant dead bodies? What ethical and ontological status should we attribute to them? I have no satisfactory answers to these questions. When discussing these issues with students, I offer instead a biopolitical delineation of the concepts they bring with them into the lab. In his recent Persons and Things from the Body’s Point of View, political philosopher Roberto Esposito describes a basic split in the Western world’s schematization of reality. According to Esposito, our most influential religious, legal, and philosophical concepts assume the division between persons and things (1). We associate personhood with autonomy, reason, activity, and spirit; things, on the contrary, are inert, passive, mindless, and material. This opposition structures our practical relationship with persons, whom we designate as the bearers of rights, and with things, which we designate as the possessions of persons (18). For Esposito, the living body intrudes on this neat delineation, drawing persons and things into indistinct relationships: “The notion that a body can be reduced to a thing is contrary to our sensibility, but the idea that the body is always equivalent to the person goes against logic” (103). This imbroglio of person-body-thing maps productively onto many basic bioethical quandaries, for it is often when living bodies cease to display the signs of personhood that we think of them as things and question their rights.
Medical students bring a world ambiguously partitioned between person, body, and thing into medical training. While bioethics offers many useful concepts and norms for navigating the resulting ethical dilemmas, as the etymology of its name suggests, bioethics provides an ethics of bios, an ethics of life. Similarly, Esposito’s framework assumes the bodies in question are living; where then, in his schema, might we situate the dead body? Although this question falls outside the scope of Esposito’s project, it reveals a link between life and personhood in the tradition he describes. The living body’s characteristics as living—its dynamism, individuality, and responsiveness—align it closely with personhood. Viewed from this perspective, a body devoid of life appears devoid of personhood, and we might thus classify it as a thing. I suspect, however, that many of us would hesitate to treat dead bodies as possessions or material resources. Dead bodies lack the intimate connection of life to personhood, but for students in the anatomy lab, they remain bodies. When students seem to ask, in so many words, if dissection might not be violence, they seem to intuit this ambiguous status.
While I reject a simple equation of violence with contemporary medical dissection, I recognize that dismissing it fails to resolve many students’ legitimate concerns about their singular ethical relationship with the dead body. Rather than dictating what students should believe about cadavers, I recommend providing a biopolitical framework that helps them recognize what is unique and challenging about their task in the lab. Although dissection will always engender distress for some students, I suspect we can reduce traumatic responses by clarifying the assumptions they bring to dissection, and by recognizing how these assumptions may fail to guide them in a new context. By encouraging them to create their own moral relationship with the dead body, we may improve students’ learning in the lab, and eventually, their ability to relieve the suffering of living persons.
Featured Image: Rembrandt, “The Anatomy Lesson of Dr. Nicoles Tulp” (1632), Public Domain, via Wikimedia Commons
Esposito, Roberto. Persons and Things from the Body’s Point of View. Translated by Zakiya Hanafi, Polity, 2015.
Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. Translated by A.M. Sheridan Smith, Vintage Books, 1994.
Sappol, Michael. A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America. Princeton University Press, 2002.