Anatomy, Education, and Ethics in a Changing World

The recognized goals of anatomy education have broadened over recent decades to include not only the student's acquisition of knowledge of the structure and function of the human body, but also of professional competencies such as self-awareness, reflective practice, and teamwork (Štrkalj, 2016; Jones, 2017). The importance of these topics has been increasingly illuminated from within dynamic curricula, providing challenges for educators who are continually presented with emerging educational and ethical considerations that reflect a changing society. Yet although these professional elements are becoming more accepted as having a well-defined place in anatomy education, their importance has not always been front and center of visible learning objectives (Coulehan and Williams, 2003; Rizzolo and Stewart, 2006; Brenner and Pais, 2014). This has perhaps been the result of a lack of empirical support and tangible evidence that might demonstrate positive cause and effect, despite anecdotal observations by clinicians and teachers. Thankfully, momentum for both the inclusion of such professional competencies and their increased visibility within anatomy curricula is growing as a result of work exploring the anatomy-teaching environment. This special issue of Anatomical Sciences Education titled “Ethics in Anatomy Education” showcases such work, building on the research of previous authors to continue emphasizing the importance of ethics in anatomy education and the impact of ethical issues on the anatomical sciences. The impact of anatomy education as contributing something other than “learning about anatomy” has become more visible in the previous two decades. One of the first comprehensive investigations of the question of ethics in anatomy was presented in 2000 by Gareth Jones in his book “Speaking for the Dead: The Human Body in Biology and Medicine” (Jones, 2000; Jones and Whitaker, 2009). This was followed by the “Professionalism and Anatomy Special Issue” in the journal of Clinical Anatomy in 2006 (Pawlina, 2006), which contributed to the development of a modern educational position that stresses the importance of topics other than “learning gross anatomy” in anatomy education. Many of the articles in this special issue pointed to the potential of learning about medical ethics during the anatomical dissection course (Escobar-Poni and Poni, 2006; Graham, 2006; Lachman and Pawlina, 2006; Notzer et al., 2006; Page, 2006; Pangaro, 2006), arguing that recognition of this subject was important. Ten years later, Jones edited a special issue of Clinical Anatomy on “Ethics in Anatomy” (Jones, 2016a), presenting works that explored the widening horizon of ethics in anatomy, including the history of anatomy (Flack and Nicholson, 2016), the commercialization of human tissues (Champney, 2016, 2019), questions of body donation and tissue use (Kaw et al., 2016; Riederer, 2016; Winkelmann, 2016; Winkelmann et al., 2016; Jones, 2016b, c), educational practices (Hildebrandt, 2016; Kahn and Gardin, 2016) and issues arising with the use of new technology in the dissection room (Cornwall et al., 2016a). Because of these earlier efforts, the discipline of anatomy finds itself more cognizant of the broad range of topics that impact, shape, and influence the delivery of anatomy education. This current special issue looks to build on previously generated momentum through exploring contemporary questions relevant to ethics in anatomy education and the anatomical sciences. The edition sees an international array of work from Australia, Canada, Germany, New Zealand, Turkey, and the United States that will potentially guide the development and implementation of anatomy education in upcoming years. Among the authors are those who have thought and worked on ethics in anatomy for many decades, while several exciting new voices with innovative ideas and methodologies are also among the authors. This new work includes studies that support the pursuit and integration of professional competencies such as self-awareness, reflective practice, and teamwork as core elements of anatomy education, while other studies highlight new and emerging challenges within the nexus of interactions between anatomical educators, medical students, body donors, and society. In this special issue, one investigation from Australia presents findings from the largest and most comprehensive study of dissecting room experience on professionalism and ethical attitudes of medical students to donated bodies (Stephens et al., 2019), providing novel evidence for the impact of anatomy training on shaping the attitudes and perceptions of future medical professionals. There are also results from a qualitative study of emotion, ethics, and humanism in gross anatomy (Goss et al., 2019), and a first qualitative exploration of the use of unclaimed bodies and the impressions of the students that work with them (Caplan and DeCamp, 2019). The value of an educational intervention with a film about body donors (Iaconisi et al., 2019) and transformation and closure for donor families after meeting with students is explored (Halliday et al., 2019), while our understanding of donor populations is also enhanced through an exploration of registered Turkish body donors (Gürses et al., 2019) that provides a fascinating insight into how religion and culture influence body donation practice. An entirely novel set of ethical questions surrounding body donors is revealed in considering anatomical bodies from persons availing themselves of medical assistance in dying, or active euthanasia, in Canada (Wainman and Cornwall, 2019). Champney, on the other hand, explores “a bioethos for bodies” in response to the commercialization and commodification of the dead human body (Champney, 2019). The delicate subject of the ethical use of remains from human embryos and fetuses is presented in a study that explores options and provides guidance for the handling of historical anatomical collections (Fourniquet et al., 2019). A focus on “Ethics in Anatomy Education” also necessitates a critical review of current concepts and methodologies that affect anatomy and anatomy education. There is an increasing need for discussions surrounding new technologies in anatomy and anatomical education, such as three-dimensional (3D) printing (Jones, 2019), as the profession responds to new and unforeseen ethical challenges. Such work is essential and needs to be ongoing, given the rapid development of digital and other technology. At the same time, it is important to explore which examples from global history or which philosophies may be relevant for the development of pluralistic views of “today's” anatomy. Here, we present an exploration of the application of Confucian ethics on the commercialization of human bodies and tissues (Nie and Jones, 2019), and the role of history and ethics of anatomy in medical education (Hildebrandt, 2019). These works highlight the potential strength of taking new and different views of anatomy and using these to forge future paths in anatomy education. Ethics in anatomy education has come a long way in recent years, but it is still working on the answers for its essential questions: Why do we dissect dead human bodies? Where do the bodies come from? Do the dead deserve respect? How does dissection impact professionalism? And how do we as dissectors retain our own humanity? We believe that this special issue of Anatomical Sciences Education will contribute some of the answers to these questions. However, it will also become clear that none of the answers presented here are final, as each topic reveals new challenges that necessitate ongoing responses to the dynamic world we live in. Future areas of study will need to address issues of governance in response to innovations in digital and healthcare technology, such as the utilization of genomic testing on bodies donated to medical science (Cornwall et al., 2016b), and further work is still required to understand how student learning in the dissection room affects the personal and professional development of those persons privileged enough to study anatomy. This should also include new perspectives on how ethics in anatomy education impacts the quality and safety of patient healthcare and wellbeing, in order to provide ongoing support for the development of new educational approaches that more appropriately and effectively integrate ethics into the teaching of anatomy and medicine in general (Narvaez, 2006). These questions will require new answers from each new generation of anatomists, bioethicists, and learners, as anatomy and anatomical education will be forever in transition (Jones, 2017).