Safety and ethical issues of bare hand cadaver dissection by medical students
Dissection is not only a skill, but also an art that is identified as the signature of a surgeon. Besides the surgeon, all medical practitioners exhibit their proficiency, or the lack of it, while performing procedures such as the draining of an abscess, removal of a cyst, venesection, and so on. The initial learning seat for this marvellous art is the anatomy dissecting room.
Beginning from the basics of sanitation like simple hand washing, we follow strict aseptic precautions while performing surgery or invasive procedures in patients. This also applies to cadavers, which may harbour a multitude of organisms like Mycobacterium tuberculosis, prions causing Creutzfeldt Jacob disease and Gertsmann Straussler Scheinker syndrome, even after embalming (1). There is no definitive evidence to show that HIV is inactivated after embalming (2, 3). Moreover, there is no system in practice to check the presence of these infections, either before or after the cadavers are embalmed. Against such a scenario, it is imperative that all persons handling cadavers follow universal precautions. However, in reality most students and teachers of anatomy in medical schools in India do not take even simple precautions, like wearing gloves while dissecting cadavers. Students who want to wear gloves are sometimes prevented from doing so by senior faculty members who believe that students will be able to appreciate the feel of the various tissues and organs better with bare hands. There is no rationale to their point of view because, as surgeons, these students will feel the same structures in live individuals in the operating theatre, only with gloved hands. So they’re actually supposed to know how structures feel to gloved hands, not to bare hands.
The principles of universal precautions will be hammered into young brains only if they are made to follow them in every invasive endeavour. Not only do gloves help in warding off infections, they also protect the skin from the irritant effects of formalin used to preserve cadavers.
It’s even more disheartening to know that the instruments used by these students are never sterilised. They are simply washed with water at the end of each session. As students are handling sharp instruments for the first time, they are more prone to cuts and bruises. There is also a high probability of these medical students being infected by highly pathogenic organisms. Adding to the problem, there is not even a steam steriliser or an autoclave in most of the departments of anatomy in medical colleges in India, to sterilise the instruments used during dissection. Even the regulatory body which approves the establishment of medical colleges in India does not make it mandatory to have these simple instruments in departments of anatomy (4).
In western countries, these precautionary measures are mandatory for everyone performing a cadaver dissection. So a basic tenet of ethics, justice, is violated by us. Moreover, as bare hand dissection of cadavers is hazardous, the second basic principle of ethics, beneficence and non maleficence, is clearly violated. Even if some students bring their own pair of gloves, preventing them from wearing them violates the third basic principle, autonomy. So it is very unsafe and unethical to allow – and sometimes force – students to dissect cadavers with bare hands. It is time that we realise this and start practising universal precautions during cadaver dissection. The regulatory bodies should also modify their regulations to include sterilisation equipment as a basic necessity in the departments of anatomy of medical colleges in India.
N Isai Vani, Department of Anatomy, Sri Venkateshwaraa Medical College and Research Institute, Ariyur, Pondicherry 605 102 INDIA e-mail: [email protected]
- Demiryürek D, Bayramo_lu A, Ustaçelebi S. Infective agents in fixed human cadavers: a brief review and suggested guidelines. Anat Rec. 2002 Aug 15;269:194-7.
- De Craemer D. Postmortem viability of human immunodeficiency virus – implications for the teaching of anatomy. N Engl J Med. 1994 Nov; 331:1315.
- Healing TD, Hoffman PN, Young SE. Commun Dis Rep CDR Rev. 1995 Apr 28;5:R61-8.
- Medical Council of India. Essential requirement for college/course: Minimum requirements for 150 admissions [Internet]. New Delhi: [updated 2009 Dec 3; cited 2009 Dec 5]. Available from: http://mciindia.org/helpdesk/how_to_start/STANDARD%20FOR%20150.pdf.