The oldest medical science is also the darkest art. But if those desperate for knowledge had not pursued the science of anatomy, progress towards life-saving modern medicine would have stumbled and stalled. It is a discipline born of brutality and violence, simultaneously repugnant and fascinating, and requiring a detachment that borders on the macabre.

Centuries after Leonardo da Vinci produced his anatomical drawings after systematically dismembering 30 human corpses, the practice of dissection was used to deny the poor and unfortunate graves, and to punish hardened criminals, who were literally hung, drawn and quartered.

By the 1700s, surgeons were named as grave robbers and there was deep suspicion that agents were being paid to obtain bodies for the burgeoning medical specialty.

From the earliest times, and from cradle to grave, our bodies have been commodities, to be bought and sold in the name of science. Even now, when the Human Tissue Act bans the sale or buying of bodies, body parts or tissue, organisations such as universities make money from the use of donated cadavers.

It is not the bodies that are traded - instead large organisations pay good money to access these bodies in the name of science; to demonstrate a new medical device they have created and to upgrade the skills of surgeons.

What is missing from this cold, commercial transaction is an intimate understanding of what drives a person to decide to donate their body to science.

"It is a desire to assist or to alleviate other people's suffering," says Thomas Faunce, a senior lecturer in law and medicine at the Australian National University. "A lot of people have benefited from medical science and feel they want to give something back; it is part of this ethos that medicine is a noble profession striving to make the world a better place."

And in light of this week's allegations of sexual mistreatment of cadavers and mislabelled bodies at the University of NSW surgical skills laboratory, there are concerns that the small number who do enter into this ultimate contract upon their death will be deterred. "It is a contract that the institution has formed with the relatives to look after and respect both the wishes of the person who has donated, but also the memories associated with the living," Faunce says.

He questions whether the lack of a cash value on donated bodies leads to a certain disrespect in our deeply consumerist society: "Is there a culture of disrespect for death and how does the consumer society regard a dead body? Because this body can no longer purchase things or worry about a mortgage, is this something that we can just disregard?"

The attempt to protect the sanctity and dignity of a body by saying it cannot be bought and sold, while allowing large corporations to profit from that altruistic donation, has also drawn criticism, and Faunce has called for a rethink on the guidelines covering body bequests.

"If you told a family, 'This body will be used by corporations to push their new products, these people are going to make a lot of money', surely that family could question what they might get from this."

The controversy surrounding the University of NSW and its handling of allegations relating to its anatomy lab have shaken staff at the surgical training centre and donors' families.

The idea that bodies and body parts could be placed in the wrong coffins is haunting relatives.

Paul McNeill, an associate professor at the Centre for Values, Ethics, Law and Medicine at the University of Sydney, believes the University of NSW could have disclosed more to the families affected. "Like any institution opening itself to public criticism, it has been slow to respond and may not have responded effectively. The Protected Disclosures Act obliges them to disclose more than they did … to the families and, given the gravity of the issues, it was in the public interest to do so."

Like many who work in this area, McNeill mentions "dark humour" and says there is a tendency for people who are working with bodies to be desensitised to the often gruesome nature of their work.

"They may not perhaps give the same significance to the treatment of the bodies that they did when they first started, and obviously they may not give the same importance to it as a family member might. We do become desensitised to the gruesome things we deal with. That is a human tendency."

But that does not mean it is impossible to manage that desensitisation and maintain respect and dignity for the bodies people work on as part of their job, he says.

"The obligation on staff is to work against that tendency - [they should] develop policies, procedures and systems to manage it, which require regular and constant review.

"Most people do try and maintain their respect, but we all know about the kind of black humour that people use as a tool to deal with the nature of their work."

Faunce also mentions humour as a defence against the nature of the science of anatomy. "There is a lot of it in medical schools - you can rationalise that because there is a stress release to it," he says. "Young, immature people are often very confronted by dead bodies … I did 12 years in intensive care and you cannot survive in a workplace with stress like that unless you have periodic humour. It is about choosing the right time and place and understanding the parameters."

Leo Brown is the body bequest program manager in the school of biomedical sciences at the University of Queensland. In his 20-plus years in the job he has spoken to hundreds of families and to those who made the decision to donate their bodies to the university. "They want to be satisfied that their body will be used in a respectful and dignified manner, and for the benefit of the students," Brown says.

"Often a prospective donor wants to donate their body to medical science in the hope that their medical condition will provide some training to students, and maybe find some solutions to their particular disease."

Yet mostly bodies are used to teach the basic foundations of anatomy - to students of medicine, physiotherapy, occupational therapy, science and other fields requiring an understanding of the workings of the human body. "It comes across to me very strongly that people want to give something back to the community," Brown says. "There is also a small number of people who see it as a way of lessening the financial burden on the family by avoiding the cost of a burial."

The University of Queensland receives between 80 and 90 bodies each year. They are kept for two years. "We send a body out in a coffin, transported by a funeral director - it goes to one of our recognised crematoriums, where the body is cremated individually and the ashes returned to the family."

On rare occasions, the family is unable to cope with the idea that their loved one's body has not been laid to rest. At those times, Brown simply releases the body early for cremation.

In preparation for a donation, he counsels the family on the need to mark the death of their loved one - a full funeral or memorial service without the body or something simple such as a quiet family gathering.

"People need to have that release," he says.

A key part of the anatomy program is to help students learn to cope with what is a confronting part of their study - dealing with cadavers, and their experiences of death.

"Whilst they are dealing with body parts they still need to focus on the real reason they are there … to learn anatomy," Brown says. "We impress upon them that the cadavers and body parts they are using have been consciously donated by someone who has made an effort while they are alive to organise this."

The University of Queensland runs a "thanksgiving service" for students, former students, families and friends of donors, as well as representatives from government and the community. Up to 800 people attend that service every year.

"We give thanks and public recognition to the people who donated their bodies," Brown says. "Families can say to the students: 'At least we know it's been worthwhile.' It gets very emotional for both the families and the students."

TIME OF TRAUMA

The shock and violence of a car accident, the suddenness of a severe brain injury. These are hardly the times when the best decisions are made. Yet for people who have chosen to donate their organs to save another life, that may be when their loved ones must face the ultimate reality.

"People often say to us that they want some good to come out of a tragic situation," says Carrie Alvaro, the state donor co-ordinator at the Australian Red Cross. "If families have had a prior discussion then it is a much easier decision; when they haven't it is so much more difficult."

Only 1 per cent of people die in such a way that organ donation is possible, she says.

Last year 732 Australians received a life- saving organ transplant, from 202 donors.

Alvaro commits to families and donors that they will be treated with respect and dignity. Bereavement support is provided. "You are not just cut up and forgotten about."

One of the fears potential donors express is that they will be used for research rather than to save a life, or that their body will be misused. Not so, Alvaro says.

"We are heavily regulated by the Human Tissue Act, which doesn't allow us to store anything without explicit permission from the families - anything that we do retain for the purposes of transplantation is explained to the family."

The article above was found on Google and was published originally on Sydney Morning Herald