Historical Context

The practice of post mortem dissections and the retention of organs was commonplace in the medical profession and dates back to the 13th and 14th centuries. However, it wasn't until the Renaissance period that physicians began to notably dissect and retain specimens, to further their understanding of anatomy and infectious disease. Doctors and surgeons had been removing body parts after death for museums, pathological/anatomical specimens, research and teaching. It became a standard for medical students to dissect bodies whilst studying, often requiring several bodies over their course (Rodgers, 2003). Until the Burke and Hare and Alder Hey scandals respectively, moral and ethical values of students or practising physicians were rarely scrutinised or questioned, as the acts of these physicians were considered mainstream (Rodgers, 2003). It was the great demand for anatomical specimens and bodies that drove the medical profession to retain bodies and organs of the deceased without consent.

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Although it was the Ancient Egyptians that went to great lengths to preserve remains of their dead and mummify the bodies of the deceased, cutting open bodies and dissecting out organs as part of their religious practices, it was the Ancient Greeks that pursued dissection for scientific purposes (MacDonald, 2005). Restricted by the values and beliefs that Christianity imposed on them, physiologists such as Erasistratus and Herophilus were the first to anatomically explore the human body in search of scientific explanation of the function of the human body (Adler,2004). 

However, it wasn't until Renaissance times that dissecting the human body was emphasised in medical training and education. Until this time, dissection was perceived by learned doctors as the work of a butcher; lowering their prestige as educated professors of the time. Vesalius, as well as many other students would have to raid the gallows and jails of Paris in order to find skeletons and bodies that were half decomposed in order to dissect and extend their learning. Sometimes they would have to even steal cadavers of executed criminals that were disintegrating after they were hung (MacDonald, 2005). Suddenly, studying the human body became reliant on accurate scientific method, with dissection informing theories. Indeed, it was King Henry VIII who recognised this driving demand for cadavers to dissect, and so ruled that criminals could be dissected post mortem, as a punishment for their crimes, to further aid anatomists (Hall, 2001). 

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In the 1800s, the increased demand for cadavers resulted in a shortage of bodies available for dissection, with the rise in demand attracting professors and students to more criminal activity (Hall, 2001). It was Burke and Hare who took what was termed “bodysnatching” to a new level, committing a series of murders in order to sell the corpses to Dr Robert Knox, an anatomy lecturer, who would use the bodies for demonstrations and dissections to educate his pupils (Rodgers, 2003). As legal supply of cadavers diminished and the number of executions reduced, this illegal activity of 'body snatching' increased, with criminals selling murder victims to anatomists to be used in dissection. What followed was immense public outrage and fear of the illegal trade, resulting in the legislation of the Anatomy Act 1832. In an attempt to limit criminal dealings and acts, the legislation gave licence to physicians and lecturers for anatomical dissections and demonstrations (MacDonald, 2005). This gave them legal access to bodies that were unclaimed following death and allowed people to donate their corpses to anatomical teachings, effectively ending the activity of “resurectionists” (Rodgers, 2003).

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The medical profession tried to justify their actions during the time of Burke and Hare and during the Alder Hey scandal by remarkably similar methods (Rodgers, 2003).

As stated above the practice of post mortem dissections and retention of organs was commonplace for centuries. Doctors and surgeons had been removing body parts after death for museums, pathological/anatomical specimens, research and teaching. It became a rite of passage for medical students to dissect bodies whilst studying, often requiring several bodies over their course (Hall, 2001. This demand for anatomical specimens and bodies is what drove the medical profession to retain bodies and organs of the deceased without consent. The ends justified the means, was the idea followed by Van Velzen and his staff; it was in everyone's best interests (Riddell, 2001).

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In the Alder Hey scandal the doctors also argued that they didn't wish to cause any more undue grief to the parents and families of the deceased children; they wanted to protect them from the truth. This paternalistic approach could have been a disguise for self-interest of the profession, a cover to obtain more organs. It was no excuse for failing to comply with the law (Redfern et al., 2001).

The justification based on the need for specimens was coupled with a plea of ignorance about the law; doctors of both times said they did not realise what they were doing was illegal, believing that because it was a commonplace ritual throughout the world that it was acceptable (Hall, 2001). During Alder Hey they also argued that the law was confusing and ambiguous with several acts barely covering the issue; how could they be expected to understand it all especially when it was never taught or explained to them. They worked in blissful ignorance (Redfern et al., 2001).

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Alder Hey, like the Burke and Hare case, created a large degree of public outrage. The actions of all those involved were deemed unlawful and extremely unethical. As the ‘victims’ of the Alder Hey scandal were all children this only amplified the public’s outcry, the children were seen as innocents who were violated by the insensitive perpetrators in the medical profession (Redfern et al., 2001). Whilst this scandal differs from Burke and Hare were the victims were killed, the acts carried out by the doctors were portrayed and viewed as criminal by the media and public, thus the children were ‘victims’ too (Rodgers, 2003).

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The outrage that occurred prior to the exposuree of the retention of organs at Alder Hey shows how much symbolic investment we put into bodies and organs, and the disgust that is felt when they are removed without permission, even after death. Since it was largely the hearts of the children that were removed this only worsened the situation, due to the ideas and emotions that are attached to it: “It didn't seem right a heart belonging to my child could be part of a collection like butterflies, or insects, something to be visited and looked at.”(BBC NEWS, 2001).

The public outcry coupled with the Royal Liverpool Children's Inquiry report drove the creation of the Anatomy Act 2004 (Human Tissue Authority, 2009), which replaced the out-dated and confusing Human Tissue Act 1961, the Anatomy Act 1984 and the Human Organ Transplants Act 1989. Unfortunately it took many years after the Burke and Hare horror and another scandal at Alder Hey to finally get the laws changed to make it clear to all medical practitioners; informed consent is required to remove bodily organs. This act would likely not have been created had the scandal not happened in London and been taken up by the media, anywhere else and it may not have created the outrage required for the creation of the Anatomy Act 2004.

Post mortems have been valuable throughout history and still are today, they provide information on cause of death –confirming diagnoses, useful for research, finding other information that could be relevant to the family –like genetic disease, and for teaching (Burton and Wells, 2002). But as shown without proper regulation and education; retention of organs and body snatching lead to scandals that can damage the medical profession and cause great distress amongst loved ones. Hopefully history does not repeat itself and another scandal does not occur in another hundred years.

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