Ética do uso de cadáveres humanos para ensino de anatomia: Uma abordagem histórica, teórica e legal.
DOI:
https://doi.org/10.60104/revhugv13236Keywords:
Bioethics, Anatomy, Dissection, History of Medicine, TeachingAbstract
The teaching of anatomy through the dissection of human cadavers was, for centuries, the fundamental pedagogical basis for the training of doctors and other health professionals. However, despite the practice following the history of medicine since its beginnings, until the present moment there is no adequate focus on the ethical aspects related to the performance of this procedure in the training of physicians. Such issues are complex and involve from obtaining the corpse, its preservation method, daily handling and subsequent proper disposal. However, the central ethical question to be debated is whether the person whose body will be a source for activities has given consent to do so. The present work aims to carry out a brief review of the history of human dissection, the ethical principles surrounding the subject, its potential conflicts and legal aspects on the use of cadavers for the training of health professionals.
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Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anatomy & Cell Biology. 2015;48(3):153. https://doi.org/10.5115/acb.2015.48.3.153
Ghosh SK. The practice of ethics in the context of human dissection: Setting standards for future physicians. Annals of Anatomy - Anatomischer Anzeiger.2020;232:151577. https://doi.org/10.1016%2Fj.aanat.2020.151577
Papa V, Varotto E, Vaccarezza M, et al. The teaching of anatomy throughout the centuries: From Herophilus to plastination and beyond. Medicina Historica. 2019;3(2):69–77. ISSN 2532-2370
Evans DJR, Bay BH, Wilson TD, et al. Going Virtual to Support Anatomy Education: A STOPGAP in the Midst of the Covid-19 Pandemic. Anatomical Sciences Education. 2020;13(3):279–83. https://doi.org/10.1002/ase.1963
Ghosh SK. Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. Anatomical Sciences Education. 2017;10(3):286–99. https://doi.org/10.1002/ase.1649
Ghosh SK. Paying respect to human cadavers: We owe this to the first teacher in anatomy. Annals of Anatomy. 2017;211:129–34. https://doi.org/10.1016/j.aanat.2017.02.004
de Melo EN, Pinheiro JT. Procedimentos legais e protocolos para utilização de cadáveres no ensino de anatomia em Pernambuco. Revista Brasileira de Educação Médica. 2010;34(2):315–23. https://doi.org/10.1590/S0100-55022010000200018
Morar S, Perju-Dumbravǎ D, Cristian A. Ethical and legal aspects of the use of the dead human body for teaching and scientific purposes. Revista Romana de Bioetica. 2008;6(4):65–83. https://doi.org/10.1590/1983-80422020283420
Cordeiro RG, Menezes RF. A Falta de Cadáveres para Ensino e Pesquisa. Revista Brasileira de Educação Médica. 2019;43(1 suppl 1):579–87. https://doi.org/10.1590/1981-5271v43suplemento1-20190217
Habbal O. The science of anatomy: A historical timeline. Sultan Qaboos University Medical Journal. 2017;17(1):e18–22. https://doi.org/10.18295/squmj.2016.17.01.004
Hershkovitz I. Trephination: the Earliest Case in the Middle East. Mitekufat Haeven. 1987;20(January):128–35. https://www.jstor.org/stable/23373189
Von Staden H. The discovery of the body: Human dissection and its cultural contexts in ancient Greece. Yale Journal of Biology and Medicine. 1992;65(3):223–41. PMID: 1285450
Mavrodi A, Paraskevas G. Mondino de Luzzi: A luminous figure in the darkness of the middle ages. Croatian Medical Journal. 2014;55(1):50–3. https://doi.org/10.3325%2Fcmj.2014.55.50
Rengachary SS, Colen C, Dass K, et al. Development of anatomic science in the late middle ages: The roles played by Mondino de Liuzzi and Guido da Vigevano. Neurosurgery. 2009;65(4):787–93. https://doi.org/10.1227/01.neu.0000324991.45949.e4
McLachlan JC, Patten D. Anatomy teaching: Ghosts of the past, present and future. Medical Education. 2006;40(3):243–53. https://doi.org/10.1111/j.1365-2929.2006.02401.x
Hildebrandt S. Capital punishment and anatomy: History and ethics of an ongoing association. Clinical Anatomy. 2008;21(1):5–14. https://doi.org/10.1002/ca.20571
Humphries E. Murder, mortsafes and Moir: A medical student looks at anatomy teaching in Aberdeen. Journal of the Royal College of Physicians of Edinburgh. 2014;44(1):67–71. https://doi.org/10.4997/jrcpe.2014.116
Halperin EC. The poor, the black, and the marginalized as the source of cadavers in United States anatomical education. Clinical Anatomy. 2007;20(5):489–95. https://doi.org/10.1002/ca.20445
Kaiser S. Tradition or change? Sources of body procurement for the anatomical institute of the university of cologne in the third reich. Journal of Anatomy. 2013;223(4):410–8. https://doi.org/10.1111/joa.12084
Redies C, Viebig M, Zimmermann S, et al. Origin of corpses received by the Anatomical Institute at the University Of Jena during the Nazi regime. Anatomical Record - Part B New Anatomist. 2005;285(1):6–10. https://doi.org/10.1002/ar.b.20068
Hulkower R. From Sacrilege to Privilege: The Tale of Body Procurement for Anatomical Dissection in the United States. Einstein Journal of Biology and Medicine. 2016;27(1):23. http://dx.doi.org/10.23861/EJBM20112734
Humphrey DC. Dissection and discrimination: the social origins of cadavers in America, 1760-1915. Bulletin of the New York Academy of Medicine: Journal of Urban Health. 1973;49(9):819–25. PMID: 4582559
Tward AD, Patterson HA. From Grave Robbing to Gifting: Cadaver Supply in the United States. Journal of the American Medical Association. 2002;287(9):1178. http://dx.doi.org/10.1001/jama.287.9.1183-JMS0306-6-1
Dalley AF, Driscoll RE, Settles HE. The uniform anatomical gift act: What every clinical anatomist should know. Clinical Anatomy. 1993;6(4):247–54. https://doi.org/10.1002/ca.980060409
Garment A, Lederer S, Rogers N, Boult L. Let the dead teach the living: The rise of body bequeathal in 20th-century America. Academic Medicine. 2007;82(10):1000–5. https://doi.org/10.1097/acm.0b013e318149e986
Abreu JLN. Os estudos anatômicos e cirúrgicos na medicina portuguesa do século XVIII. Revista da SBHC. 2007;5(2):149–72. http://www.sbhc.org.br/resources/download/1320064407_ARQUIVO_artigos_3.pdf
Aires Neto J. O Ensino da Anatomia no Brasil. Revista Brasileira de Estudos Pedagógicos. 1948;12(33):78–94. https://doi.org/10.24109/2176-6681.rbep.12i33
Araújo C da S. Fatos e personagens da história da medicina e da farmácia no Brasil. Revista Continente. 1979;1:32. https://minerva.ufrj.br/F/?func=direct&doc_number=000113723&local_base=UFR01
Talamoni ACB, Bertolli Filho C. A anatomia e o ensino de anatomia no Brasil: A escola boveriana. História, Ciências, Saúde – Manguinhos. 2014;21(4):1301–22. https://doi.org/10.1590/S0104-597020140
Torres Homem JV. Utilidade das cadeiras criadas em 1854 nas faculdades de medicina. Gazeta Médica do Rio de Janeiro. 1862;10(5):51–2. http://memoria.bn.br/DocReader/809411/59
Brasil. Lei Federal no 8.501 de 30 de novembro de 1992. Dispõe sobre a utilização de cadáver não reclamado, para fins de estudo ou pesquisas científicas e dá outras providências. 1992. https://legis.senado.leg.br/norma/550377
Brasil. Lei Federal No 10.406 de 10 de janeiro de 2002. Institui o Código Civil. Diário Oficial da União: Brasília, 11 jan 2002; 2002. https://www2.camara.leg.br/legin/fed/lei/2002/lei-10406-10-janeiro-2002-432893-publicacaooriginal-1-pl.html
Vicente B dos S, de Queiroga DA, da Silva KT, et al. Aspectos éticos e legais da utilização de cadáveres com fins de ensino na extensão. Centro de Ciências da Saúde, 2013. http://www.prac.ufpb.br/enex/trabalhos/4CCSDMPROBEX2013422.pdf
Winkelmann A. Consent and consensus-ethical perspectives on obtaining bodies for anatomical dissection. Clinical Anatomy. 2016;29(1):70–7. https://doi.org/10.1002/ca.22651
Kant I, Gregor MJ. Groundwork of the metaphysics of morals. New York: Cambridge University Press; 1998. 76 p. ISBN: 978-1-107-00851-9
Carlson RV, Boyd KM, Webb DJ. The revision of the Declaration of Helsinki: past, present and future. Br J Clin Pharmacol. junho de 2004;57(6):695–713. https://doi.org/10.1111%2Fj.1365-2125.2004.02103.x
Benhabib S. Situating the self—Gender, community and post- modernism in contemporary ethics. Cambridge: Polity Press; 1992. https://doi.org/10.2307/2941083
Habernas J. Diskursethik. Frankfurt/Main: Suhrkamp; 2009. ISBN: 978-3-518-58528-3
Gauthier D. Morals by Agreement. Oxford: Clarendon Press; 1986. https://doi.org/10.2307/2220134
Vallentyne P. Contractarianism and rational choice: essays on David Gauthier’s Morals by agreement. New York: Cambridge University Press; 1991. https://doi.org/10.2307/1964371
Jones DG, Whitaker MI. Anatomy’s use of unclaimed bodies. Clinical Anatomy. 2012;25(2):246–54. https://doi.org/10.1002/ca.21223
Attfield R. Ethics: An Overview. A&C Black; 2012. 282 p. ISBN: 9781441182050
MacKay D. Opt-out and consent. Journal of Medical Ethics. 2015;41(10):832–5. https://doi.org/10.1136/medethics-2015-102775
da Silva EV, Aversi-Ferreira TA, da Rocha AO, Leite KJN de S, Faria AB, da Silva ADD, et al. Body Donation Programs in Brazil / Programas De Doação De Corpos No Brasil. Brazilian Journal of Development. 2020;6(12):101260–71. https://doi.org/10.34117/bjdv6n12-572
Jones DG. Searching for good practice recommendations on body donation across diverse cultures. Clinical anatomy. 2016;29(1):55–9. https://doi.org/10.1002/ca.22648
Nie J, Jones D. Confucian Ethics on the Commercial Use of Human Bodies and Body Parts: Yi (Righteousness) or/and Li (Profit)? Anatomical sciences education. 2019;12(4):444–53. https://doi.org/10.1002/ase.1876
Wainman BC, Cornwall J. Body Donation after Medically Assisted Death: An Emerging Consideration for Donor Programs. Anatomical Sciences Education. 2019;12(4):417–24. https://doi.org/10.1002/ase.1874
Balta J, Cronin M, Cryan JF, O’Mahony SM. Human preservation techniques in anatomy: A 21st century medical education perspective. Clinical anatomy. 2015;28(6):725–34. https://doi.org/10.1002/ca.22585
Hayashi S, Naito M, Kawata S, Qu N, Hatayama N, Hirai S, et al. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anatomical science international. 2016;91(1):1–7. https://doi.org/10.1007/s12565-015-0299-5
Ghosh SK, Sharma S. Cadaveric preservation under adverse climatic conditions. Surgical and Radiologic Anatomy. 2015;37(10):1287–8. https://doi.org/10.1007/s00276-015-1505-9
Mason JK, Laurie GT. Consent or Property? Dealing with the Body and its Parts in the Shadow of Bristol and Alder Hey. The Modern Law Review. 2001;64(5):710–29. https://doi.org/10.1111/1468-2230.00347
Riederer BM, McHanwell S, Brenner E, et al. The legal and ethical framework governing Body Donation in Europe - A review of current practice and recommendations for good practice. European Journal of Anatomy. 2008;12(1):1–24. ISSN: 1136-4890
Richardson R, Hurwitz B. Donors’ attitudes towards body donation for dissection. The Lancet. 1995;346(8970):277–9. https://doi.org/10.1016/s0140-6736(95)92166-4
Lala M. Cadaveric Oath And Its Relevance In Anatomy. International Journal Of Advances In Case Reports. 2016;3(6):282–5. ISSN 2349-8005
Sharadkumar PS, Shaheen R. Cadaveric Oath and Its Relevance for Students of Anatomy. Indian Journal of Anatomy. 2016;5(2):189–93. http://dx.doi.org/10.21088/ija.2320.0022.5216.15
Gregory JK, Lachman N, Camp CL, Chen LP, Pawlina W. Restructuring a basic science course for core competencies: an example from anatomy teaching. Medical teacher. 2009;31(9):855–61. https://doi.org/10.1080/01421590903183795
Prakash, Prabhu LV, Rai R, D’Costa S, Jiji PJ, Singh G. Cadavers as teachers in medical education: knowledge is the ultimate gift of body donors. Singapore Med J. 2007;48(3):186–9. PMID: 17344998
Jones D, King M. Maintaining the anonymity of cadavers in medical education: Historic relic or educational and ethical necessity? Anatomical sciences education. 2017;10(1):87–97. https://doi.org/10.1002/ase.1618
Riederer BM, Bueno-López JL. Anatomy, respect for the body and body donation - a guide for good practice. Eur J Anat. 2014;361–8. http://www.eurjanat.com/data/pdf/eja.140189br.pdf
Tschernig T, Schlaud M, Pabst R. Emotional reactions of medical students to dissecting human bodies: A conceptual approach and its evaluation. The Anatomical Record. 2000;261(1):11–3. https://doi.org/10.1002/(sici)1097-0185(20000215)261:1%3C11::aid-ar4%3E3.0.co;2-k
Quiñonero F, Mesas C, Doello K, Láinez-Ramos-Bossini AJ, Perazzoli G. Learning anatomy through dissection: emotional influence on the first-year medical student: a systematic review. Eur J Anat. 2023;643–9. https://doi.org/10.52083/OSUR2683
Romo-Barrientos C, Criado-Álvarez JJ, González-González J, Ubeda-Bañon I, Flores-Cuadrado A, Saiz-Sánchez D, et al. Anxiety levels among health sciences students during their first visit to the dissection room. BMC Med Educ. 2020;20(1):109. https://doi.org/10.1186/s12909-020-02027-2
Chiou RJ, Tsai PF, Han DY. Impacts of a gross anatomy laboratory course on medical students’ emotional reactions in Taiwan: the role of high-level emotions. BMC Med Educ. 2021;21(1):489. https://doi.org/10.1186/s12909-021-02923-1
Lucas B de L, Rocha AO da. Análise de lacunas e perspectivas sobre programas de doação de corpos: relato de experiência no Brasil. Rev bras educ med. 2023;47:e102. https://doi.org/10.1590/1981-5271v47.3-2022-0375
Prohmann LAV, Figueiredo RR, Mendes VS, Carvalho MBB de, Almeida FS de, Gama Filho OP. Perspectivas de uma comunidade universitária acerca da doação de corpos para estudo em anatomia humana. Rev bras educ med. 2023;47:e038. https://doi.org/10.1590/1981-5271v47.1-20220309
Ghosh SK, Chakraborty S. Voluntary body donation in India: perceptions of first year medical students. Investigación en educación médica. 2018;7(27):61–71. https://doi.org/10.22201/facmed.20075057e.2018.27.1741
Brasil. Lei Federal No 6.105 de 31 de dezembro de 1973. Dispõe sobre os registros públicos, e dá outras providências. Diário Oficial da União: Brasília, 31 dez 1973; 1973.
Vieira PR. A Utilização do Cadáver para Fins de Estudo e Pesquisa Científica no Brasil. Rev bras educ med. 2021;25:60–3. https://doi.org/10.1590/1981-5271v25.2-008
Distrito Federal (Brasil). Portaria Pró-Vida/MPDFT no 1 de 23/06/2010. Atualiza o protocolo para destinação e utilização de cadáveres e de partes do corpo humano para o ensino e a pesquisa científica. Brasília, DF: MPDFT; 2010. https://www.normasbrasil.com.br/norma/portaria-1-2010_220263.html
Doação de cadáveres para ciência: entenda lei que facilita processo e evita falta de corpos nas universidades [Internet]. G1. 2023. https://g1.globo.com/df/distrito-federal/noticia/2023/07/06/doacao-de-cadaveres-para-ciencia-entenda-lei-que-facilita-processo-e-evita-falta-de-corpos-nas-universidades.ghtml