| ‘Features of the retained organs controversy include the cynical exploitation of the grief of the bereaved, the cult of sentimentality attaching to the dead body, and widespread anxieties surrounding medical science.’ |
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'We buried a shell.' The major complaint of the relatives of those whose organs were retained in the course of autopsy is that this violation of the integrity of the corpse meant that they were unable to complete the process of mourning. In some cases, this could only be achieved when returned organs were interred together with the corpse (sometimes requiring two or three burial services). But why has the integrity of the body of the deceased become such a central feature of the mourning process?
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As I have argued in previous articles on the Bristol and Alder Hey controversies, a number of factors have contributed to the current furore over retained human body parts  . These include long-standing trends towards the fragmentation and secularisation of society, leading to increasing individuation in life and the 'sequestration of death'. The recent growth in the fetishism of the living body has intensified anxieties about the fate of the body after death.
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A new sentimentality about death - most potently expressed in the mourning for Princess Diana - finds a morbid focus on the body of the deceased. (This was confirmed by the recent flutter of controversy over photographs of the dying princess appearing on American television.) In a commentary on the Alder Hey scandal, the historian Ruth Richardson, one of the leading critics of the role of the medical profession over retained organs, notes that 'the body of a four-month-old baby is a very small and tender thing' .
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This sentimental formulation reflects a profound confusion. A living four-month-old baby is indeed a tender thing (whether very small or not). The dead body of a four-month-old baby may be small, even very small, but it is cold and hard, silent and unresponsive; to describe it as 'tender' is to attribute properties of the living person to the dead body. Richardson cites, disparagingly, the assertion of the eighteenth-century anatomist William Hunter that a 'necessary inhumanity' was required for the advance of medical science through the dissection of the human body (though the benefits to humanity of this work have been prodigious).
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It is a far greater inhumanity to reduce our distinctively human attributes to the form of a corpse. Yet a recognition of the radical distinction between the living and the dead body is not only a requirement for the 'clinical detachment' of the doctor or the medical scientist. It is also necessary to the process of mourning to recognise that, after death, the personhood of the deceased can no longer be located in their body. Whatever the religious faith of the bereaved, they have to come to terms with the fact that their loved one no longer inhabits his or her familiar physical form. Moreover, this is subject to decay and presents a problem of disposal.
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It is true, as Eva Hoffman argues in her reflection on the Holocaust, that 'the meaning of being human would be diminished if we could not hold those who have died in our minds, if we could not sustain a symbolic relationship to them' . Our difficulty of finding ways to sustain these relationships is likely to be compounded if we make the body of the deceased, rather than some symbolic representation, the central focus of any memorial ritual.
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In Victorian Britain the dead of the rich were accommodated to a much higher standard than the masses of the living poor. While the rich enjoyed extravagant funerals and newly landscaped graveyards, the poor at home and abroad were treated with little mercy, respect for the law or loyalty to high ideals, in life or in death (as the horror of the pauper funeral reflects). An excess of feeling for the dead of the wealthy coexisted with a callous disregard for the masses, whether alive or dead.
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It is worth emphasising that the obverse of Victorian sentimentality about death was a lack of feeling for the living, because that is also the consequence of the contemporary cult of the dead body. While politicians and anti-medical campaigners proclaim their commitment to respecting the dead and to compensating those who claim to be victims of the actions of doctors who, despite acting in good faith and within the law, retained organs at autopsy, living people continue to suffer from diseases that might be alleviated by transplants or by research on cadavers. Our current state of decadence is confirmed by the fact that some seek now to elevate the dead over the living.
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A further distinctive factor in the current retained organs controversy is the cynical exploitation of the grief of the bereaved, the cult of sentimentality attaching to the dead body and widespread anxieties surrounding medical science, promoted by populist politicians and so-called reformers and modernisers of the medical profession . Lawyers preying on the culture of compensation have encouraged claimants to pursue hitherto unrecognised grievances, which have been amplified and popularised by the media.
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What one commentator has described as the 'puzzlement and almost mute defencelessness of the British medical profession' in face of the resulting upsurge of anger and resentment has only encouraged the burgeoning forces of anti-medical and anti-scientific reaction and the general climate of irrationality around this issue . The retained organs commission, established by the government, gives institutional form to the prejudices unleashed by this furore, to the detriment of medicine, science, and to the families drawn into the degrading quest for compensation.
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Advocates of the new system point to a wider breakdown of trust in relations between doctors and patients and to a loss of public confidence in the medical profession and in its mechanisms of self-regulation. In fact, surveys reveal remarkably high levels of popular respect for the medical profession. The greatly exaggerated perception (among doctors) of their loss of prestige reflects the underlying force driving this process forward: the crisis of confidence of the medical profession itself. In invoking public demand for tighter regulation, the leaders of the medical profession have projected their own insecurities into society.
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To the extent that there is popular support for these measures, it has largely been fostered by leading medical figures in their responses to the 'body parts scandal'. The danger is that further regulation will exacerbate the medical profession's loss of confidence rather than alleviating it. This will degrade the profession as a whole and do further damage to the relationship between doctor and patient.
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Dr Michael Fitzpatrick is a London GP and author of The Tyranny of Health. His new book MMR and Autism is published by Routledge in June 2004. He is speaking at the Cheltenham Science Festival on Sunday 13 June.
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