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Canada For anatomy labs in search of cadavers, assisted-dying law brings scheduled arrivals, and ethical complications

Dr. Bruce Wainman poses alongside students as he leads a lesson on renal and reproductive anatomy on a cadaver in his lab at the McMaster University Health Sciences Centre in Hamilton, April 5, 2019. From left, students Tanya Hodkinson Kierra McDougall, Rachel Harding, Neda Pirouzmand, and Justin Lu.

Cole Burston/The Globe and Mail

In the normal course of his work as director of an anatomy lab, Bruce Wainman can’t predict when a new body might arrive for his students to dissect.

Most registered body donors are years away from their own demise. They have no idea – and neither does Dr. Wainman, of course – when the end will come, or whether a traumatic death or infectious disease will disqualify them from an afterlife in the anatomy lab.

So it was a major departure the first time that Dr. Wainman, director of the Education Program in Anatomy at McMaster University in Hamilton, received word – before the patient had died – that the body of a medical-aid-in-dying recipient would be rolling into his lab.

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“We had zero direction on this,” Dr. Wainman said. “There’s absolutely nothing in law talking about the acquisition of bodies after medical assistance in dying.”

In a paper published this month in the journal Anatomical Sciences Education, Dr. Wainman and a New Zealand colleague are now looking to fill that chasm in knowledge – one brought on by the fact that Canada’s nearly three-year-old federal assisted-dying law is something of a double-edged scalpel for anatomy programs.

The law opens up an important new source of good-quality cadavers, but it also raises delicate questions about how anatomy programs should deal with grievously ill patients and families who contact them about body donation while they are exploring the option of a physician-assisted death.

“We spend a lot of time telling people – and we certainly believe it – that donating your body for education and research purposes is a noble, altruistic and good act,” Dr. Wainman said. “We want to make sure that these vulnerable people who are trying to decide whether their life is worth living, that we’re not providing them with some reason to end their life.”

A line of work stations are seen in Dr. Bruce Wainman's anatomy lab at the McMaster University Health Sciences Centre in Hamilton, April 5, 2019.

Cole Burston/The Globe and Mail

Students pick out cadavers to study at Dr. Bruce Wainman's anatomy lab at the McMaster University Health Sciences Centre in Hamilton, April 5, 2019.

Cole Burston/The Globe and Mail

Canada’s assisted-dying law does have checks in place to ensure the gravely sick are not unduly influenced: Two physicians have to independently approve patients for the procedure, which is restricted to people with a grievous and irremediable illness who are suffering intolerably and whose natural deaths are reasonably foreseeable.

But as long as patients meet the eligibility criteria, the choice is ultimately theirs – and Dr. Wainman does not want such patients swayed by the possibility of bolstering medical research after they die.

McMaster has received six whole-body donations from people who underwent an assisted death since Canada’s law took effect in June, 2016.

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Some other universities report similar figures: The University of Alberta has accepted seven such donations; the University of Calgary has accepted five; and Queen’s University in Kingston has accepted an estimated four or five, but can’t say for certain because the school’s anatomy program does not always know whether a death was doctor-assisted.

At the University of Saskatchewan, one request from a medical-aid-in-dying recipient was reviewed and approved by the school’s legal office, but in the end the potential donor decided against the bequeathal.

We spend a lot of time telling people – and we certainly believe it – that donating your body for education and research purposes is a noble, altruistic and good act. We want to make sure that these vulnerable people who are trying to decide whether their life is worth living, that we’re not providing them with some reason to end their life.”

— Dr. Bruce Wainman, director of the Education Program in Anatomy at McMaster University

Others, including the University of Western Ontario in London and the University of Toronto, have accepted bodies from donors who ended their lives with the help of a physician, but those schools have not tracked the numbers.

Dr. Wainman found that next to nothing had been written about the frequency and ethics of body donation after medical-aid-in-dying when he set out to explore the issue in his paper.

One of the trickiest things about drafting the article, he said, was acknowledging the fact that physician-assisted death is a new source of comparatively high-quality bodies for teaching the next generation of doctors, surgeons, midwives, physiotherapists, chiropractors and other health professionals.

Such bodies tend not to be as emaciated as those of people who allow a terminal illness run its course.

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Dr. Wainman and his co-author, Jon Cornwall, a medical ethicist from the University of Otago in New Zealand, are urging their global professional body, the International Federation of Associations of Anatomists, or IFAA, to draft official guidance before moral quandaries inevitably arise.

Andreas Winkelmann, an anatomy professor at the Brandenburg Medical School in Germany and chair of the IFAA’s ethics and humanities committee, said it is paramount that anatomists are not seen to be benefiting from anyone dying of something other than a natural cause, which is why it would be unethical to accept the bodies of murder victims or executed prisoners.

“The difference with [medical-aid-in-dying] is obviously that people die according to their wishes, not against their wishes,” Dr. Winkelmann said by e-mail. “I see the problem that anatomists may be perceived as benefiting from a procedure that is at least controversial in some communities and certainly not accepted practice around the world … consent must remain entirely free.”

Debbie Adkinson says she is confident that her younger sister, Sheila Adkinson, got exactly what she wanted when she choose to donate her body to McMaster after receiving an assisted death at the age of 56 last July.

A trainer of champion Airedale Terriers, Sheila was diagnosed in 2016 with cervical cancer that later spread to her lungs, liver and bones.

Once Sheila had decided to receive an assisted death at the Beamsville, Ont., country home that she and her sister shared with their five dogs, Debbie had less than a week to help Sheila fulfill her final wish for body donation.

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“She wanted somebody to learn something,” from her death, Debbie said.

Although the arrangements are in many ways similar to body donations after unexpected deaths, Maureen Letang, the bequeathal co-ordinator at McMaster, said medical-aid-in-dying cases have required some extra support for families.

“It’s definitely surreal,” she said. In one case, Ms. Letang called to speak to the husband of a woman who was scheduled to die less than two hours later. The wife picked up the phone herself.

In Sheila’s case, her body has been used primarily to teach future vascular surgeons how to repair blood vessels, Dr. Wainman said.

When students have learned all they can from Sheila’s body, Debbie will receive a call from the university asking her what she would like to do with her sister’s remains.

Debbie has already decided that she will find a place on her acreage in Beamsville, which is near Niagara Falls, to inter Sheila’s ashes alongside those of the beloved dogs that predeceased her.

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“Some place there, under a tree, I will bury them all.”

A cadaver sits under lights in Dr. Bruce Wainman's anatomy lab at the McMaster University Health Sciences Centre in Hamilton, April 5, 2019.

Cole Burston/The Globe and Mail

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