In my next look at minor issues surrounding independence, I take a look at the cheerful subject of laws and regulations governing anatomy and use of human body parts in science and medicine.
The History of Grave-robbing
Dissection was once considered a “punishment after death” and usually the fate that awaited executed criminals. However, as medical science matured, and subjects like anatomy became more important in teaching future doctors, supply of cadavers was outstripped by demand.
As the system was completely unregulated, fresh corpses were dug out from their graves and sold on the open market. Grave-robbing became so prevalent that some cemeteries had watchtowers, and although it was illegal, it wasn’t considered serious enough to warrant a prison sentence.
The public revulsion prompted the UK Parliament to pass the Anatomy Act 1832 which, for the first time, introduced a licensing system for anatomy teachers and specifically stated that dissection could only proceed with the permission of the deceased’s relatives, or where bodies have gone unclaimed. It also created the government-appointed Inspectors of Anatomy.
The trouble was that instead of the bodies coming exclusively from prisons, they came from workhouses as well, and the offer by anatomy schools to cover the costs of burial ensured a disproportionate burden on the poor. The subsequent protests and rioting resulted in anatomy demonstrations moving behind closed doors.
The Anatomy Act 1984 updated the original Act’s provisions and ensured only the deceased can donate their body to medical science willfully while they’re alive, in addition to placing greater restrictions on who can or can’t carry out an anatomical examination.
The Human Tissues Act & Human Tissues Authority
The most recent changes to laws governing anatomy were, again, the result of scandal.
In something that reads like a bad horror story, a pathologist at Liverpool’s Alder Hey Children’s Hospital illegally and unethically retained the organs and body parts of up to 850 children in the late 1980s and early 1990s. It was also revealed that Alder Hey and Birmingham Children’s hospitals passed over thymus glands from living patients to private companies for research, while more than 100,000 organs were retained by English hospitals.
As a result of the scandal, the Anatomy Act 1984 was itself repealed and superseded by the Human Tissues Act 2004. This ensured only informed consent would be given to body or organ donation, made it a criminal offence to sell body parts, and also created a quango – the Human Tissue Authority (HTA) – to deal with all issues relating to anatomy in England, Wales and Northern Ireland.
Scotland passed a similar law in 2006, but instead of creating a quango, they left the regulatory responsibility to government ministers and an Inspector of Anatomy.
Based in London, and with around 48 members of staff in 2014-15, the HTA issues guidance and codes of practice for use of human tissues. They also issue licences and collect fees. In 2014-15 these fees ranged from £1,500 a year for public display, £2,150 for anatomy teaching institutes and £5,100 for mortuaries – with various sub-charges.
In 2014-15 (pdf), the HTA raised £3.63million and spent £4.15million. £115,000 of that income came directly from the Northern Irish and Welsh Governments, with the vast bulk of the rest coming from fees.
The Human Tissues Act has been modified in Wales following the Human Transplantation Act 2013 which, as you’ll probably all be aware, created an “opt-out” organ donation system.
It’s unclear whether powers over anatomy teaching, anatomical gifts or anatomical displays extend to Wales, but as they’re not included as reserved powers in the draft Wales Bill, they might be.
Your Corpse & Independence
Wales only has one university that still uses cadavers for anatomy teaching – Cardiff University. As far as I know, Swansea’s graduate medical school uses computer modelling and prostheses. Medical science donations from north Wales usually go to Liverpool University and I presume in central Wales they’ll go to Keele and Birmingham universities.
The provisions of the Human Tissues Act aren’t necessarily restricted to medical schools because it covers all issues relating to human tissues – so that includes undertakers, blood and organ donation authorities etc. I don’t think the spirit of the Act needs to be changed in Wales, just the specifics of how it’s applied.
Because of the smaller population, smaller case load and smaller regulatory burden, Wales could follow Scotland’s lead and leave the responsibility for regulating human tissues, organ donation, anatomical displays and anatomy teaching to the relevant government minister. Any regulations would be approved and debated by the legislature.
So the Human Tissue Authority in Wales would be scrapped and replaced with a government-appointed Inspector of Anatomy, whose office would probably be part of Public Health Wales.
Ideally, all science donations from within Wales would stay in Wales, but that might not always be practical because of geography or personal wishes. To deal with cross-border issues – like the Liverpool example above – any medical establishment based outside Wales looking to use Welsh cadavers or organs for research would at the very least require some sort of written permission from the relevant government minister.
Any attempt to create a “trade” in cadavers or organs would be repugnant and wholly unethical, so the wishes of the donor should be paramount in any and all cases.
The consent conditions don’t need to change, but I don’t know whether donations of individual organs or tissue samples (rather than whole bodies) to science should be as easy as carrying a donor card – for example, we’re going to need more brain tissue for research into diseases like dementia, Parkinson’s and Alzheimer’s in the near future. None of this would be possible without the generosity of those who leave anatomical gifts.
As licence fees would be raised by the government, and there wouldn’t be a quango with almost 50 staff to pay for, it could work out to be a cost neutral move.