Questions for Dr. Mary Faith Marshall

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Durring the month of July, 2006, Dr. Mary Faith Marshall answered questions about body donation and bioethics.

Your Comments, Thoughts, Questions, Ideas

Anonymous's picture
Anonymous says:

I would like to know why it is that some people would prefer not to have bones donated to them by us Native Americans.

posted on Fri, 07/07/2006 - 10:15am
Mary Faith Marshall's picture
Mary Faith Marshall says:

Do you mean bones for museums or bones for individual persons?

I know that because repatriation of American Indian remains back to their tribes and burial grounds is important for many American Indians, museums may be reluctant to acquire new specimens since they would not want to offend individuals or tribes, or go through the process of repatriating something that they just acquired.

Does that answer your question? If not, please let me know, and I'll try again. Thanks for asking! Mary Faith

posted on Mon, 07/10/2006 - 3:47pm
Anonymous's picture
Anonymous says:

you were on the committee that helped bring BODYWORLDS to the museum. What kinds of things were you asked to consider?

posted on Sat, 07/08/2006 - 8:41am
Mary Faith Marshall's picture
Mary Faith Marshall says:

We considered a number of things; ethical issues primarily. Informed consent to donation was probably the biggest question that we had.

We wanted to know the provenance of the bodies and body parts. We wanted to be assured that the bodies were from individuals who had given primary, informed consent to donation; that they had specifically donated their bodies for display in this particular exhibit. That there was no undue influence or coercion.

We also talked about cost of the exhibit, and the need to make it available to all of the citizens who wanted to see it, even if they couldn't afford it, so that there should be a sliding scale price for tickets, or some mechanism to allow all who wanted to to attend the exhibit.

We talked about the appropriate age for attendees (children); those attended by adults, etc.

We talked about placement of the pregnant woman and her fetus in the exhibit area, and the desire not to offend anyone attending the exhibit.

Those are some of the main issues that came up. Thanks for asking! Mary Faith

posted on Mon, 07/10/2006 - 3:54pm
Anonymous's picture
Anonymous says:

I know that Body Worlds utilizes a body donation program, but what are your thoughts on similar exhibitions that use unclaimed bodies? Wouldn't these bodies be donated for medical schools anyway?

posted on Sun, 07/09/2006 - 10:41pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

I have a real problem with the use of unclaimed bodies in such exhibitions. There should be primary (ie by the person himself or herself) informed consent specifically giving permission for one's body to be used in a public exhibition.

Most bodies in medical schools in the United States come from willed body programs. People donate their bodies prospectively for use in medical education and research.

There are so many uncertaintees with unclaimed bodies (where did they come from, how did they die, why haven't they been claimed) that I feel we owe it to our society to treat those persons' remains with dignity, and not presume that those individuals would have wanted their cadavers to wind up in a public exhibition.

Thanks for your question! Mary Faith

posted on Mon, 07/10/2006 - 4:00pm
Anonymous's picture
Anonymous says:

What about the fetuses in the exhibition - how does concent work for them?

posted on Sun, 07/09/2006 - 10:42pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Good question!

My understanding is that the pregnant woman in the exhibit consented to the use of her body and that of her fetus, and that her husband consented as well. So, for the fetus, there was proxy, or surrogate consent just as we use for health decisions with infants or those who are not capable of making their own decisions.

Apparently, in some of the other exhibitions, the fetuses have been obtained from medical museums that were letting go of part of their collections.

Thanks for asking! Mary Faith

posted on Mon, 07/10/2006 - 4:04pm
Anonymous's picture
Anonymous says:

Do you think it would be ethical to receive an organ or tissue transplant, or to benefit from the knowledge gained from cadaver research, if you're not willing to donate yourself?

posted on Sun, 07/09/2006 - 10:44pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Good question, and I understand where you're coming from!

I do think that it would be ethical to receive an organ or tissue transplant, or to benefit from medical knowledge gained from cadaver research even if you, yourself, aren't willing to donate.

The reason is that the moral framework for the donation of an organ (or cadaver) from one person to another that of the "donation" as a gift. And true gifts come without caveats or restrictions.

Another consideration is that people have all sorts of reasons for not donating; some of them are belief or value-based, some based on physical condition or constraints, some based on psychological issues.

The fairness doctrine that governs how we allocate scarce organs first takes into account who needs the organ the most (ie who is the sickest). Secondly, there must be a chance for a succesful tranplant, otherwise the organ should go to someone else who needs it. So, whether you have donated an organ in the past, or not, is not a criterion that is used to select recipients.

posted on Mon, 07/10/2006 - 3:42pm
Anonymous's picture
Anonymous says:

Why are "opt-in" donation programs (i.e. you tell your family and health care providers that you want to donate) considered more ethical than "opt-out" programs (i.e. it's assumed that you want to donate unless you specifically tell someone that you don't)?

posted on Sun, 07/09/2006 - 10:44pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Opt-in programs are not necessarily more ethical than opt-out programs, but they do reflect the values of the country/community. Here in the United States we prize individual autonomy very highly. Individual rights are important to us, more so than in other countries where the good of the community may come first and the good of the individual second. Thus, the notion of "presumed consent" to organ donation feels a little foreign to us. We would rather err on the side of making sure that organ donation is what an individual really wanted than take organs from someone who may not have wanted to donate and simply never got around to opting-out.

Secondly, we don't want to alienate family members or the general public with bad feelings about organ donation. So, even if I have filled out documentation to donate my organs for transplant or my body for medical education, if, after I die, my family is opposed to that idea, then an organ procurement program will not take the organs. The idea here is that maintaining good public relations will ultimately result in more people being willing to donate organs, thus more organs available for transplant/medical education in the long run.

Good question! Thanks for asking. Mary Faith

posted on Thu, 07/20/2006 - 3:37pm
Anonymous's picture
Anonymous says:

Is the display of the mummy in the museum different than the display of the bodies in Body Worlds since the remains of the mummy are those of an unknown person, long dead and from another culture?

posted on Sun, 07/09/2006 - 10:45pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Great question. I would say that the answer hinges on informed consent. We presume that the people whose bodies are on display in BodyWorlds gave informed consent to have their bodies plastinated and displayed in public for education/artistic purposes.

The person whose mummified remains are on display in a museum most likely never even conceived of being on public display, and certainly never consented to it. You could say the same thing about the sources of some of the organs/fetuses on display in the BodyWorlds exhibit. Some of these specimens were acquired from medical museums - and thus are older specimens for which (we presume) there was not informed consent for their use for education or display.

Here are several other thoughts about your question. First, we sometimes know who the mummified individual was (especially if he/she was a king/queen, etc). So they aren't always anonymous. Because their culture was obviously very different than ours, they probably never comtemplated being on public display after they were dead, but presumed that their remains would stay where they were buried or housed.

So, an important question is whether we, as another culture in another time, are entitled to remove remains from their resting place and display them in public. This has been controversial depending on the country/society from which those remains originated.

There are some American Indian tribes, for example, for whom repatriation of bodies/body parts from museums back to their original burial grounds is extremely important.

So the ultimate answer to your question is, "it depends."

Thanks for asking! Mary Faith

posted on Thu, 07/20/2006 - 3:55pm
Anonymous's picture
Anonymous says:

Does an artistic presentation of plastinated specimens necessarily constitute a violation of human (not singular, but plural) dignity? Yes, the donors consented, but what about the voyeurism of the viewers?

posted on Sun, 07/09/2006 - 10:46pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

I've thought long and hard about the answer to this one. I think it depends on your individual perspective. There are some, for example, Aaron Ginsberg, a BodyWorlds protester in Boston, who has said, "The fact that people have donated their bodies is irrelevant. They have surrendered their right to privacy, but it is not in their power to surrender their right to dignity. It is incumbent on us the living to treat the dead with dignity no matter what the 'subjects' may have intended or authorized."

I personally, do not have any problem with the human body being used for artistic puposes IF the individual himself or herself gave informed consent. I think that there are parts of the BodyWorlds exhibit that are primarily artistic, not educational, and that this is not inherently bad, as long as the donor was OK with it.

The issue of the voyeurism (or motives) of the viewers is an interesing one. Let me ask, for example, whether you or others you know would be as interested in seeing the exhibit if the platinates were made wholly out of plastic - but looked just the same -- and were not human cadavers at all? I think part of people's fascination with the exhibit is that these are real human cadavers. And I don't think that that is necessarily a bad thing at all.

If you read the public comments books at the exhibit, you'll find a wide range of reactions. Some feel that parts of the show lack taste or dignity, others are in absolute awe of what they've seen and learned.

Great question! Thanks a lot, Mary Faith

posted on Thu, 07/20/2006 - 4:11pm
Anonymous's picture
Anonymous says:

why won't you donate your boby to the exhibit?

posted on Mon, 07/10/2006 - 9:52am
Mary Faith Marshall's picture
Mary Faith Marshall says:

I would have no problem donating my body to the exhibit. However, I would rather, if possible, donate my organs for transplantation to someone who needs them. So, this is just an issue of what you see as most important. I think that educating the public about anatomy and psysiology is a wonderful thing. But I would rather have my body/organs go to a live human who needs them. Make sense? Thanks for asking!

posted on Wed, 08/02/2006 - 2:34pm
Dan's picture
Dan says:

Dr. Marshall, I noticed you mentioned in a previous statement that you considered what ages would be appropriate. I wonder, why did the museum decide to make the exhibit open to all ages?

posted on Tue, 07/11/2006 - 9:19pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Well, there IS the caveat of parental permission/being part of a school exhibition (otherwise there is an age limit). The thinking was that parents know their children best and have their best interests at heart. And that they are best positioned to know how their children might react to the exhibit, what they want them to learn, etc.

Thanks for asking! Mary Faith

posted on Thu, 07/20/2006 - 4:15pm
Anonymous's picture
Anonymous says:

i was wondering. . . i have donor on my drivers licence. i heard that if you are almost dead, but not quite they sometimes dont try to save you because someone else needs a body part of theirs. is that true. . . could that really happen?

posted on Wed, 07/12/2006 - 10:32am
Mary Faith Marshall's picture
Mary Faith Marshall says:

Boy am I glad you asked that question! The answer is ABSOLUTELY NOT!!!!!

First, physicians and other clinicians have their own patient's best interest at heart, so they are not going to stop treating him/her simply to benefit someone else. Doesn't matter whether you are rich or poor, etc., etc. those caregivers are going to take care of you - that's their reason for choosing that profession.

Second, the process (at least in the United States and most of the world) involves a separation of procedures, so that the folks involved in asking for organ donation, and in harvesting organs are not in any way involved in the care of the patient who is a potential donor.

The organ procurement professionals (the folks who ask the family for permission to harvest organs, and who organize the harvesting and transfer of the organs) are people who are trained specifically for the job they do, and do it full time.

Finally, from a pragmatic standpoint, there are too many people involved in the care of a dying or critically ill patient for something shady to happen.

That said, there are countries in the world (China, Brazil) where there is a black market in organs, and where prisoners and other disadvantaged folks have even been killed for their organs. China just this week passed a law outlawing the commercial sale of organs; hope it works!

We're lucky to live in this country, in that respect.

Hope that answers you question, and thanks for asking! Mary Faith

posted on Thu, 07/20/2006 - 4:28pm
Jake Ilika's picture
Jake Ilika says:

I am curious if the families of the specimens know of their decision to donate, and if they are aware, if they would be able to recognize them (their deceased loved one). Could this harm loved one's psychological health?

Thank you

Jake

posted on Sun, 07/16/2006 - 4:57pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

Jake, great question!! Some family members know; some members of the same family have even made plans to donate. My understanding is that donors bear the expense of having their dead bodies transported to the plastination facilities. So generally, the family knows. I'm sure, however, that this is not always the case. Some of the plastinates, for example, are cadavers provided by the German state (unclaimed bodies). So, it may be possible for someone who is unprepared to come across a family member or acquaintence who is displayed as a plastinate at the exhibit.

It could be possible, depending on the way the body is displayed, to recognize the person who donated. I think the chances of this are fairly slim given the degree of dissection that has taken place.

Could it by psychologically damaging to see a plastinated loved one? Sure, possibly, for several reasons. First, the fact that your loved one is on display in a public venue could be troublesome. Second, even if you had no problem with the idea of your loved one being displayed, seeing him/her in plastinated form could be shocking or traumatic. Think about how hard it is for some to see their dead loved ones at the funeral home, for example. And third, if you were opposed to the idea of your loved one donating his/her body to the exhibit, but they did so over your objections, it might be especially disturbing - even if you never were to see the exhibit, you would know that your loved one's body is on display. Thanks, Jake!

posted on Wed, 08/02/2006 - 2:54pm
Body Blunder's picture
Body Blunder says:

What's bioethics?

posted on Wed, 07/19/2006 - 11:42am
Mary Faith Marshall's picture
Mary Faith Marshall says:

Bioethics is a field of study that deals with ethical issues in health and the life sciences. So, for example, it includes clinical ethics, which involves ethical issues in patient care (like forgoing life-sustaining treatment or privacy and confidentiality ), research ethcis, which includes ethical issues that arise in research with humans and animals, and environmental ethics, which raise questions about what we owe to the environment, to other species, and to our progeny. These are just some examples. Bioethics is a broad and multidisciplinary field. If you'd like to know more about it, you could contact us at the Center for Bioethics at the University of Minnesota; we'd love to hear from you! (612-624-9440).

posted on Wed, 08/02/2006 - 3:02pm
Anonymous's picture
Anonymous says:

Do you know what will happen to the bodies when the exhibit is over. will they be burried, or cremated or put into a more permanent exhibit?

posted on Sun, 07/23/2006 - 1:06pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

I do not know what happens to the bodies for certain, but I surmise that they will not be buried or cremated for several reasons. Once the bodies are plastinated, they do not decompose like normal cadavers. My understanding is that Gunther Von Hagens has plans for a permanent display at a "Museum About the Body." The plastination process is expensive and time-consuming, so he is going to want to hold on to the plastinates that he has.

The display is subject to the burial laws of Baden Wurttemberg, Germany where the German plastination facility is located. Because the plastinates are not "corpses" in the traditional sense of the term, they have been determined not to need burial or cremation.

Thanks for asking! Mary Faith

posted on Wed, 08/02/2006 - 3:26pm
Anonymous's picture
Anonymous says:

What do you think of the policy Body Worlds has on not identifying the donors or their cause of death?

posted on Sun, 07/23/2006 - 3:51pm
Mary Faith Marshall's picture
Mary Faith Marshall says:

I guess I'm of two minds on this. I would really love to see the informed consent documents for each cadaver/plastinate displayed beside the body or organ so that the informed consent process is as transparent and open to scrutiny as possible.

However, privacy is important, too, and the viewers have no legitimate need to know who the donors/cadavers/plastinates were.

Knowing cause of death would be really interesting to some of us, so I'd be in favor of knowing that. It would also further the end of ensuring primary prosective informed consent from the donors.

Thanks for asking! Mary Faith

posted on Wed, 08/02/2006 - 3:15pm
Anonymous's picture
Anonymous says:

While I absolutely agree with the comments about consent, I wonder about the issue of public display and lack of control of the visitor/viewer respect paid to the body/human which none of the donors seem to have been able to consent. It is the same visceral discomfort that I have with public display of "deformed bodies" from the circus past. It is the discomfort that I have with unconscious patients in a hospital getting visitors when they didn't know that they would be unable to communicate or respond for a long period of time.

posted on Wed, 08/02/2006 - 9:37pm
Cassandra Filler's picture
Cassandra Filler says:

Dear Ms. Marshall

On my drivers license it states that I am a donor but if my family is against it could they change it? Thank You.

Sincerly,

Cassie

posted on Sat, 08/05/2006 - 1:55pm
Anonymous's picture
Anonymous says:

How can ethical perspectives be based on individual perspectives yet have broad societal meaning?

posted on Sat, 08/05/2006 - 2:00pm