Many human remains were collected as relics for display but there is an equally strong tradition of using them in the education of health professionals. As a result, the use of human remains in teaching has long been associated with medical schools which use the dissection of human cadavers to teach anatomy (Flack & Nicholson, 2016). The value of the human body to educate fed a need for cadavers, which in the United States (Halperin, 2007) and the United Kingdom (Mitchell et al., 2011) resulted in grave robbing and a certain disregard for the dead themselves, often located in narratives about their worth, associating them with criminality, disease or being unwanted (unclaimed). It is now common for the use of cadavers to be tightly regulated and restricted to specialist settings, developments that have occurred alongside innovations that contest the need for human remains to teach anatomy.
The sourcing of skeletons for use in educational settings is particularly problematic as the removal of tissues from the bone is likely to limit the chances of identifying the donor. This indignity is exacerbated
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by the very deep and hidden nature of the human skeleton meaning that the body has to be subjected to destructive processes (natural or imposed) to uncover the bones themselves. For a long time, a trade in human bones and skeletons flourished from India where a law, passed in 1985, was believed to have resulted in a collapse in the international trade (Carney, 2007).
Despite these steps to address illicit trade in both cadavers and skeletons there is evidence that in some parts of the world a reliance on cadavers remains, to at least some degree, (Gangata, Ntaba, Klok & Louw, 2010) and that skeletons are still procured from India (Carney, 2007). Human remains have historically been procured during war (Aumüller & Grundmann, 2002) and continue to be so across the world (Gessat- Anstett & Dreyfus, 2015). In extreme cases, families have discovered that identifiable remains from loved- ones have been harvested and traded (Scheper-Hughes, 2006). The reduced demand for human remains for educational purposes has been supported by ethical considerations (as illustrated in the repatriation from museum collections) along with religious and cultural imperatives, at the same time as technological innovations, bringing the need for human remains in the teaching of anatomy into question.
The argument that human remains are essential for educating health professionals cannot prevail when it is not the norm (or even acceptable) in many parts of the world (McLachlan, Bligh, Bradley, & Searle, 2004). This is especially the case where religious beliefs and cultural practices make the use of human remains unacceptable (Biasutto et al., 2014; Riederer, 2016). The educational arguments for using human remains as teaching resources include the value of real tissue as opposed to substitutes, but this is not universally agreed. Estai and Bunt (2016) discuss ‘living anatomy’, which engages students with living bodies while ensuring the models have consented. The benefits include accurate textures and colours which are not present in cadavers.
The availability of electronic resources such as holograms (Rizzolo et al., 2006) and high-quality models (Zilverschoon, Vincken & Bleys, 2017) means that most students in the health professions do not need to come into contact with human remains in order to learn anatomy (McLachlan & Patten, 2006). A tension remains between the view that actual human remains are best for research and teaching and the availability of new technologies such as 3-D printing for synthetic copies of bones (Moxham & Plaisant, 2014). The use of human remains is appropriate in advanced medical dissection settings but unnecessary for the majority of undergraduate clinical programmes (Estai & Bunt, 2016). In fact, the argument that there is a need for specialist teaching to involve human remains has been used to defend questionable practices. In both Aotearoa New Zealand and the United Kingdom the practices of hospitals and medical museums holding human remains for educational purposes have come to light in recent ‘scandals’. Within the United Kingdom enquiries into the retention of human remains, which became synonymous with ‘Alder Hey’ and ‘Bristol hearts’ (Seale, Cavers & Dixon-Woods, 2006; Sheach Leith, 2007), raised issues of consent, while the ‘Greenlane Hearts’ story from Aotearoa New Zealand (NZ Press Association, 2010) caused considerable anguish, especially for tangata whenua. These ‘collections’ had begun decades earlier, when, it was argued, legislative contexts and clinical conventions did not prioritise consent. Cases were also made that the remains were ‘invaluable’ for the education of health professionals. However, these arguments, and others like them, ignore the humanness of the ‘donors’ and appear defensive as they assume consent would not have been given if it had been sought either by the donor or their next of kin.
In any situation in which human remains are still held and used, cultural and religious rituals should be incorporated into the teaching and learning journey. Universities in Aotearoa New Zealand have practices
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firmly in place (Kramer & Louw, 2017), including specific rituals such the lifting of tapu (Kaw, Jones & Zhang, 2016; Riederer, 2016) and Australian Universities are also considering the complexities involved in using human remains to teach anatomy (MacDonald, 2007). Key questions any institution must continually ask; relate to storage, display of (including images) and access to (including touch) (Cornwall, Callahan, & Wee, 2016; Kaw, Jones & Zhang, 2016; Jones, 2016) human remains. Within Aotearoa New Zealand, there is also a need for educators and students to have a sound appreciation of tapu, tikanga (cultural practices) and kaitiaki (guardianship).