J Forensic Sci Educ 2022, 4(2) 2022 Journal Forensic Science Education Zangari Personal identification and ethical values Francesca Zangari, Forensic Odontologist, Ravenna, Italy, francescazangari65@gmail.com Abstract: In the biomedical context, the dead human body is an invaluable resource for research and teaching. In many if not most countries around the world, medical and dental students learn anatomy by dissecting a human body, and questions of ethics have become a focus of attention in many of them. The autopsy is another time when medical and dental students face a dead body, in diagnosing the cause of death and in personal identification procedures. Not everyone maintains that the rights of the personality also apply to the dead, some argue that a human corpse is a thing in the legal sense. The question is if and how you can harm a dead person. Especially in mass disasters, forensic pathologists and odontologists are mostly faced with remains that barely retain the appearance of a human body. These tragic events are aggravated by the need to act quickly in search of identities and trapped in repetitive and highly technical gestures, which risk cancelling the emotional component. A dignified handling of corpses should be central in daily practice of forensic medicine and forensic staff should always have in mind the ethical dimension of human corpses in spite of their regular confrontation with the dead. Key words autopsy, personal identification, human dignity, ethics for the dead, respect for the dead Commentary In the role of forensic dentist, I have asked myself several times if dignity extends not only to living persons but also to their dead bodies, and how to define what the dignity of a living person implies. In the biomedical context, the dead human body is an invaluable resource for research and teaching. Since 1220 in Montpellier, the human cadaver dissection had been used for the teaching of anatomy. Vesalius, a student in Montpellier then in Italy, wrote the first book on human anatomy (1). The Italian interest in anatomy and physiology originates in the fourteenth and sixteenth centuries with the cadaveric dissections and studies conducted by Mondino de Liuzzi, Leonardo da Vinci and Giovan Battista Morgagni (2). While time spent on anatomical education in medical school curricula has been diminishing over the last decades, the recognized role of anatomical dissection has expanded. It is not only a mean of learning the structure and function of the human body, but also an opportunity for the acquisition of professional competencies such as team work, patient–doctor interaction, medical epistemology, self-awareness and an understanding of medical ethics (3-11). One of the objectives of modern medical education is to empower medical students to become humanistic clinicians. Human anatomy plays a crucial role in this mission by using cadavers to cause reflections on death, dying, illness, and the role of medical practitioners in humanistic care. The gross anatomy course has a significant educational impact on medical students by consolidating their knowledge and skills on human bodies, internalising their attitude towards death and providing them the first opportunity to appreciate patients as whole persons. (12-15). In the anatomy laboratory students palpate, probe, cut, explore, discuss, and evaluate bodies, as they will do as doctors. The student-donor relationship can be considered a model for the clinician-patient relationship or as a way to learn professional detachment, but it’s noteworthy that it is not devoid of important ethical and emotional implications. (3,9,11,16) (FIGURE 1). FIGURE 1 Dead human body: a model for research and teaching. A great deal of literature emphasises the respect for the dead during personal identification practice. It doesn’t matter if you are in front of a body donor or an unclaimed The dead human body is an invaluable resource for research and teaching A model for the clinician-patient relationship A way to learn professional detachment First opportunity to appreciate patients as whole persons Student-donor relationship mailto:francescazangari65@gmail.com J Forensic Sci Educ 2022, 4(2) 2022 Journal Forensic Science Education Zangari body, all bodies should be treated with dignity and respect. However, even today there are those who consider the human corpse simply a thing in the legal sense (16-20). A complete autopsy is an external and internal examination of the body after death using surgical techniques. The primary purpose of an autopsy is to answer any questions the family or physician may have about the illness, cause of death, and/or any co-existing conditions. Establishing a cause of death can be a source of comfort to families. The question is if and how you can harm a dead person. The ethical relationship between human identification and corpses is realised in the awareness that the recognition of human rights also concerns the dead. And the dead have the right to have a name and an identity. First, a name and an identity will allow owned religious beliefs to be respected. In addition, identification allows surviving family members to complete the grieving process, to solve legal, business and personal affairs, and to continue with their lives (FIGURE 2). FIGURE 2 Flowchart showing the right to have an identity. Especially in mass disasters, both man- made and natural (i.e. earthquakes, hurricanes, typhoons, acts of terrorism, bombings, wars, motor vehicle and train accidents, aviation and navy disasters) forensic pathologists and odontologists are mostly faced with disfigured or mutilated bodies, with fragmented, co- mingled, burned or decomposed remains that barely retain the appearance of a human body. In these tragic events a race against time begins. These tragic events are burdened by the need to act quickly in search of survivors and identities of the remains. In this context, the forensic team finds themselves often trapped in mechanical, repetitive and highly technical gestures, which require concentration. These conditions, even if necessary, risk cancelling the profound meaning of their intervention and neglecting the emotional component. A dignified handling of corpses should be central in daily practice of forensic medicine. Thus, forensic staff should be trained and regularly retrained in the ethical dimension of human corpses in spite of their usual confrontation with the dead. It’d be helpful to take some time to stop and reflect on the significance of the remains, before starting autoptic and identification activities, and it’s strongly recommended to get the opportunity for periodic ethical education practices (FIGURE 3). FIGURE 3 Ethical dimensions of identification activities. We are in the era of virtual autopsy and a new approach to anatomy with computers is going to be used in the future among medical students (21,22). Virtual autopsy has advantages and disadvantages: the acquisition and storage of always available digital images versus the high cost of the technology; reduced infectious risk of the operator versus the lack of histopathological samples for toxicological and microbiological analysis (FIGURE 4). This kind of autopsy, compared to classical which can never be repeated, allows access to data from the corpse with a non-invasive or minimally invasive, non- destructive approach, allowing for better acceptance by certain religious or cultural communities, and certainly desirable in particular cases such as those involving children. Even if we take and manage only images, we should never forget that they belong to a person. In whatever way and by whatever means the examination is carried out, the approach to the human corpse, or to the fragments of what was once a human body, must always take place with a respectful attitude, bearing in mind that those human remains belong to an interrupted life, to a world of broken emotional ties. The dead have the right to have a name and an identity This will allow own religious beliefs to be respected This will allow surviving family members to complete the grieving process to solve legal, business and personal affairs to continue with their lives Take some time to stop and reflect on the significance of the remains Strongly recommended periodic ethical education practices A dignified handling of corpses is central in daily practice of forensic medicine J Forensic Sci Educ 2022, 4(2) 2022 Journal Forensic Science Education Zangari FIGURE 4 Virtual autopsy: advantages and disadvantages. 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