Artigo de revisão
IMPRISIONED BODIES AND A FREE LEGACY: THE USE OF PRISIONERS’ BODIES IN MEDICAL EDUCATION
Como citar: Souza PHRD, Mochiuti CF, Angelis MAD, Junior AA, Junior OP, Silva RND. Corpos aprisionados e um legado livre: a utilização de corpos de prisioneiros no ensino médico. Persp Med Legal Pericia Med. Vol. 10, 2025; 250308
https://dx.doi.org/10.47005/250308Aceito em 04/09/2025
The authors report no conflict of interest.
IMPRISIONED BODIES AND A FREE LEGACY: THE USE OF PRISIONERS’ BODIES IN MEDICAL EDUCATION
Resumo
INTRODUÇÃO: É crucial discutir os valores éticos e morais envolvidos na utilização de corpos de prisioneiros no ensino médico. OBJETIVO: Apresentar uma análise comparativa dos aspectos éticos, culturais, religiosos e legais relacionadas à doação de corpos de prisioneiros para o ensino de anatomia. METODOLOGIA: Foi realizada uma revisão da literatura composta estudos selecionados nas bases de dados, os quais apresentaram conexão entre a doação de corpos e prisioneiros. RESULTADOS: Na Coreia do Sul, utilizavam corpos de prisioneiros para a formação de estudantes, mas a questão ética no país foi um empecilho, pois os doadores deixaram de doar seus corpos com medo de serem confundidos com prisioneiros. Nos Estados Unidos, a utilização desses corpos é regulamentada por leis estaduais e políticas de instituições penitenciárias. Na China, corpos de prisioneiros eram utilizados sem a autorização de parentes ou das próprias vítimas. Na Turquia, o principal meio para conseguir cadáveres é utilizar corpos de prisioneiros e de indigentes, sendo eticamente questionado pela população mais pobre. Com a abolição da pena de morte, houve queda no recebimento dos corpos pelas instituições de ensino. CONCLUSÕES: Embora alguns países tenham utilizado corpos de prisioneiros para fins educacionais, a evolução das normas tem diminuído essa prática. A promulgação de leis exemplifica a transição para a doação voluntária, que atende às demandas éticas e legais. Contudo, o número de corpos doados é insuficiente para atender às necessidades acadêmicas, tornando-se urgente a retomada de discussões para suprir as demandas científicas e garantir o respeito aos direitos humanos.
Palavras Chave: doação, corpos, prisioneiros, medicina legal, ética, legislação.
Abstract
INTRODUCTION: It is crucial to discuss the ethical and moral values involved in the use of prisoners' bodies in medical education. OBJECTIVE: To present a comparative analysis of the ethical, cultural, religious, and legal aspects related to the donation of prisoners' bodies for anatomy education. METHODOLOGY: A literature review was conducted using selected studies from databases that presented a connection between body donation and prisoners. RESULTS: In South Korea, prisoners' bodies were used for student training, but ethical issues in the country were a hindrance, as donors stopped donating their bodies for fear of being mistaken for prisoners. In the United States, the use of these bodies is regulated by state laws and prison institution policies. In China, prisoners' bodies were used without the authorization of relatives or the victims themselves. In Turkey, the main way to obtain cadavers is by using prisoners' and indigents' bodies, which is ethically questioned by the poorer population. With the abolition of the death penalty, the number of bodies received by educational institutions decreased. CONCLUSIONS: Although some countries have used prisoners' bodies for educational purposes, the evolution of regulations has reduced this practice. The enactment of laws exemplifies the shift towards voluntary donation, which meets ethical and legal demands. However, the number of donated bodies is insufficient to meet academic needs, making it urgent to resume discussions to meet scientific demands while ensuring respect for human rights.
Keywords (MeSH): donation, bodies, prisoners, forensic medicine, ethic, law.
1. INTRODUCTION
The dissection of bodies for scientific study dates back to periods before it was institutionalized in contemporary universities. Several studies have highlighted the importance of using bodies in medical education and the training of other health professionals (1,2,3,4).
For direct observation of the human body, post-mortem dissection provides advanced anatomical and surgical learning and the refinement of complex techniques. This traditional method has been fundamental to the progress of medicine, offering a detailed understanding of human anatomy, essential for surgical practice and other medical specialties, as well as being crucial for the development of scientific research (5).
Analyzing the use of prisoners’ bodies for teaching and research is a complex and controversial issue. There are various discussions on this issue, which raise doubts about the procedures, methods and legal processes adopted. In addition, it is of the utmost importance to discuss the ethical and moral values involved, promoting an in-depth debate to contribute to the creation of new laws regulating this practice.
This study presents a comparative analysis of policies related to the donation of prisoners’ bodies, with an emphasis on ethical, cultural, religious and legal aspects.
2. METHODOLOGY
This study was conducted by means of a punctual review of the literature, with the aim of gathering and synthesizing evidence on the use of prisoners’ bodies in medical education, considering ethical, cultural, religious and legal aspects.
The PubMed, LILACS and Scielo databases were used to search for the articles. The main search terms were “body donation” and “prisoners”. In order to refine the search, we included terms such as “ethics” and “legislation”.
The inclusion criteria for the selection of studies were to present a connection between body donation, prisoners and medical education, in addition to addressing the ethical, cultural, religious or legal repercussions related to this practice. Articles that did not directly address the use of prisoners’ bodies in medical education were excluded.
After applying the inclusion and exclusion criteria, a total of 27 studies were selected for final analysis. The selection process involved reading the titles and abstracts of the articles. The full texts of the studies considered relevant were then assessed to ensure the quality and consistency of the data. The selected studies were then analyzed in terms of geographical and historical context, ethical and legal approaches, and sociocultural implications of the practice.
The analysis was carried out in a comparative way according to the policies and practices related to the use of prisoners’ bodies. The cases of South Korea, the United States, China and Turkey were analyzed, since these countries have relevant historical records and distinct practices on the subject.
Each context was explored in order to highlight how cultural and religious factors, and the development of ethical norms have influenced the acceptance or rejection of the use of prisoners’ bodies for teaching and research.
3. RESULTS
The first historical records come from ancient Greece, more specifically in Alexandria, during the 3rd century BC (6,7). At that time, the Greek medical school used the dissection of cadavers as the main teaching method in anatomy classes. Herophilus of Chalcedon and Erasistratus of Ceos were the pioneers, conducting classes and dissecting human cadavers in the first half of the third century BC (7). Studies indicate that cultural, religious and psychological factors prevented the spread of this practice during antiquity, resulting in the interruption of studies after the death of Herophilus and Erasistratus (8).
During the Renaissance in Europe, studies on body dissection resumed (9). The creation of universities in Paris, Bologna, Oxford, Montpellier and Padua, together with the legalization of dissections by the Church for specific purposes, made it possible for these studies to resurface (9,10). The eagerness for knowledge, a defining characteristic of the period, also permeated the medical field (11,12). In 1315, at the University of Bologna, the first official human dissection since Ancient Greece was recorded. Mondino de Liuzzi, considered the “restorer of anatomy”, was responsible for this dissection, using the body of an executed individual (12). Over the years, Europe became the center of advances in anatomical studies, thanks to the use of the bodies of executed criminals (12).
However, it was observed that execution no longer had the same legal and ethical principles. Noting that the use of the bodies of executed prisoners influenced the time and manner of the execution, in order to preserve the body for dissection (13).
Countries such as France, the United States (US) and England have used deceased bodies of executed criminals for educational and scientific purposes (14,15,16). However, the enactment of the Anatomy Act of 1832 marked a paradigm shift in obtaining human cadavers for anatomical dissection. Instead of using the bodies of executed criminals, the law allowed body donations (17). This change was necessary due to the scarcity of criminal bodies to meet the medical and scientific demands of the time and the associated ethical and legal challenges (18). In places where the use of criminal bodies was permitted, there were legal abuses to obtain more bodies for medical schools and dissection became synonymous with the death penalty, used as a means of punishment and intimidation (17,18,19).
In South Korea, prisoners’ bodies were used to train students at universities. However, before the rise of Christianity, ethical concerns in the country posed an obstacle, as many potential donors refrained from donating their bodies out of fear of being mistaken for prisoners, who constituted the majority of bodies used for study. From a cultural point of view, Confucianism was against this program, claiming that it was an “objectification of the body”, but with the popularization of Christianity, this thinking was replaced by a feeling of altruism and helping others (20).
In China, for many decades, prisoners’ bodies were used without the authorization of relatives or the victims themselves, especially for organ donation. An attempt was made to create a bill which, as of 2015, stated that prisoners would no longer be viable sources for such acts, however, after the deadline, the subject was not mentioned again (21).
In Turkey, there is a legal means for body donation, but no research has mentioned the existence of a law on the subject. The main means of obtaining corpses is to use the bodies of both prisoners and the indigent, which is ethically questioned by the country’s poorer population. As well as religion being against body donation, socio-economic status, age and schooling are aspects that interfere with the number of donors (22,23).
The United States is currently the only country that legally accepts prisoners being used in scientific research and in a body donation program. Historically, with the formation of the first medical schools, the country needed deceased bodies for anatomy classes and medical teaching. Following a course very similar to European countries, in 1790 the United States enacted a federal law that gave judges legal permission to add dissection to a death sentence for prisoners convicted of murder (24).
A study involving 21 prison institutions analyzed the lack of data available on post-mortem donations, pointing to the urgent need for bodies such as the United Network for Organ Sharing to develop clear guidelines preventing the exploitation of these prisoners (24).
Another point observed was that, in order to meet the demand for human bodies, states began to increase the number of crimes punishable by execution and, consequently, the availability of bodies for dissection (25).
Therefore, the legalization and adoption of the practice of using prisoners as a source for body donation places prison institutions on a fine line between fulfilling their social role and transgressing their right as an institution to repress the freedom of those who are judged guilty (13).
In this context, Arthur Caplan (2011), professor of bioethics at the Grossman School of Medicine at New York University in the United States, has argued that prisoners cannot give truly free consent because of the imposing environment that prisons create. Prison is responsible for compromising the autonomy of such a decision, which makes any consent ethically dubious (24).
This type of reasoning helps us to understand that the prisoner, from the moment they are incarcerated, is no longer the owner of their freedom and has no real autonomy to make decisions. It was based on thoughts like these those countries like South Korea and China began to ban these measures (26).
4. DISCUSSION
Based on these descriptions, the policies related to the donation of prisoners’ bodies reveal a multifaceted panorama, marked by ethical, cultural, religious and legal issues.
Although countries such as South Korea, China and Turkey have used prisoners’ bodies for educational purposes, the evolution of norms has gradually reduced this practice (20,21,23).
The enactment of laws, such as the Anatomy Act of 1832 in England, exemplifies the transition from a reliance on prisoner bodies to a system based on the voluntary donation of bodies. This model responds to ethical and legal demands and promotes a spirit of altruism and social solidarity (20,21,22,23,24).
In the case of the United States, a possible legalization of the use of prisoners as a source of body donation, in the current scenario, in which there are no clear rules and each state adopts its own measures, could generate ethical and moral problems (27). On the other hand, it is laws that ensure human rights and allow for a prosperous future for the evolution of teaching and research with cadaveric specimens.
The need for body donation increases daily and the current collection programs are unable to meet the demand from academics. In this scenario of scarcity, it is necessary for organizations and countries to resume studies into the possibility of using the bodies of prisoners, especially for medical teaching.
5. CONCLUSION
Forensic medicine can contribute to the creation of new laws regulating the use of prisoners’ bodies for teaching and research, meeting the need for medical courses and ensuring respect for human rights.
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