Haunting Poverty: The Ethics of Cadaver Research and Economic Disparity
What does it mean when many of the cadavers used for biomedical research are the bodies of people who, when they were living, could never have afforded the treatments they helped develop?
In the throes of grieving a loved one, many families discover cadaver donation companies when they have to seek alternative ways to cover funeral expenses. Although for-profit whole body donation companies do not track the income or socioeconomic data of donors, public reviews online and my own experience working as a coordinator suggest that a large majority choose to donate their bodies to science out of economic desperation. Medicine’s long and storied history of disparity and racial inequality continues to be built upon the bodies of impoverished people who cannot afford many of the healthcare treatments in life that their corpses have helped to develop. The for-profit cadaver industry is a symptom illustrating how poverty and disparity of healthcare haunt so many Americans, even in death.
The ways in which biomedical research is conducted impact us all when treatments and procedures are based on inaccurate standards gathered from outlier data, predicated on the bodies of people who have survived poverty. Historically, this has been seen in “booze for ooze” blood donation programs as detailed in a 1972 Congressional hearing about health insurance, or the conception of hysteria as a diagnosis and “wandering wombs” being excised with hysterectomies. It is the ignored legacy of Henrietta Lacks and medical experiments performed on the bodies of slaves. In considering the thymus gland, these exploitative cadaver practices had unintended consequences even for wealthy patients. For about a century, we defined an abnormally small thymus size as healthy and normal. This resulted in decades of physicians mistakenly diagnosing their patients with enlarged thymus glands to be forcibly shrunken with radiation. A treatment that frequently killed the patient in an attempt to cure them of an ailment that they never had in the first place. Based entirely on dissected cadavers who had died from highly stressful poverty-related diseases like malnutrition, tuberculosis, and infectious diarrhea, the miscalculated size of a “healthy thymus” led to over 10,000 deaths until 1945. These forgotten social histories skew the canon of our medical knowledge, witnessed by countless victims who were once slaves, graverobber-retrieved corpses, and poor people unnamed and unclaimed by their families to be dissected and studied in the early days of Medicine.
It is easy to say that these are horrors of the past, but poor peoples’ bodies continue to represent the greatest number of cadaver donors simply because they cannot afford the cost of cremation, burial, or other services. A 2018 Seattle study found that the cost of a death can lead to homelessness for those living on the precipice of just getting by. “Of survey respondents, 2.9% cited a death in the family as the reason they fell behind in rent. For rent-burdened tenants, the unexpected costs of paying for a funeral and other related costs can reduce their ability to pay rent.” We must learn to see poverty as a comorbidity.
Whole body donation companies do not track donors’ income status, but it is apparent that financial hardship is a deciding factor for many, not idealistic altruism. This predatory framework exploits the poverty that likely contributed to their death in the first place. Due to stringent laws, donors are never directly compensated, however many have no other viable means to pay for funeral services. In Better Business Bureau reviews, many donor families cite cost as a deciding factor. In 2019 the Federal Reserve reported that four in ten Americans would not be able to afford an unexpected expense of $400 without borrowing or selling something. And death is the epitome of something unexpected. In 2017, the Federal Reserve reported that “one in four [Americans] skipped a medical treatment in the past year due to an inability to pay.” In the midst of COVID, this figure is likely to be far worse, as many people’s health insurance is intrinsically tied to their job. The American Hospital Association warns of the dire consequences of 2020’s high unemployment rate resulting in even more uninsured patients and how this equation for disaster is already financially impacting many hospitals. Adding to the ethical dilemma of for-profit cadaver donation companies, the industry often misleads families and donors into believing that they are non-profits when this is only true for university teaching hospitals.
It is wonderful to donate to science so that we can discover new cures for diseases, and so that our loved ones will be able to live healthier, happier lives. However it is grossly unethical when this research is predicated on the economic misfortune of our most vulnerable citizens. Not everyone donates their body to science because they cannot afford the cost of cremation, but many do. How can we justify biomedical research on the bodies of people who do not have equal access to healthcare, housing, education, and nutrition? As long as we have an inequitable healthcare system, rampant medical racism, and no comprehensive system to cover funeral costs, the sinister legacy of biomedical research’s past will continue to be repeated.