CADAVER---The Living Cadaver: Medical Uses of Brain-Dead Bodies

THE LIVING CADAVER:
MEDICAL USES OF BRAIN-DEAD BODIES

OUTLINE:

I. INTRODUCING THE LIVING CADAVER:
            A NEW CONCEPT IN MEDICAL ETHICS

II. DEAD IN MOST OF THE MEANINGFUL SENSES OF THE WORD

    A. A LIVING CADAVER IS LEGALLY DEAD.

    B. A LIVING CADAVER IS SOCIALLY DEAD.

    C. A LIVING CADAVER IS ECONOMICALLY DEAD.

III. BUT A BRAIN-DEAD BODY IS STILL BIOLOGICALLY ALIVE.

IV. POSSIBLE MEDICAL USES FOR A LIVING CADAVER

    A. ORGAN AND TISSUE TRANSPLANTS

    B. TESTING NEW SURGICAL PROCEDURES AND DEVICES

    C. MEDICAL RESEARCH TOO RISKY FOR LIVING SUBJECTS

        1. TESTING NEW ARTIFICIAL ORGANS
                    AND OTHER MEDICAL DEVICES

        2. TESTING NEW DRUGS FOR DISEASES
                    INTENTIONALLY GIVEN TO THE LIVING CADAVER

    D. PRACTICE SURGERY FOR SURGEONS-IN-TRAINING

    E. ANATOMICAL STUDY
                    FOR THE EDUCATION OF DOCTORS, DENTISTS, & NURSES

THE LIVING CADAVER:
MEDICAL USES OF BRAIN-DEAD BODIES

by James Leonard Park

I. INTRODUCING THE LIVING CADAVER:
            A NEW CONCEPT IN MEDICAL ETHICS

    How do we make progress in medical ethics?
Someone proposes some change of principle or practice,
such as allowing brain-death to count as full death.
The first response is always: "No No No!"
"It has never been done before!"

    After the first shock of rejection has passed,
then the pros and cons of the new idea can be examined rationally.
For example, 3 decades ago brain-death was proposed
as an alternative means of determining human death.
Now, in the advanced parts of the world,
brain-death is routinely used for declaring death.
The lay public does not always understand or agree,
but the medical profession now fully accepts brain-death
as a valid set of criteria for determining human death.

    Human cloning will be another change in medical ethics.
The initially response has already been heard:
Many voices have been raised saying that
we will never allow this means of human reproduction.
It has never been done before.
It violates established medical ethics and traditional religion.
But before the end of the 21st century,
we will probably have human beings alive who were created by cloning
rather than by other means of reproduction.
We will see that a clone is a biological twin born several years later
—as the result of new reproductive technology.
(Ordinary twinning is an accident of nature.)

    How long will it will take, how much discussion will be needed,
before the concept of a 'living cadaver' will be accepted
—first by the medical profession and later by the lay public?
Delays in acceptance might depend
on how the idea of a 'living cadaver' is treated in the mass media
and on how strong the organized resistance becomes.

    Brain-death was quietly accepted by the medical world
without much public discussion or controversy.
Human cloning will probably be more debated in public.
And the idea of a 'living cadaver' might be even more controversial.

    A living cadaver is the biological body of a human being
whose mind has permanently ceased to function.
We must be 100% certain that consciousness will never return
before a body can be declared dead and then used as a living cadaver.
If there is even a sliver of doubt about the permanent unconsciousness,
then medical and/or surgical steps must be taken
to guarantee that this body will never have another thought or emotion.

    In addition, we should have written statements of agreement
from the first persons who donate their bodies as living cadavers.
Such legal declarations will show that the donor
fully understood the concept of a living cadaver
and fully agreed to have his or her body used in this way
—after consciousness was over forever
and death was officially declared.

    I am volunteering to have my body used as a living cadaver
after I am finished with my life.
And I have already executed the necessary document
showing that I fully understand this donation of my body after my death.
Also this essay explains even more fully my informed consent.
My Advance Directive for Medical Care
contains the relevant authorizations.
See Answer 21: I Wish to Donate My Whole Body as a Living Cadaver.
My Advance Directive also refers to the article you are reading
to explain more fully the possible medical uses of a living cadaver.

    Thus, my interest in a living cadaver is not merely academic.
I am willing for my body to be used as a living cadaver,
even if I am the first person to make such a donation.
Brain-dead bodies will only be used as living cadavers with permission.
Only we few people who voluntarily take the initiative
to offer our bodies for various uses in medicine
will have our donations accepted.

    And after you have finished reading this article,
you can decide whether or not you would like to donate your remains
to be used in medical research and education.
If you have already decided to donate your cadaver after death,
allowing it be be used as a living cadaver
after your consciousness has gone out forever
(and after death is officially declared using established criteria)
will be no different for you as a person who experienced living.

II. DEAD IN MOST OF THE MEANINGFUL SENSES OF THE WORD

        A. A LIVING CADAVER IS LEGALLY DEAD.

    It used to be very easy to draw the line between the living and the dead.
But modern medical technology has created many in-between conditions.
The most widely recognized of these is brain-death.
When most of the functions of the whole brain have ceased forever,
a doctor can declare the patient legally dead.
For example, before transplanting organs or tissues,
the donor must be declared dead.

    It might be legally and politically helpful to use the concept of brain-death.
Even tho the general public does not fully understand or accept brain-death,
we have several years of experience with this concept in the medical world.
Perhaps the living cadaver would have to meet the same criteria
now used for declaring brain-death.
And if there is some uncertainty concerning any of the tests for brain-death,
further medical steps such as drugs or surgery could be completed
so that everyone would be satisfied that this body is now brain-dead.

    The time and date of death are recorded by the doctor who declares death.
Thereafter the body is treated with the respect due to human remains,
but the person whose body it was
has no further rights or responsibilities as a human being.
The official death-certificate shall be completed by the doctor in charge;
and it will record the date of death as the day when death was certified.
And all laws that depend on separating the living from the dead
will now classify this individual as dead.

    All medical care ends,
along with payment by every form of health-care insurance.
(However, 'life-supports' will still be used
to maintain the biological functions still present in the living cadaver.)
Informed consent is no longer required for future procedures.
Ownership of the living cadaver passes to the medical institution.
In every legal meaning, this human individual is now dead.

        B. A LIVING CADAVER IS SOCIALLY DEAD.

    The family will hold a funeral or memorial service,
even if the body is being kept 'alive' on machines
in order to keep it useful for the purposes of medical science.

    When we speak of people who have lived on the surface of the Earth,
we always distinguish between the living and the dead.
For a living cadaver, the following practices should proceed as usual:
The newspaper obituary page reports the death.
If the person whose life is now over was married,
then that marriage automatically comes to an end
as happens whenever one spouse dies.
And the surviving spouse is free to marry again if he or she wishes.
In every social meaning of death, this person is dead.

        C. A LIVING CADAVER IS ECONOMICALLY DEAD.

    When a living cadaver is declared dead,
then several economic implications follow:
If the person was still being paid a salary
by some company, agency, individual, or organization,
then all such income and benefits cease—including health-care benefits.
If there is any death benefit to be paid by any kind of life-insurance,
that payment will be made immediately.
Estate planning of the individual goes into effect:
His or her assets will be distributed as described in a will or trust.
If any form of pension was being paid,
those payments end immediately—as they do with any death.
Or benefits shift to survivors as specified in the pension plan.

    Even more important for the practice of using living cadavers,
the health-care dollars that were paying
for the medical care of this patient now come to an end.
Health-care dollars are never spent on the dead.
The cost of maintaining the living cadaver passes immediately
to the medical institution that now has legal possession of the body.
This switch-of-payer should be handled exactly the same way
that teaching hospitals pay to maintain dead cadavers.

    All economic activities in which living persons may engage
have now ended for this dead individual.

III. BUT A BRAIN-DEAD BODY IS STILL BIOLOGICALLY ALIVE.

    A living cadaver is dead in all of the senses just named:
legally dead, socially dead, & economically dead.
But on the biological level, the living cadaver is still functioning
in all dimensions except those related to consciousness.
The living cadaver will never have another thought or emotion.
If there are physical responses to external stimuli,
these will only be reflex actions,
having no connections with a brain that can experience pain, etc.

    Thus, it will be possible to conduct many kinds of medical research
on an organism that is really a human body
without the possible harms involved with human experimentation.

    Because the living cadaver is still biologically alive,
it will be kept in a hospital bed with all of the usual 'life-support' systems
necessary to keeping its biological functions working.
But, as said before, the economic costs of supporting this body
will now be borne in the same ways that dead cadavers are maintained.

    If it would be helpful to the family and/or the medical personnel,
the living cadaver could be officially declared brain-dead
if it meets all of the criteria for such a declaration of death.
This individual has now died,
even if some 'vital' functions are maintained by tubes and machines.

IV. POSSIBLE MEDICAL USES FOR A LIVING CADAVER

    A. ORGAN AND TISSUE TRANSPLANTS

    The least controversial uses of this new kind of cadaver
will be conventional organ and tissue transplantation.
When the living cadaver has a heart or lungs still fully functional,
then these can be harvested from the living cadaver
and transplanted into living persons
who will soon be dead if they do not get new organs.

    Since most organ-transplants will end all biological life,
this use of the living cadaver might actually be among the last uses.
Without its vital organs, the living cadaver becomes a dead cadaver
—unless it is placed on life-support machines to replace vital functions.
This could be part of the planned medical experimentation,
since new forms of life-support should first be tried on bodies
that cannot suffer any harms.

    Because the living cadaver will already be in a hospital,
it should be very easy to coordinate organ-transplants.
The organs will be kept alive in the living cadaver
until they are needed by the recipient.
Actually, there will probably be several patients
prepared to receive the transplantable organs.

    And because these transplants can be planned weeks in advance,
all the necessary testing for tissue matching, etc. can be done
and the patients receiving the living organs can be carefully selected
—which might contrast somewhat with the current emergency process
of selecting recipients when an organ-donor dies unexpectedly.

    B. TESTING NEW SURGICAL PROCEDURES AND DEVICES

    Medical science and technology make advances every week.
Whenever a new kind of operation is proposed by a surgeon,
it is essential that this new method of repairing a human body
be tried on living bodies that cannot be harmed
before it is used on patients who are hoping to recover.

    Right now animals are used for testing new surgical procedures,
which can yield large amounts of useful information.
But no animal body is precisely the same as a human body.
After animal testing proves that the new procedure can work,
it should be tested on living cadavers before it is used for living patients.

    As a side benefit, advocates of animal rights should be pleased
because fewer animals will be needed for testing new medical procedures.
And these advocates can decide to donate their own bodies to science
with the knowledge that their donations will reduce the use of animals.

    C. MEDICAL RESEARCH TOO RISKY FOR LIVING SUBJECTS

    Every form of medical research must ultimately be tried on human bodies.
Many brave individuals volunteer their bodies each year for medical research.
And all such medical experimentation is carefully controlled
to make sure that the volunteers will not be harmed by the research.
Elaborate committee-systems oversee medical research on human subjects.

    (And these same committees must approve the first uses of living cadavers.
After living cadavers are routinely used in medical research,
there will be separate committees overseeing such uses of brain-dead bodies.
Perhaps committees now controlling the uses of dead cadavers
will have their scope expanded to cover living cadavers.
And here again, any precedent of using brain-dead bodies might be useful:
Have some research committees already approved
medical procedures using brain-dead but still breathing bodies?)

    When a new drug or other treatment is first developed,
we do not know all of the possible side-effects.
And if the toxicity of the drug might prove too harmful,
it would be better to test it on a living cadaver than on a living human being.
The drug might kill the living cadaver, which would be very useful to know.
And if the new drug proves to do more harm than good,
we would not want to lose a human life in the process of testing it.

    Thus, whenever a human-experimentation committee
turns down a request to use human subjects in medical research,
the scientists will next turn to living cadavers
as possible means to do that very risky research.

                1. TESTING NEW ARTIFICIAL ORGANS
                        AND OTHER MEDICAL DEVICES

    New medical devices such as artificial hearts and lungs
need to be thoroly tested before they are used in living patients.
A living cadaver would be an ideal way to test a new artificial heart.
For example, a new internal mechanical heart
could be implanted in the living cadaver I will donate.
Then careful observations can be made to see
how well it works and what problems turn up.

    When implantable devices are are being devised
to regulate any biological processes,
these should first be tested in human bodies that cannot be harmed.
If a new drug-delivery system works in a living cadaver,
that will be evidence that it might be safe enough for living patients.

    Even mundane devices such as new artificial joints
should first be tested in living cadavers
to see how well a human body tolerates the surgery
and the after-effects of having an artificial part.

                2. TESTING NEW DRUGS FOR DISEASES
                        INTENTIONALLY GIVEN TO THE LIVING CADAVER

    One problem of ordinary medical research to treat diseases
is finding people with that disease to use in testing.
And when we do have people who are actually suffering AIDS, for example,
there might be so much damage already done to the body
that it is difficult to isolate the effects of a new treatment.

    But when a living cadaver has been donated for medical research,
it could be given a disease intentionally
in order to test the new treatment in a controlled situation.
We would never consider intentionally giving diseases to human subjects.
At least we would never give medical volunteers very dangerous diseases.
But the most serious diseases of the human race
—heart disease, cancer, various infections, etc.—
could be experimentally introduced or created in a living cadaver
in order to learn everything possible about the course of the disease
and the efficacy of various risky treatments that should be tried.

    Every scientist who is working
on one of the dread diseases that befalls the human race
would be glad to have biological organisms for early research
that is definitely too dangerous to try on living human subjects.
Living cadavers would be ideal for all such dangerous research.

    D. PRACTICE SURGERY FOR SURGEONS-IN-TRAINING

    Every surgeon who is now operating on living human beings
was trained using dead cadavers first.
They had to learn how the cut and sew using dead flesh.
And there was no realistic way to test the after-effects of the surgery.
But living cadavers would be ideal ways to learn surgery.
The body is identical in every way to a living human patient
—except there will be no return to consciousness after the operation.
However, because this cadaver is still living biologically,
all of the benefits and harms of the surgery can be observed
as they would happen in a regular human body.

    If this use of living cadavers becomes routine,
then every surgeon-in-training
will move up from practice on dead cadavers
to doing real-life surgery on living cadavers,
where they can see the living results of their efforts.
The living cadaver will either heal as planned
or suffer some unwanted damage due to the surgery.
The remaining biological functions of the living cadaver
might come to an end because of some surgical mistake or failure.

    Obviously, it is better for beginning surgeons
to learn from their mistakes on living cadavers
than for living patients to suffer because of their inexperience.
Every surgeon must have a first operation.
Why not allow practice surgery to be performed
on a human body that cannot be harmed—a living cadaver?

    E. ANATOMICAL STUDY
            FOR THE EDUCATION OF DOCTORS, DENTISTS, & NURSES

    Every doctor, dentist, or nurse must learn his or her art
by handling real human bodies.
They must study how the body fits together by dissecting dead cadavers.
A certain amount of human anatomy can be learned from books
and other visual aids such as pictures and videos,
but the best way to understand a human body is to handle it.

    Dead cadavers have long been educational tools for medical training.
It was first a controversial practice
because people rejected the idea of cutting into dead bodies.
And sometimes the means of obtaining dead cadavers was unsavory,
such as digging up the newly dead in the middle of the night.

    But now enough people are donating their bodies for anatomical study
by students being trained in the medical sciences.
However, even more realistic than cutting into a dead body
to see how the parts work together
would be to do anatomical study on a living body—a living cadaver.
This would allow the medical student to see the organs in action.

    Anatomical study would probably be the last use of a living cadaver
because dissection will prevent most future uses of the living cadaver.
But after it has been thoroly studied by students
who will later be treating living persons,
the living cadaver can finally be laid to rest.
And a living cadaver could even be preserved as a dead cadaver
after its last vital functions have ceased.
After all biological functions have stopped,
the now-dead cadaver could still be as useful
as all of the other dead cadavers being studied.

    After all such uses, the remains of the remains can be cremated
and the ashes returned to the relatives of the donor.

Once these elementary uses for living cadavers have been established,
then a never-ending series of new experiments will be proposed.
Whenever we need to know something more about the human body
or test something to treat medical problems,
we can first turn to living cadavers donated by public-spirited persons
who are happy to be of service even after they are dead.

Created February 2, 2006; revised 12-15-2007; 5-31-2009; 9-15-2009;
5-8-2010; 11-4-2010; 3-12-2011; 11-16-2011;
12-13-2012; 1-24-2013; 8-5-2014; 1-21-2015; 1-19-2016; 12-23-2016;
4-7-2018; 7-11-2019; 8-11-2020;

AUTHOR:

    James Park is an independent philosopher
with deep interest in medical ethics,
especially the many issues surrounding the end of life.
As said above, he would like to donate his body as a living cadaver.
Another essay explains this plan in greater detail:
"If I Get Alzheimer's, Donate my Organs"

    Both essays has now become chapters in
Medical Ethics at the End of Life.

    Here are a few related essays:

Losing the Marks of Personhood:
Discussing Degrees of Mental Decline

Advance Directives for Medical Care:
24 Important Questions to Answer

Fifteen Safeguards for Life-Ending Decisions

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Medical Methods of Managing Dying

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

The Living Cadaver:
Medical Uses of Brain-Dead Bodies

The Dead-Donor Rule:
How Dead Do You Have to Be?

Depressed?
Don't Kill Yourself!

Further Reading:

Best Books on Voluntary Death

Best Books on Preparing for Death