Last September, NBC News aired a one-sided report on the arrangement between a county coroner and a medical school apropos the transfer of unclaimed corpses with reportedly inadequate effort to find family. In addition to a grieving family, an academic bioethicist was interviewed who expressed horror at the transfer procedure. The report did a disservice both to bioethics and to necessary medical training and research.
In a similar incident, a coroner did more than usual to find a family with repeated announcements (including photos of belongings) on major local TV channels and statements on radio stations with Black audiences for a month. Receiving no response, Mr. Doe was interred. Weeks later, a family appeared and angrily demanded to know why they were not informed about their loved one. They had not bothered to file a “missing person’s report,” although these are essential to family identification. They did not hesitate, however, to file a civil suit claiming a lack of “due diligence” by the coroner—an expectation possibly fueled by the ease of family identification on TV crime dramas or perhaps by the attorney who sought them out.
Family tracing is complicated by numerous factors: multiple and incomplete databases, lacking missing person’s reports, name changes, people who do not want to be found, etc., and it can consume significant resources and staff time. This complexity is illustrated in the book Dead Center by S. Ribowsky and T. Shachtman, which detailed the identification of bodies and families in general and from the 9/11 tragedy. That process required a task force, years, and special funding, and it still remains incomplete.
A basic lesson in ethics is that it does not provide answers but only frameworks by which one can develop an answer. Thus, the bioethicist’s expression of revulsion was her opinion, and another ethicist, using different frameworks, may arrive at a different conclusion.
I favor two ethical philosophies: the humanitarian and the utilitarian. The former considers all humans of equal worth and entitled to reasonable or even equivalent shares of whatever is under consideration (i.e., food, housing, etc.). This is a utopian perspective but a worthy ideal that, whenever possible, should be considered.
Utilitarianism is community-focused and advocates collective benefits, from which the individual, in turn, profits. It considers that circumstances may dictate differential valuation of individuals (i.e., who may best benefit from the remaining ventilator). Government intervention may be required, albeit only to the extent necessary, and terminated when the causative situation has concluded.
The need for cadavers and body parts of people of color for medical training and research is essential for understanding differences in physiology, susceptibility to some diseases, and differential responses to medication between ethnicities. The provision of corpses for whom family cannot be identified is an appropriate means of achieving better care for a specific community and its constituents. Black researchers and physicians have emphasized this need, noting that, given historical incidents (i.e., the Tuskegee Syphilis Study), few Black people donate their bodies for medical use, hampering progress in this understanding. This is especially true as Black unclaimed bodies constitute a minority of the unclaimed.
Granted, the deceased did not give consent to this use of their bodies, as the bioethicist claimed. However, I would consider it acceptable given the potential communal benefit. This is in line with the “opt-out” system for organ donation, another scarcity in which silence is considered consent, that most European Union (EU) countries utilize. The body transfer policy is not publicized but is available for viewing on request, similar to the EU “opt-out” policy.
A coroner’s office has a fixed budget that, like other governmental agencies, is too limited for the necessary work they perform. This budget is divided among departments based on their importance to the organizational mission. This does not mean that family notification is unimportant, but it is not an essential function, and this unit performs the best job possible with its allocated funding. Should family notification expend disproportionate resources on one cadaver and be unable to do anything for another? Indeed, family identification saves the cost of burial or cremation. Perhaps money could be diverted from another unit, but which one, without reducing its functioning?
The coroner could request a larger budget from its funding agency, usually a county administration. However, a county’s income, primarily taxes, is difficult to expand, and to increase the coroner’s budget would likely reduce another department’s allocation. Here too, which unit is sufficiently unimportant that less money and reduced services would not negatively affect the populace?
Similar difficulties exist on state and federal levels, although of greater magnitude. On these strata, considerable money is wasted on pet projects, inflated prices, and influential entities or persons. Is there any justifiable reason, for example, why the military pays many times the store price for trash bags that do not improve military preparedness? Or why Medicare reduces clinician payments yearly while increasing subsidies to Medicare Advantage companies, which not only brag about record profits but also request larger reimbursements?
Rectifying these imbalances necessitates a utopian perspective. Realistically, these inequalities will never be eliminated. Nonetheless, given a humanitarian outlook, reduction is a worthwhile goal while accepting that we live in an imperfect world.
M. Bennet Broner is a medical ethicist.
