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INTRODUCTION
A main feature of modern anatomy is a changed attitude towards the acquisition of bodies for study and research, and their treatment in the anatomy laboratory (Strkalj, 2014, 2016; Strkalj et al., 2015; Champney et al., 2019). This is of great importance because of anatomy’s controversial past where bodies for dissection were obtained in ethically dubious and at times illegal ways. This included cadavers of executed criminals, remains stolen from mortuaries and graveyards and, more recently, unclaimed human remains from hospitals, asylums and other institutions. The recent Recommendations of Good Practice for the Donation of Human Bodies and Tissues for Anatomical Examination issued by the International Federation of Associations of Anatomists advise that the only ethically justifiable and educationally sound mean sof acquiring cadavers is through willed body donation. While according to the recent report, only 32 % of 68 surveyed countries around the world rely solely on body donation, there seems to be a global trend towards increasing donation and replacing other modes of cadaver procurement (Habicht et al., 2018).
In addition to this trend, bodies in the anatomy laboratories are being given back their dignity and treated with respect, often absent in previous times. Cadavers in anatomy laboratories are not referred to and treated as “biological specimens” but as “first patients” or “silent teachers” of anatomy. Body donors and their families are acknowledged as partners and key stakeholders in medical education who are honoured and thanked for their gift to anatomy. One of the best ways to publicly highlight the importance of donation and express gratitude toward body donors and their families is through events and activities that are held to pay respect to body donors known as commemorations (Tschernig & Pabst, 2001; Strkalj & Pather, 2017; El-Haddad et al., 2020) or through the stablishment of memorial objects and places (Strkalj & Pather).
Commemorations and memorials are appearing at an increasing frequency at many institutions where they are presented in various formats that cater to the individual cultural and social norms or the communities to which they belong (McClea, 2008; Flack et al., 2017). Apart from addressing body donors, their families and, indeed, the wider community - commemorations and memorials play a key pedagogical role, particularly in developing non-traditional discipline independent skills (Ghosh, 2017; Evans et al., 2018).
In this paper, we describe the preparation and implementation of a first-ever commemoration for body donors at Macquarie University, Sydney, Australia. It is hoped that the experiences from these initiatives will help anatomy educators in Australia and globally at institutions where ways of honouring body donors are being considered.
THE COMMEMORATION FOR BODY DONORS
Setting. Macquarie University (MQU) was established in 1964 (Mansfield & Hutchinson, 1992), and until recently anatomy was taught only a tan introductory level with practicals being carried out in the all-purpose science laboratories. In the last decade, the university branched off significantly, in both teaching and research, into biomedical and medical fields (Strkalj & Dayal, 2014). Consequently, there has been a need for in-depth instruction of human anatomy. To cater for this demand, the infrastructure and resources for teaching anatomy were built, including the state-of-the-art anatomy laboratory. This laboratory, which curates human tissue, became functional in 2010. In Australia, bodies are sourced for anatomical education only through body donation programs. As teaching of anatomy based on donated bodies commenced at MQU, plans were being made to establish an anatomy commemoration.
Preparation. Organisation of the commemoration at MQU was preceded by several preparatory activities. From the published literature, it was recognized that the format of the ceremonies is dependent on several variables, including the resources and the way the anatomy teaching is organized at the particular institution as well as the local cultural milieu (McClea; Flack et al.; Strkalj & Pather; da Rocha et al., 2020; El-Haddad et al.).
Because of the organisational complexity, the constraints of faculty organisation (anatomy at MQU is delivered from two different faculties) (Alexander et al., 2014; El-Haddad et al.), and the fact that the human remains for anatomical teaching are sourced from other Australian universities (MQU does not have an embalming unit), it was decided that the commemoration would be introduced in a staged manner. To begin with, the commemorative ceremony was planned to be organised for students only, followed by a commemoration that would be inclusive to family members of the body donors.
It was also taken into consideration that Australia is a multicultural society and that the commemoration has to be organized in an inclusive manner, which would be inclusive of all participants. Consequently, before the commemoration was introduced a survey was carried out on several cohorts of anatomy students - those taking introductory anatomy and not yet exposed to human remains, those taking higher level anatomy units and were at the time of the survey studying human remains in the anatomy laboratory, and senior students who completed their higher level anatomy courses in previous years and were no longer exposed to human remains (El-Haddad et al.).
The results from the survey revealed that students were strongly in favour of introducing a ceremony that commemorated body donors. Students also expressed their preferences for the format of a potential commemoration. Students expressed that anatomy staff and students should organize the commemoration, that the commemoration should be secular and should include and acknowledge Australian Indigenous Custodians, and for the commemoration to not be recorded for social media (El- Haddad et al.).
When the results of the survey, resources and academic infrastructure were considered, it was determined that the commemoration ceremony would be best implemented embedded in the first lecture of the course that students first have activities in the anatomy laboratory and learn from the prosected human remains. This strategy did not incur any additional costs and facilitated the attendance of the whole class of students without any extra-curricular requirement of their time. As the class was comprised of students from multiple faculties and programs, finding a time outside of existing lecture and laboratory schedules that was not exclusionary was near impossible.
Implementation. The commemoration for body donors was first carried out in the second teaching semester of the 2019 academic year. Students enrolled in the course were informed that the first lecture would be a commemorative ceremony for body donors and that attendance would be required (attendance in person to anatomy lectures is not required at MQU as all lectures are recorded and available to students via the course Moodle based web page). The commemoration was also inclusive of sessional staff members; however, attendance was optional (as there was no financial reimbursement available). Regardless, the commemoration was well attended by sessional staff.
After a short introduction by the course coordinator at the time and Acknowledgement of Country, talks were given by an anatomy lecturer, anatomy tutor (sessional academic staff member) and a student from the previous year’s cohort. The first presentation, delivered by the anatomy lecturer, outlined the history of anatomy with special reference to body acquisition for anatomy teaching and research with an intent to provide context to the commemoration. It concluded with current practices of body donation in Australia, and the ethics underpinning body sourcing and treatment of human remains in the anatomy laboratory. This presentation was accompanied by PowerPoint slides that included the key points from the talk. Two other presentations contextualised the ethical requirements within the courses delivered at MQU. These presentations also prepared students for possible emotional challenges of working with human remains (Dosani & Neuberger, 2016).
The tutor and the student focused on personal experiences of working with human remains during their anatomy teaching and education respectively, emphasizing the importance of the altruistic act of body donation for educational purposes and respectful treatment of human remains. These presentations were accompanied by two landscape photographs taken by one of the authors of the paper (JE). The landscapes were intended to serve as both a symbolic gesture as well as a form of including artistic performances, both of which were expressed as important by students in the survey which heavily influenced the format of this commemoration (El-Haddad et al.).
All three talks were aligned with course learning outcomes which included an appreciation and demonstration of respect for those who have bequeathed their bodies to anatomical education. Each presentation was allocated 20 minutes. The commemoration was then concluded by a guest lecturer and students were invited to ask questions or discuss body donation.
Changed circumstances. In 2020 the commemorative ceremony was supposed to happen in the same format, with some minor content changes. However, the crisis caused by COVID-19 pandemic, which affected tertiary education in general and particularly anatomy (Pather et al., 2020), induced changes in the format of the commemoration. The COVID-19 outbreak resulted in most of the teaching activities being transferred fully online. However, in the second semester, when new students first enter the anatomy laboratory, anatomy practicals were reinstituted in face to face delivery while lectures stayed in their online format. As the anatomy commemoration was carried out as a lecture, delivering it online was an easy transformation. Even if the practicals stayed online, commemoration would still be implemented preparing students for encounter with images and videos of human remains human.
Looking forward. It is hoped that once the crisis of COVID- 19 subsides and face to face lectures are possible again, a face to face commemoration will be held. Upon reflection of the first commemoration at Macquarie University, the organisers should invite an Australian Indigenous representative for a Welcome to Country, consider inviting students to contribute/preform artistic gestures (paintings, pictures, music) that can be used during the different presentations. Furthermore, the organisers of future commemorations at MQU should consider inviting family members of donors’ as guest speakers.
CONCLUSIONS
With no additional financial investment, little disturbance to the complex timetable and following both course’s learning outcomes and students’ cultural preferences a commemoration for body donors was successfully organised at Macquarie University. The format of the ceremony, embedded in the lecture, also enabled easy transition to the new, online modes of the delivery induced by the COVID-19 pandemic in Australia.
