Medical Schools Are Still Desecrating the Corpses of the Poor

Medical schools in the United States used to acquire corpses for research from literal grave robbers. They don’t anymore — but in most US states, your corpse may still end up on a medical slab without your consent if no one will pick up the tab to bury you.

In the US, if no one pays for the cremation and burial of your body, it will be donated to be used for medical education. (Andrew Fox / Getty Images)

In the nineteenth-century folklore of black Southerners, “night doctors” were doctors or medical students who kidnapped and murdered people they thought no one would miss to supply medical schools with the cadavers students use to learn anatomy. Regional variations sometimes called them “bottle men” or “needle men” for the methods they supposedly used to sedate their victims.

The belief seems to have persisted as late as the 1950s. One 1954 article in Time magazine reported that “in some southern states, mothers threaten children with ‘the night doctor will get you. . . .’”

There are no confirmed cases of this happening in the United States — although there were at least two very real “night doctors,” William Burke and William Hare, in nineteenth-century Scotland. The pair killed sixteen people before they were caught. Hare took a deal with prosecutors to testify, and Burke was hanged.

Putting aside the extreme option of murder, plenty of medical schools historically got their bodies from grave robbers. The Freedmen’s Cemetery Project in Dallas, for example, uncovered evidence of cases of the remains of black people in Dallas in post–Civil War Texas being taken in this way, with cities and counties often complicit.

In the third decade of the twenty-first century, though, that sordid practice is a thing of the past. We’ve long since decided as a society that bodily autonomy extends even beyond death. That’s why organs can’t even be taken from your freshly dead body for lifesaving transplants unless you consent while you’re still breathing. Surely every corpse on a slab at a medical school today was voluntarily donated by the deceased themselves or their next of kin . . . right?

The truth is more complicated. If a middle-class person wants their body to end up being used for medical education, there are plenty of forms to be filled out. But even in 2023, there’s a much simpler way to “donate” your body: you don’t have to fill anything out. You don’t even have to want your remains used in this way. You just have to die in grinding poverty, with no one in a position to pay to cremate you or put you in the ground.

Unclaimed Bodies in Texas

Eli Shupe is a philosophy professor at the University of Texas–Arlington, where she also serves as the codirector of the Medical Humanities and Bioethics Program. (Full disclosure: She’s also a good friend from the years when both of us were at Rutgers.) Back in August, she published a study in the Journal of the American Medical Association entitled “Unclaimed Bodies in Texas.” As far as she knows, it’s the first study of its kind in any state. She and her collaborators, Serena Karim and Daniel Sledge, used Texas Public Information Act requests to get information from the public medical schools in the state and convinced the private ones to voluntarily disclose information on how they acquired bodies for medical research.

What they found surprised them. Almost 43 percent of the schools either directly accepted unclaimed bodies (14.3 percent of them did that) or accepted bodies transferred from schools that did (another 28.6 percent). The number of such corpses in Texas medical schools actually went up from sixty-four (2.27 percent of all “donations”) in 2017 to 446 (14.12 percent) in 2021.

While some people may hear “unclaimed” and assume that it means “unidentified,” Shupe cautions me that all of the bodies in question are identified. Unidentified bodies need to be held for longer because of the possibility that they’ll be needed for criminal investigations. Even when this period is over, they’re buried rather than cremated in case they need to exhumed.

So what we’re talking about here are bodies of known individuals whose next of kin don’t claim them for burial or cremation. Sometimes, as Shupe noted in an op-ed in the Dallas Morning News, they are the remains of people who were “isolated or estranged from their families” — as is the case for some people who end up living on the streets — and sometimes the families simply didn’t claim them because they couldn’t afford funeral costs. And some immigrants might not have family in a position to travel to Texas to claim them.

The whole thing raises ethical issues about the nonconsensual use of these bodies. Shupe also told me that there’s a “dark legacy of racialized grave robbery in the United States, particularly in the American South” and that “given the demographics” of those most likely to end up as unclaimed bodies, “one might worry that this is an echo of those practices.”

It’s easy to see her point about the history. “Night doctors” might have been an urban (or, often, rural) legend, but the corpses of slaves routinely ending up in medical schools was a very real phenomenon in the antebellum South. One advertisement for Northern students to study at the South Carolina Medical School during this era advertised that “arrangements for private dissection are peculiarly attended to, and subjects are obtained in abundance, and with great facility.” Another ad for the same school spelled out the connection between this “abundance” and institution of slavery:

Some advantages of a peculiar character are connected with this institution, which it may be proper to point out. No place in the United States offers as great opportunities for the acquisition of anatomical knowledge. Subjects being obtained from among the coloured population in sufficient numbers for every purpose, and proper dissections carried on without offending any individuals in the community!

However different today’s world might be from the nightmarish realities of antebellum South Carolina, it’s hard not to notice the racial disparities in this kind of nonvoluntary “donation.” An article published in the Fort Worth Report after Shupe started making noise about this issue even quotes the manager of one medical school’s Willed Body Program touting the “more diverse pool of cadavers” resulting from counties turning over unclaimed bodies.

Putting aside the racial disparities and the uncomfortable historical associations they evoke, though, there’s a much more basic issue here about economic justice. If we believe, as a society, that human beings are owed the respect of burial or cremation when they die — and our normal practices sure seem to indicate that we do — why shouldn’t that apply to people who die in severe poverty? If you or I would have to consent in writing to relinquish our claim on this dignity, why shouldn’t someone who dies penniless and has no one to claim their remains?

Legal Graverobbing in Texas — and 46 Other States?

Shupe told me that, while her study was specific to Texas — and no one has yet done a similarly comprehensive study in any other states — she has little reason to think the picture is much different elsewhere.

She and one of her students are currently working on a comprehensive review of the legality of the practice across the United States. So far, she has found that New York, Hawaii, and Vermont have passed laws that prevent the practice, but it seems to be legal in the rest of the country. In some places, the state decides what to do with unclaimed bodies; in Texas, as in most other states, it’s the county.

The Fort Worth Report article mentions Tarrant County (which includes the city of Fort Worth). Before the county started turning over unclaimed bodies to the Health Science Center at the University of North Texas, it had to provide free burial or cremation to anyone whose family didn’t step up to claim the body and foot the bill. According to Lisa Martin, director of the Tarrant County Department of Human Services, this cost them about half a million a year.

I looked up the county’s annual budget, and to put that half a million in perspective, it would be about one-tenth of one-half of 1 percent of Tarrant County’s projected 2024 budget of $896.6 million. For scale, the county just spent over two-thirds as much money on buying its Sheriff’s department an actual, honest-to-God tank. Still, I suppose every penny counts, and Martin seemed happy to report that costs “plummeted” when the Health Science Center got the county contract.

It’s worth noting that no one needs to be especially concerned medical schools will have a shortage of cadavers if this source is shut down. Some prefer computer simulations these days anyway, but even if bodies are needed, the great majority already come from actual donations. If we really needed more, we could simplify the process — perhaps with a box on drivers’ licenses à la organ donation, which would be a simple enough reform to enact state by state.

But even that might be unnecessary. New York State, for example, decisively outlawed the use of unclaimed bodies in 2016, and anatomical education in New York medical schools seems to be proceeding just fine.

It’s telling that some medical schools that do use unclaimed bodies show signs of shame about the practice. Many don’t share this information with their students. The very Health Science Center that gets all those unclaimed bodies from Tarrant County has glowing material on its website about its remembrance of its generous “donors.” But according to an article in the Dallas Morning News, about 35–40 percent of its cadavers are the unclaimed bodies of the poor.

You could, I suppose, make a utilitarian argument that it’s silly to care what happens to anyone after they die. What difference does it make to them? Perhaps the universal prohibitions on everything from necrophilia to cannibalism to the activities of the grave-robbing medical students of times past are so many irrational prejudices, and all our attitudes toward the dead need to be rethought from the ground up. All I can say to anyone pushing for this particular social reform is, “Good luck with that.”

But if we do believe that treating someone as a dead person and not as human roadkill means the default is giving them a decent burial, that should be the default for all people. If we believe that respect for bodily autonomy means that you or I should have to consent to having our bodies end up in a medical school rather than a graveyard, then that should go for everyone. You don’t stop being deserving of respect because you died poor and alone.