Maintaining Dignity of the Dead

- A Challenge for All

Dr. Shrabana Kumar Naik
Professor, Forensic Medicine,
Lady Hardinge Medical College & Associated Hospitals,
New Delhi-110001
Ph: 9891224143
Email: naikshrabana@yahoo.co.in
Abstract
Humans are most intelligent animals in the planet earth being bounded with
strong socio-cultural relationships. As long as person is alive, family members and
others love him; respect him for his role in family and society. However, once he is
dead, all love and respect vanishes within no time and no one bothers to maintain
dignity of the dead body violating tradition, socio-cultural norms, religion, ethics
and humanity. No doubt, all are somewhat aware of this disgraceful status. All the
medical oaths starting from Hippocratess oath teach us about the importance of
preservation of life from mothers womb till end of life, but remain silent about
our duties towards the dead. Although India is in dire need for progress in
cadaveric organ donation, however, considering frivolous litigations of possible
organ removal for disfigurement caused by rodents and wild animals due to ill
preservation of dead bodies at hospitals and morgues for lack of infrastructures
and supervision, compounded by frivolous RTI applications about removal of
organs without consent of relatives, it is not only our duty but also need to
maintain the dignity of the dead at least till its disposal from hospital premises.

Key Words: Dignity of dead; Ethics; Humanity; Organ donation; Legal suits
Introduction
The Dead= The Dead Human being.

Dignity= The state or quality of being worthy of honour or respect.

Introduction
People say that you can measure how civilized a country is by the way it
treats its dead.
As a country, we are moving into the brave new world of designer babies,
face transplants and cloning. These advances are held to be evidence of the
superiority and prowess of our civilization.
The way we treat the dead is of the greatest possible significance, not just
to the health service but to society at large.
For if we do not show respect to the dead, we will not show it to the living.
The rituals surrounding our treatment of dead people signify the respect
we have for human life itself.
Disposal by Hindus

Burning

Burial

Floating
Hindu Rituals After Death- Putting over
Bamboo rods
Hindu Rituals After Death- Carrying over four
shoulders
Hindu Rituals After Death- Cremation with
Mukhagni
Hindu Rituals After Death- Shaving Head by
near and dear ones
Hindu Rituals After Death-Serving Mass
Hindu Rituals After Death- Cheering Memory
during Anniversary
Muslims and Christians
Burial of Dead Bodies under ground with or without coffin.
Rituals After Death- Muslim
Rituals After Death- Muslim- Prayer
Rituals After Death- Muslim- Burial
Rituals After Death- Christian- Prayer
Rituals After Death- Christian- Prayer
Rituals After Death- Christian- Keeping Identity
Intact
Rituals After Death- Christian- Floral Tribute During
Special Days like Christmas
Hue and Cry About Violation of Dignity of Dead
If every things are okay then why there is hue and cry
about violation of dignity of dead from time to time?

And whether we treat all dead bodies in same way?

By Soldiers to dead soldier.
They know the value of life more than others.
They even do not hesitate to exchange body of enemy soldier or
terrorist.
Wrapping dead soldier with national flag.
Flowers tribute.
Salute.
Gun Salute.
Treating Dead Soldier- Wrapping with National Flag
Treating Dead Soldier- Salute or Gun Salute
For VPPIPs.
Wrapping with National flag.
Keeping dead body for public view.
Flowers tribute.
Respect with National anthem.
Salute.
Gun Salute.
National or state mourning.
Declaration of holiday.
Bending of national flag for certain period etc..
Treating VVIP Dead Body- Wrapping with National
Flag, Flower Tribute
Treating VVIP Dead Body- Wrapping with
National Flag, Flower Tribute
Treating VVIP Dead Body- Flower Tribute
Treating VVIP Dead Body- Flower Tribute
Treating VVIP Dead Body- Kept for Public View
Treating VVIP Dead Body- Gun Salute
Other side of Dignity for Dead
Other side of Dignity for Dead
Other side of Dignity for Dead- Flotation in
River
Other side of Dignity for Dead-Dead Body near
River Bed and Dog about to Eat
Other side of Dignity for Dead- Dog Eating
Human Dead Body
Other side of Dignity for Dead-Vultures Eating
Dead Human Body
 No one is yet sure of what the real cause of these horrific incidents
is.
Theories and explanations are several;
1. Some traditional practices believe minors and unmarried girls are not
cremated or buried, so they are simply allowed to flow away in the
river.
2. Some believe that last rites are not performed on those who die of
snake bites.
3. Priests, in order to save on wood and also to cremate more than
what would generally be possible in a day, let not fully burnt bodies
flow away.
4. The police department disposes of unclaimed bodies to save money
and even to escape registering a case in their area.

Whatever the reason or cause be, the sight of dead bodies floating in
the river and eagles and vultures and dogs feasting on them is
something any nation would be ashamed of.

Dignity to the dead is something that cannot be compromised with.

During Mass Disaster
The Problem aggravated during death of thousands of people during
mass disaster and natural calamities.
Tracing of all the dead bodies spread over large geographical area
with devastation of road surfaces is difficult task.
Autopsy of all the dead bodies is not possible for many reasons.
Identification of all is near to an impossible task, require DNA profiling
and availability of surviving near and dear ones.
During Mass Disaster
In the absence of identification of caste and religion, it may not be
easy to follow rituals during cremation.
Due to pile of large number of dead bodies, cremation of dead bodies
individually is not possible practically.
General public get horrify to deal with decomposed dead bodies.
In the absence of proper cremation or burial, there is always
possibility of spread of infectious diseases to the survivors.
Cyclonic water tiding
Hurricane Sandy
Ternado
Hurricane Katrina
Earthquake
Flood- devastation of Road Network
Piling of dead bodies during Super Cyclone
Difficulty in Recovery and Cremation
Difficulty in Transportation of Dead Body
Difficulty in Identification
 Period, even in a war, any civilized society ensures that the enemy
soldier is given the burial as per his/her traditions and customs.

At times, the bodies are even handed over to the other party, for the
dignity of the dead soldier is important.

When this dignity can be maintained at the time of war, shouldnt it

be a given to a person at any other time?

When dignity of dead can be maintained by soldiers or for VVIPs,

shouldnt it be maintained for any common person?
 When journalists exposed that an Austrian University was using
human corpses as crash test dummies to get more realistic testing
results for RTA, the public was shocked!!

In many peoples opinion, such a handling of dead human bodies was

disrespectful and a violation of the peoples human dignity.
 The preamble to the Charter of the United Nations describes a
modern and secular concept, in which the equality of all human
beings is agreed on, regardless of their ethnicity, social status,
nationality or religion. Every one is born free in rights and dignity.

All the medical oaths starting from Hippocratess oath teach us about
the importance of preservation of life from mothers womb till end of
life, but remain silent about our duties towards the dead.
Legal Aspects-International
In rulings of the Supreme Court, it was held that the fundamental
principle of human dignity a constitutional right in Israel includes
not only the dignity of a person when alive, but also the dignity
following his death, and the dignity of the deceased person's loved
ones who cherish his memory.

These statements reflect the special importance that the state and
society in Israel give to respect for the dead.
Legal Aspects-International
The refusal to return the bodies to their families constitutes collective
punishment, which contradicts the fundamental principle that a
person not be punished for acts he did not commit.
Eg., Secret disposal of Osma Bin Laden
Not returning dead body of Afzal Guru

The state further contended that the policy is also intended to

prevent the use of funerals to disturb public order. This argument is
an insufficient basis for denying the respect to which the dead are
entitled and to the right of the family to bury their loved one.
Legal Aspects-India
The Kerala State Legal Services Authority [KELSA] has asked the State
government to express its view on the evolving guidelines to ensure
dignity of the corpse.

KELSA Executive Chairman, Justice Thottathil B.Radhakrishna issued

the proceedings in the backdrop of the recent incident in which a
half-burnt body was found dumped inside a toilet of a crematorium at
Tripunithura .
 The Chairman said that the right to privacy of a human being did not
end with death. The privacy was an indispensable element of dignity.
Human dignity includes the fundamental right to decent disposal of
the remains of a particular person. That right was inherent in human
rights. It was only equally protected under the Right to life enshrined
under Article 21 of the Constitution. Therefore, it was abundantly
necessary that such issues had to be immediately addressed by any
civil society whenever its infraction was noticed.
Legal Aspects-India
Honble High Court of Delhi (Honble Mr. Justice P.K. Bhasin and
Honble Mr. Justice J.R. Midha) in Criminal Appeals A. 1545/2013 &
M.A. 670/2014 passed direction for preservation of Dignity of Dead at
Hospitals.
In that case there was allegation of eye removal without consent of
the relatives of the deceased.
In fact, that was disfigurement/mutilation of eyes of the dead by rats
due to preservation dead body inside ill maintained morgue.
Legal Aspects-India
Following the direction, as remedial measures, Ministry of Health &
Family welfare, Govt. of India has prepared and circulated the SOP
regarding management of Mortuaries across the country.

But whether the paper works solved the whole problem???

Dignity of Dead in Hospital
Death is a process, not an event.

Organs and tissue die slowly some times/ hours after cessation of
functions of brain, heart and lungs- hence, still have chance for organ
donation.

Therefore, dead body cannot be treated as mere object.

Problem Associated With Leaving Dead Body Over
Hospital Bed for Long Period
Problem Associated With Leaving Dead Body Over
Hospital Bed for Long Period
Dead body in bed may cause distress to other patients and their
relatives.
Chance of transmission of infection to other near by living persons or
patients.
Chance of generating bad smell.
Non-availability of beds for needy patients.
Non-availability of life saving support systems (if not removed) for
needy patients.
Problems Associated With Dead Body Over
Hospital Bed- Cause

Delay in Death declaration- even after development of rigor mortis.

Non- availability of relatives.
Relatives may unwilling to take away the dead body for logistical or
security reasons during odd hours.
Casual attitude shown by attending nurses.
Problems Associated With Dead Body Over
Hospital Bed- Cause

Non-availability of dead body transport carrier or word boys for

transfer of dead body to cold storage room or mortuary.
Allegation of Medical negligence.
Pending Police investigation in medico-legal cases.
Non- release of dead body pending large sum hospital Bill.
Problem Associated With Transport of Dead
Problem Associated With Transport of Dead Body-
Lack of Mortuary Trolley and Staffs
Problem Associated With Transport of Dead Body-
Lack of Hearse Van or Ambulance and Driver
Problem Associated With Transport of Dead
Body- Cause
Non- availability of;
Body Bag.
Mortuary trolley.
Sufficient supporting staffs.
Hearse Van or ambulance, Driver etc. at the particular period of
day or just as a hospital policy to reduce cost.
Lack of willingness by relatives of deceased to forward helping
hands.
Dead Body Kept in a Corner- Not in Proper
Place
Problem Associated With Preservation of Dead
Body inside Hospital

Non-availability of cold storage room or morgue.

Lack of well built morgue.
Lack of sufficient space for storage of large number of dead bodies.
Lack of separate cold storage rooms for MLC and non-MLC dead
bodies.
Lack of Security and Proper Lighting near Mortuary.
Problem Associated With Preservation of Dead
Body inside Hospital

Lack of paste control inside hospital premises.

Increasing number of eateries inside or adjacent to hospital.
Throwing food remains in open places by the relatives of patients.
Preserving dead body already infested with maggots.
Introduction of artifacts to the dead body including by ant and
cockroach bites.
Lack of Proper Infrastructures
Non-Availability of Cold Storage Room or Dead
Body Freeze
Not well Built Mortuary
Dead Bodies on the Floor without Proper Platforms-
especially during Mass Disaster
Lack of Storage facilities During Mass Disaster
Non-Availability of Security for Mortuary
Lack of Paste Control
Problem Associated During Autopsy

Autopsy only during specified working hours barring VVIPs.

Relatives not reaching in time.
Unknown dead body.
Investigating Police officer not turning for autopsy.
Delay in preparing Inquest papers.
Delay in constitution and assembling of Medical board for autopsy.
Fighting among relatives of paternal and in-laws sides in dowry
deaths.
Lack of Security for Doctors and mortuary staffs while mob violence.
Problem Associated During Autopsy

Lack of proper infrastructure and facilities.

Not giving standard incision, mostly in peripheral mortuaries;
Due to Lack of interest of autopsy surgeon,
Non-skilled morgue attendant.
Not keeping organs in-situ after internal examination.
Improper reconstruction of dead body after post-mortem
examination.
No provision for supplying body bags.
No provision for supplying viscera boxes.
Periphery mortuaries- Unattended dead body- even mutilation
can occur by crow, eagle etc.
Improper Handling of Dead
Not putting standard Incisions
Problem Associated After Autopsy

There may be request for further preservation of dead body.

Relatives reluctance to handle the dead body.
Thus extra work for morgue attendants.
Undue demand by morgue staffs- Hence, complain of corruption,
harassment by relatives from time to time.
Lack of embalming facility for further preservation and transport of
dead .
Problem Associated with Improper disposal of
Dead

Burning-
May be partial to collect bone for bisarjan in holi river.
May be due to lack of sufficient woods for combustion.
May be due to interference by rain.
Release of toxic gases to the environment.
Difficult to identify and determine cause of death in body of crime.
Problem Associated with Improper disposal of
Dead

Burial-
Dig out by wild animals and mutilation.
Mixed up with crime scene- body of crime, hence, difficult to differentiate.
Floating-
Pollution to river and water body/ Transmission of infection.
Difficult to differentiate from drowning death.
Allegation of Disrespect towards Dead
Allegation of Disrespect towards Dead
Causes behind Allegation of Disrespect towards
Dead

Demand for number of Old age home increasing day by day.

Reducing family size.
If we cannot treat our elderly parents and grandparents,, then what
about dead?
Relatives may try to gain money by the death.
Nowadays, hardly any one really mourn over death; they are more
concerned with money and property left by the deceased.
Causes behind Allegation of Disrespect towards
Dead

Thus, there is degradation of moral values in all spheres.

Growing intolerance among people.
Allegation of medical negligence, improper treatment of dead may be
aimed towards getting rid of large sum hospital bills, even towards
gaining extra money.
Allegation of Disrespect towards Dead
In India, there is dire need for many folds increase in cadaveric organ
donation,
But to the contrary, there are frivolous RTI applications demanding
answers regarding;
Removal of organs without consent of relatives.
Organ trading in hospital.
Hence, maintaining dignity of dead in hospital is not only our duty but
our need.
Frivolous RTI Application
Suggestions;
Well behavior with relatives of the deceased.
Proper maintenance of register.
Obtaining proper consent whenever required (eg., organs or tissues
removed for academic or research purpose).
No undue delay in release of dead body or harassment for any
reason.
Conducting autopsy at the earliest.
Proper stitching and cleaning of dead body.
Providing body bag free of cost.
Providing viscera boxes free of cost.
Suggestions;
No undue demand of money from relatives by any hospital or morgue
staff.
Installation of CCTV.
Periodic check and maintenance of cold storage room for cadavers.
Proper training and periodic sensitization of all the hospital staffs
dealing with dead.
Proper communication with media.
Circulating guidelines or SOPs by govt. is not the solution; Central and
state governments must extend finance for proper infrastructure,
equipment, adequate staffs and facilities.