The anatomy of ontological ambiguity: exploring moral distress in cadaveric dissection

This study investigates sources of distress experienced by some medical students performing cadaveric dissection in the anatomy lab. Using a novel theoretical framework adapted from the humanities, faculty at the University of Rochester sought to understand the connection between distress, dissection, and the ontological assumptions students hold about cadavers. Between 2019 and 2021, the authors engaged in an iterative inductive thematic analysis to better understand student experiences. We conducted 14 semi-structured individual interviews with medical students about their experiences. We found that students' experiences of distress were closely related to confusion surrounding the cadaver's ontological status. Our study contributes to understanding this connection in three significant ways: (1) our findings bolster the existing literature linking distress to the ontological ambiguity surrounding the cadaver-an ambiguity related to the ontological status of persons in Western societies; (2) we share a conceptual framework, derived from Roberto Esposito's work on persons and things in Western history, to better understand distress in the anatomy laboratory and to facilitate development of healthy coping strategies for morally complicated situations in patient care; and (3) applying our framework, we demonstrate how dissection challenges norms fundamental to our moral understanding, and consider how it may create experiences of moral distress for some students.