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The Anatomy of Ontological Ambiguity: Exploring Moral Distress in Cadaveric Dissection

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Title: The Anatomy of Ontological Ambiguity: Exploring Moral Distress in Cadaveric Dissection
Language: English
Authors: Erik Larsen, Christopher Mooney (ORCID 0000-0003-2881-2169), Natercia Rodrigues, Margie Hodges Shaw
Source: Advances in Health Sciences Education. 2026 31(1):87-101.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 15
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Human Body, Donors, Laboratory Procedures, Student Attitudes, Stress Variables, Coping, Social Attitudes, Moral Values, Philosophy
DOI: 10.1007/s10459-025-10436-5
ISSN: 1382-4996
1573-1677
Abstract: 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.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1508908
Database: ERIC
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  Value: <anid>AN0191807139;oak01feb.26;2026Feb25.05:07;v2.2.500</anid> <title id="AN0191807139-1">The anatomy of ontological ambiguity: exploring moral distress in cadaveric dissection </title> <p>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: (<reflink idref="bib1" id="ref1">1</reflink>) 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; (<reflink idref="bib2" id="ref2">2</reflink>) 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 (<reflink idref="bib3" id="ref3">3</reflink>) 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.</p> <p>Keywords: Dissection; Anatomy; Moral distress; Cadaver; Ontology</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0191807139-2">Introduction</hd> <p>Medical students gain critical knowledge about human structure and function by dissecting cadavers (Insausti & Muñoz, [<reflink idref="bib29" id="ref4">29</reflink>]; Ghosh, [<reflink idref="bib19" id="ref5">19</reflink>]; Korf et al., [<reflink idref="bib35" id="ref6">35</reflink>]). In addition to providing essential training in morphology and physiology, studies indicate that the dissection experience exerts a significant influence on students' professional and personal identity formation (Hafferty, [<reflink idref="bib24" id="ref7">24</reflink>]; Hafferty, [<reflink idref="bib23" id="ref8">23</reflink>]; Brown et al., [<reflink idref="bib5" id="ref9">5</reflink>]; McDaniel et al., [<reflink idref="bib40" id="ref10">40</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref11">50</reflink>]). How students initially come to understand their roles, relationships, and work as physicians-in-training appears partially linked to their experience of and response to cadaveric dissection (Hafferty, [<reflink idref="bib24" id="ref12">24</reflink>]; Hafferty, [<reflink idref="bib23" id="ref13">23</reflink>]; Goss et al., [<reflink idref="bib22" id="ref14">22</reflink>]). Often an introduction to medical training, cadaveric dissection may inaugurate patterns of behavior, emotional response, and thought that shape students' future medical practice (Hafferty, [<reflink idref="bib23" id="ref15">23</reflink>]; Vinson, [<reflink idref="bib55" id="ref16">55</reflink>]).</p> <p>For some, the task of cutting, deconstructing, and dismembering cadavers, while educationally and professionally invaluable (Korf et al., [<reflink idref="bib35" id="ref17">35</reflink>]; Ghosh & Kumar, [<reflink idref="bib21" id="ref18">21</reflink>]), is emotionally and experientially distressing (Wisenden et al., [<reflink idref="bib56" id="ref19">56</reflink>]; Boeckers et al., [<reflink idref="bib3" id="ref20">3</reflink>]). Among other negative responses, some students report nightmares (Finkelstein & Mathers, [<reflink idref="bib14" id="ref21">14</reflink>]), guilt (Chang et al., [<reflink idref="bib9" id="ref22">9</reflink>]), and doubts about the adequacy of informed consent for donors and their families (Stephens et al., [<reflink idref="bib50" id="ref23">50</reflink>]). Finkelstein and Mathers ([<reflink idref="bib14" id="ref24">14</reflink>]) found that some students' experiences resembled symptoms of post-traumatic stress disorder (PTSD). These and other studies have identified, measured, and analyzed common distress experiences originating from cadaveric dissection among diverse student populations (Boeckers et al., [<reflink idref="bib3" id="ref25">3</reflink>]; Bernhardt et al., [<reflink idref="bib1" id="ref26">1</reflink>]; Romo-Barrientos et al., [<reflink idref="bib49" id="ref27">49</reflink>]).</p> <p>This study proposes that student distress can be productively reinterpreted as an expression of moral distress, rather than physical disgust, academic stress, or other conditions unique to the anatomy lab. In other words, some students experience distress in the anatomy lab because they perceive dissection as either transgressing moral norms or having the potential to do so (Olejaz, [<reflink idref="bib45" id="ref28">45</reflink>]). Our use of moral distress to understand the experience of dissection is grounded in a redefinition of the concept from prior work on moral distress in healthcare: "[moral distress is] one or more negative self-directed emotions or attitudes that arise in response to one's perceived involvement in a situation that one perceives to be morally undesirable" (Campbell et al., [<reflink idref="bib44" id="ref29">44</reflink>]). While departing from understandings of moral distress traditionally used in ethics (Morley et al., [<reflink idref="bib8" id="ref30">8</reflink>]), by emphasizing perception, this definition links distress in dissection with commonly recognized contexts of moral distress in medical training and practice (Morley et al., [<reflink idref="bib44" id="ref31">44</reflink>]). This reframing may also productively inform educational interventions designed to foster positive professional development.</p> <p>Because moral distress is increasingly identified as a source of student and physician disillusionment (Ulrich et al., [<reflink idref="bib52" id="ref32">52</reflink>]; Epstein & Hamric, [<reflink idref="bib11" id="ref33">11</reflink>]; Dean et al., [<reflink idref="bib10" id="ref34">10</reflink>]) and burnout (Ong et al., [<reflink idref="bib46" id="ref35">46</reflink>]; Vincent et al., [<reflink idref="bib54" id="ref36">54</reflink>]; Kherbache et al., [<reflink idref="bib33" id="ref37">33</reflink>]), our reframing prompts a need to critically reassess the effects of cadaveric dissection on students. Our research was inspired by the empathy of anatomical science faculty who recognized the persistent distress experienced by some students in the lab, despite intentional practices to provide support (e.g., modelling professionalism; providing information about donors; integrating health humanities materials, including a conversation with a geriatrician and a patient who consented to whole body donation; and holding a donor memorial service). The ensuing study represents a collaborative and ongoing effort with anatomy and health humanities faculty to understand and ameliorate student distress using humanities methods and materials.</p> <p>Our approach to moral distress in dissection and its effects on professional identity formation originate in humanities sources, including the AAMC's FRAHME Report (Fundamental Role of Arts and Humanities in Medical Education) (Howley et al., [<reflink idref="bib27" id="ref38">27</reflink>]). The Report focuses on how the humanities can be used to address "morally injurious" situations, "inherent paradoxes and tensions in the learning and practice of medicine today," and how humanities perspectives can be applied to develop personal insight into "maladaptive behaviors and coping mechanisms" (Howley et al., [<reflink idref="bib27" id="ref39">27</reflink>]). The moral distress experienced by some students in cadaveric dissection reflects these issues and given dissection's formative placement at or near the beginning of medical school, research into distress may offer a powerful tool for understanding and mitigating harmful experiences with potentially long-term consequences. Our multi-disciplinary approach resonates with recent calls to reimagine the "ethos of anatomy education" (Hildebrandt et al., [<reflink idref="bib26" id="ref40">26</reflink>]).</p> <p>Initially designed to investigate the effects of integrating health humanities instruction within the lab, our study was revised and expanded when early interviews revealed general distress surrounding dissection. In many instances, distress seemed linked to a struggle to define the ontological and moral status of cadavers. Many of the students interviewed seemed uncertain if cadavers are fundamentally persons, and thus deserving of the highest moral regard, or if they are more like a thing— a tool or object used for instruction. This ontological confusion prompted a new set of research questions: What normative concepts of person and thing define the moral expectations of students entering the lab? How does dissection challenge these assumptions, potentially producing a distinctive form of moral distress? How does this confusion influence maladaptive coping mechanisms and identity formation? Several studies have identified similar ambiguities and concerns around the cadaver's ontological status (Hafferty, [<reflink idref="bib23" id="ref41">23</reflink>]; Goss et al., [<reflink idref="bib22" id="ref42">22</reflink>]; Prentice, [<reflink idref="bib48" id="ref43">48</reflink>]; Olejaz, [<reflink idref="bib45" id="ref44">45</reflink>]; Burr & Russell-Sewell, [<reflink idref="bib6" id="ref45">6</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref46">50</reflink>]; Kassam et al., [<reflink idref="bib32" id="ref47">32</reflink>]; Macleod et al., [<reflink idref="bib39" id="ref48">39</reflink>]). Focusing on how the tension between person and thing manifests in medical contexts, these studies inquire minimally into the historical, conceptual, and social traditions influencing how Western societies have divided people from things (Olejaz, [<reflink idref="bib45" id="ref49">45</reflink>]), and how dissection ambiguates these fundamental distinctions. As part of our revised study, we developed a novel theoretical framework to explore this ambiguity, one based on a recent philosophical study of persons and things in Western societies (Esposito, [<reflink idref="bib12" id="ref50">12</reflink>]). In addition to offering opportunities to formulate educational interventions to ameliorate distress, the framework reveals that distress in the lab is related to fundamental ambiguities surrounding the relationship between bodies, persons, and things in Western societies. More specifically, we show that distress in the lab is connected to a general ambiguity around the ontological status of bodies—an ambiguity informing medical and non-medical contexts alike.</p> <p>By proposing a connection between moral distress and cadaveric dissection, we do not intend to critique the practice. Our aim is to better understand this connection to mitigate or avoid unnecessary moral distress and its maladaptive consequences. We also acknowledge that not all students report experiences of moral distress consequent to cadaveric dissection.</p> <p>Throughout this study, we use the common medical term "cadaver," but recognize that many terms such as "donor" and "human remains" are used in anatomy labs. These linguistic differences are significant, as they carry distinct ontological and moral implications. While alternatives such as "deceased" or "decedent" may humanize the cadaver and reduce depersonalization (Štrkalj, [<reflink idref="bib51" id="ref51">51</reflink>]), our use of "cadaver" was intentional– to maintain consistency and avoid reinforcing the ontological ambiguity that is central to our findings. This approach aligns with other work examining the ambiguous status of cadavers (Olejaz, [<reflink idref="bib45" id="ref52">45</reflink>]). Although our purpose is not to explore how terminology affects student experience, our ontological framework might be productively applied to investigate this issue in future studies.</p> <hd id="AN0191807139-3">Method</hd> <p></p> <hd id="AN0191807139-4">Design</hd> <p>We began with an inductive thematic analysis to examine our research questions. Thematic analysis is a flexible qualitative analytic method for identifying, analyzing, and reporting patterns in data (Braun & Clarke, [<reflink idref="bib4" id="ref53">4</reflink>]). The inductive approach to thematic analysis bears resemblance to grounded theory in that resulting themes and their coherence are informed by the data without imposing they fit a priori theoretical interests or analytic preconceptions (Braun & Clarke, [<reflink idref="bib4" id="ref54">4</reflink>]). This approach also allows for the evolution of research questions during analysis. Distinct from other qualitative methods, thematic analysis is not bound to a specific epistemology, but our approach aligns with a constructionist paradigm that recognizes truth as multiple and relative, and realities as co-constituted and informed by structural conditions and sociocultural contexts (Braun & Clarke, [<reflink idref="bib4" id="ref55">4</reflink>]; Gergen, [<reflink idref="bib17" id="ref56">17</reflink>]).</p> <hd id="AN0191807139-5">Participant selection and data collection</hd> <p>Interviews, coding, and analysis took place between 2019 and 2021. We sent recruitment e-mails to all first-year medical students (102 total) at our institution approximately one year following their anatomy lab experience. The time elapsed between dissection and interviewing was intended to provide students with some distance from their experiences to eliminate reporting of minor and temporary experiences of distress. From the initial participant pool, we used snowball sampling to recruit and access subsequent participants. Two team members, not in supervisory or assessment roles (NR, EL), conducted 14 individual semi-structured interviews. The interviewers used open-ended questions flexibly and adjusted according to each participant's context. Specific questions explored how participants were shaped by their experiences in the anatomy lab, challenges they encountered, coping processes used, and reflections on their own and others' behaviors in this setting. The interviews, lasting 45–60 min, were conducted in-person. Audio recordings were transcribed verbatim by professional transcriptionists. We reviewed and edited all transcripts for accuracy, removing or altering participant identifiers before analysis. We entered all transcribed text into Dedoose software, v.9.0.17 (Los Angeles, CA: Socio Cultural Research Consultants, LLC) to support data organization and analysis.</p> <hd id="AN0191807139-6">Analysis</hd> <p>Our thematic analysis was guided by Braun and Clark's ([<reflink idref="bib4" id="ref57">4</reflink>]) recursive, stepwise approach and involved three team members (CM, MHS, NR). The team began by performing a close-reading of the data, which involved recording reflections and memo-writing. Following data immersion, team members independently coded several transcripts line-by-line using inductive coding techniques (Miles et al., [<reflink idref="bib42" id="ref58">42</reflink>]) to develop a provisional code list and coding framework. The team members then applied the coding framework to the entire data, expanding and refining existing codes, while noting patterns, relationships, and inconsistencies that could inform theme development. For instance, we addressed challenges in distinguishing codes related to team relationships and dynamics by creating a single code representing a spectrum of team functioning (e.g., dysfunctional/challenging). Using a 'latent level' approach (Braun & Clark, [<reflink idref="bib4" id="ref59">4</reflink>]), the team identified and explored candidate themes and sub-themes, ensuring they had adequate coverage and fit within the data and provided unique insights (Kiger & Varpio, [<reflink idref="bib34" id="ref60">34</reflink>]). Once complete, we revised themes and subthemes to ensure that participant experiences and voices were accurately reflected and that their relationships provided a coherent and conceptually meaningful understanding of the data. Validity checks included the use of analytic memos, discussion of discordant findings, and confirming plausibility of themes and their relationships with team members (Lincoln & Guba, [<reflink idref="bib38" id="ref61">38</reflink>]).</p> <p>Aligned with our constructionist position, we acknowledge that research is co-produced by participants, researchers, and their interrelationship (Etherington, [<reflink idref="bib13" id="ref62">13</reflink>]; Finlay, [<reflink idref="bib15" id="ref63">15</reflink>]). To this end, we practiced reflexivity in pre-research, data collection, and analysis stages, examining how the team's positions, experiences, and emotions influenced the research process. We regularly reflected on how our respective backgrounds shaped participant interviews, analysis, and interpretation. The expertise in humanities and bioethics in our team was critical in developing a unique theoretical framework to interpret findings and draw conclusions.</p> <hd id="AN0191807139-7">Ethics</hd> <p>The University of Rochester Medical Center's Research Subjects Review Board approved this study (STUDY00003059).</p> <hd id="AN0191807139-8">Theoretical framework: Person-body-thing</hd> <p>Following the coding stage, we found that a theoretical framework improved our understanding and contextualization of coded extracts. This approach to thematic analysis is consistent with theory-informed inductive data analysis, where theory is used as an interpretive tool to help guide study understandings and conclusions (Kiger & Varpio, [<reflink idref="bib34" id="ref64">34</reflink>]). To this end, we developed a theoretical framework to clarify themes and their interconnections (Kiger & Varpio, [<reflink idref="bib34" id="ref65">34</reflink>]).</p> <p>Our framework consists of a tripart-conceptual structure influenced by Roberto Esposito's philosophical work, <emph>Persons and Things from the Body's Point of View</emph> ([<reflink idref="bib12" id="ref66">12</reflink>]). Following Esposito, we contend that Western culture divides experience into two opposing categories: persons and things. We generally define persons through qualities like consciousness, rationality, self-awareness, self-regulation, and agency. In contrast, things are frequently understood as inanimate and fungible, and are classified and valued in terms of their uses for persons—as possessions, resources, and commodities. Persons are regarded as deserving of certain protections and rights; things are generally lacking in all such entitlements. The diminutive moral status of things is defined in opposition to the superlative moral value we attribute to persons.</p> <p>Esposito argues that a third entity, the body, troubles the clear opposition between person and thing ([<reflink idref="bib12" id="ref67">12</reflink>]). Occupying an ambiguous space in our ontological paradigms, bodies seem neither identical to persons, nor entirely unlike things. They connect mutually opposed categories, complicating our moral and ethical relationships.</p> <p>Although Esposito mentions dead bodies minimally, based on his categories, we argue that dead bodies occupy a complex and ambiguous space in our moral structures ([<reflink idref="bib12" id="ref68">12</reflink>]). Even as they resemble things, most of us would likely resist categorizing cadavers as such. We hesitate to think of cadavers as things because they are bodies, and we connect bodies ambiguously, but intimately, with personhood. Even if we were to describe cadavers as more thing-like than living bodies, we might also concede that cadavers connect uniquely to the personhood of the deceased. Cadavers ambiguate the line between person and thing in a distinctive way—one posing distinctive challenges for medical students performing dissection.</p> <p>This ambiguity has been observed and investigated in several other studies (Goss et al., [<reflink idref="bib22" id="ref69">22</reflink>]; Prentice, [<reflink idref="bib48" id="ref70">48</reflink>]; Olejaz, [<reflink idref="bib45" id="ref71">45</reflink>]; Burr & Russell-Sewell, [<reflink idref="bib6" id="ref72">6</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref73">50</reflink>]; Kassam et al., [<reflink idref="bib32" id="ref74">32</reflink>]; Macleod et al., [<reflink idref="bib39" id="ref75">39</reflink>]). Burr and Russell-Sewell ([<reflink idref="bib6" id="ref76">6</reflink>]) argue that the donor body collapses "boundaries; neither object nor subject; human but not human, between the living and dead but not of either world" (<reflink idref="bib382" id="ref77">382</reflink>). Resonating closely with our perspective, Olejaz ([<reflink idref="bib45" id="ref78">45</reflink>]) writes that cadavers do not "rest comfortably in either the domain of things or people," (<reflink idref="bib130" id="ref79">130</reflink>) and finds that "the ambiguity of the anatomical cadaver is not resolvable" (<reflink idref="bib132" id="ref80">132</reflink>). As in our model, the cadaver maintains elements of personhood, what Olejaz describes as its "postvital life"; never simply a lifeless thing, the cadaver "embodies" the life it has lived (<reflink idref="bib126" id="ref81">126</reflink>). Similarly, Hallam ([<reflink idref="bib25" id="ref82">25</reflink>]) observes that the embalmed body maintains "material traces of a person and their life," meaning that the "donor's personhood and social relatedness" are not nullified but remain "latent" (<reflink idref="bib111" id="ref83">111</reflink>).</p> <p>Our framework helps to identify a similar ambiguity in the cadaver's ontological status, while making several novel contributions to the scholarship on this topic: (<reflink idref="bib1" id="ref84">1</reflink>) to our knowledge, no studies have presented a framework for understanding and mapping the ontological terrain of dissection. Our framework provides a clear conceptual structure that educators, scholars, and students can use to navigate this challenging space; (<reflink idref="bib2" id="ref85">2</reflink>) unlike previous studies, which focus on binaries between person and thing, we identify the body as an ambiguating third entity and connect the cadaver to general Western assumptions about the body; (<reflink idref="bib3" id="ref86">3</reflink>) this connection suggests that distress in the lab is related to basic moral norms around personhood and embodiment, and might thus be reinvestigated as a form of moral distress.</p> <p>In sharing this framework, we acknowledge that some students entering medical schools do not hold Western assumptions about persons, bodies, and things; however, in as much as these assumptions shape the responses of many students, the framework and resulting analysis are broadly applicable to cadaveric dissection.</p> <hd id="AN0191807139-9">Results</hd> <p>We identified three themes informing students' experiences of distress in dissection: (<reflink idref="bib1" id="ref87">1</reflink>) sense of duty and moral obligation, (<reflink idref="bib2" id="ref88">2</reflink>) perceptions of violence, and (<reflink idref="bib3" id="ref89">3</reflink>) coping and meaning-making (Stephens et al., [<reflink idref="bib50" id="ref90">50</reflink>]; Goss et al., [<reflink idref="bib22" id="ref91">22</reflink>]; Olejaz, [<reflink idref="bib45" id="ref92">45</reflink>]). We found that confusion about the ontological status of the cadaver informed each thematic area. For many students, the cadaver seemed positioned ambiguously between opposed ontological categories of Western societies—between persons and things. Dissection instigated distress because students perceived themselves as treating the cadaver as both person and thing (Olejaz, [<reflink idref="bib45" id="ref93">45</reflink>]), and thus as violating basic moral norms.</p> <hd id="AN0191807139-10">Duty and moral obligation</hd> <p>Across the interviews, students routinely described a duty to respect their cadaver: "this is a person. We need to respect her" (P13). They demonstrated this sentiment by exhibiting respectful and reverent behaviors such as "very gently draping the body with the sheet and being gentle if I had to move it" (P1). For some, this sense of reverence manifested in protective behaviors when they felt their cadaver was disrespected:I would get to lab and my donor would already be exposed on the table. I didn't like that... I would rather know that someone, I particularly, who has a relationship with this person, took the time to properly greet them. And I usually greet them when I come in, and expose them gently... I'm not sure how the other person handled them. (P4)</p> <p>And yet, veneration of cadavers was inherently threatened by the dissection process as students feared making mistakes, "There's always this struggle of when you mess something up, it felt disrespectful to your donor... you're like, 'Oh my God, was I too harsh?" (P10) or "am I desecrating it? Am I doing good? How good?" (P4). Similar concerns around respect and moral obligation have been reported in several other studies (Olejaz, [<reflink idref="bib45" id="ref94">45</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref95">50</reflink>]; Goss et al., [<reflink idref="bib22" id="ref96">22</reflink>]).</p> <p>One participant connected this duty towards cadavers to their course performance, "to honor their gift, it was up to me to learn as much as I could and to do the best on the exams" (P5). Another participant highlighted the pervasive nature of this sentiment in the learning environment, affecting their interactions with peers and shaping their emerging professional identity, "they say things like...as doctors we are held to a higher standard than everyone else and we are not allowed to make mistakes... you're not allowed to make mistakes in anatomy lab. You're not allowed to say anything inappropriate... that's what made it stressful" (P10). Participants characterized dissection as "a duty" (P5), "a job" (P1), or necessary to their professional identity: "I'm going to be using it in the future to save lives and be a better doctor" (P5).</p> <p>Because these students identified the cadaver fundamentally with personhood, responding negatively to those who treated it in a more thing-like fashion, they experienced dissection as morally fraught. Making a "mistake" became a potential act of desecration or irreverence rather than a common and expected part of the learning process. Treating the cadaver as thing-like, as an object for educative purposes in a lab, resulted in critique of self and peers.</p> <hd id="AN0191807139-11">Perceptions of violence</hd> <p>The distress from doing harm was evident during "violent" (P5), "disturbing and invasive" (P14), and "emotional" dissections where students confronted their cadaver's "humanity" (P2) or "semblance of self" (P1) by making them "unrecognizable as a person" (P13). One participant recounted the physically demanding nature of certain dissections:Like it's very violent because you have to take the spinal column apart... and to do so, one of my lab mates was applying a lot of force, and it was... like, "Oh my God, this is so violent, what are we doing?" And was freaked out at how brute strength sometimes is required (P5).</p> <p>Another shared their discomfort regarding "aggressive" dissections which raised concerns about informed consent:It felt invasive. A lot of the times during lab, I would remember the donor as an individual... How would people feel about them? It could be very aggressive at times...sometimes I wonder whether donors would know what exactly goes into anatomy lab. (P12)</p> <p>Others struggled with the cadaver's status in relation to patients and felt uneasy about the process of dissection:Oh my God, this is someone's family member. Like I'm dissecting them. (P5) There's the old trope these donors are our first real patients, and I'm like, I've done things to this person that we would never do. I decapitated her! I would never do that to a real patient... It's like asking someone to truly fundamentally violate someone. (P8)</p> <p>These students interpreted dissection as an act of "violence" or "aggression" because they equated the cadaver with personhood (Goss et al., [<reflink idref="bib22" id="ref97">22</reflink>]; Olejaz, [<reflink idref="bib45" id="ref98">45</reflink>]). They utilized terms such as "person," "individual," "self," "family member," and "humanity" to discuss the cadaver. Dissection became morally distressing because it assumed a contrasting ontological and moral status for the cadaver—one seemingly anathema to the value attributed to persons. The student who rejected the "old trope [that] these donors are our first real patients," described dissection as antithetical to the moral treatment of patients—as a practice engaged with a different sort of object. Experiencing dissection through conflicting moral relationships, the student described the activity in the language of intense moral distress: "It's like asking someone to truly fundamentally violate someone." (P8).</p> <hd id="AN0191807139-12">Coping and meaning making</hd> <p>Distressing experiences in the anatomy lab often led participants to discuss disassociation and detachment: "I think you have to disassociate a bit to get through it. There's not really much that prepares you for taking a sharp knife and cutting someone's eyeball." (P1) Others explained the importance and challenge of suppressing emotions to complete tasks: "Compartmentalizing and keeping those (emotions) separate at times was hard." (P12) Another participant vividly described the struggle to disassociate:We all struggled. If you get too emotional you can't dissect, because you're like freaking out.... My donor was a guy and my grandpa is pretty old. And so the guy's hand was reminding me of my grandpa's hand and I was like, "Holy crap!"... that's not a productive emotion to have in your brain when you're trying to learn. So I had to be like, "Okay, I am not going to go down that rabbit hole. This is my donor's hand, it's not my grandpa's hand. I'm just going to go do it." You have to learn how to turn a little bit of emotion off, but keep enough on so that you don't say some stupid comment that's super disrespectful. (P5)</p> <p>Others aimed to disassociate themselves from difficult dissections while maintaining a personal connection to the cadaver as a person. One participant emotionally recalled a dissection that left their cadaver "unrecognizable":... and at the end of that she was in like three different parts...I think separating who she was from what we were doing in that moment, was important to me, but then kind of even after those specific dissections taking some time to be like, she is a person. (P13)</p> <p>Despite some participants finding their experiences morally acceptable, others expressed intense feelings of guilt:I didn't do anything that anyone else didn't do, right? I did exactly what I was supposed to do, but I'm still forgiving myself for bisecting (donor name's) pelvis" (P8).</p> <p>This same participant shared advice they provided to a friend entering medical school and preparing for anatomy lab: "The best thing you can do is forgive yourself for what you're going to do" (P8).</p> <p>Students expressed guilt differently, with some feeling less affected by their experiences. One participant shared: "I know a lot of people feel guilty for not feeling guilty about it, and I know people feel a lot of guilt for doing what they've done." (P3) Some participants felt puzzled about their own identity and how it related to others due to their lack of struggle: "Why am I so okay with this and other people are struggling?" (P10) or "Do they think it's weird that I'm so calm?" (P5).</p> <p>Although some students struggled with academic stress and physical disgust in the lab, they disassociated from and compartmentalized their experiences because dissection seemed to violate essential ontological and moral limits. Thus, after conducting the dissection that left the cadaver in three parts, one student felt the need to separate "who she [the donor] was from what we were doing," and to "take some time to be like, she is a person" (P13). Deconstructing the body into "parts," and thus approaching it as a thing, had to be mentally and chronologically separated from thinking about the cadaver's connection to personhood. Relating to the cadaver through opposed concepts but as a single entity—as both person and thing—was so morally distressing that the student worked cognitively to hold them apart. Other researchers have identified similar tensions with objectification and personalization in the lab (Goss et al., [<reflink idref="bib22" id="ref99">22</reflink>]; Prentice, [<reflink idref="bib48" id="ref100">48</reflink>]; Olejaz, [<reflink idref="bib45" id="ref101">45</reflink>]).</p> <hd id="AN0191807139-13">Discussion</hd> <p>This study utilized inductive thematic analysis of interviews and a theoretical framework derived from a philosophical source (Esposito, [<reflink idref="bib12" id="ref102">12</reflink>]) to reinterpret the distress experienced in cadaveric dissection. Focusing on the cadaver's ambiguous ontological status—its position between person and thing—we identified a common source of distress informing students' accounts of dissection.</p> <hd id="AN0191807139-14">Distress, ontology, and objectification in dissection and beyond</hd> <p>Our results add to the existing literature on distress and dissection (Wisenden et al., [<reflink idref="bib56" id="ref103">56</reflink>]; Boeckers et al., [<reflink idref="bib3" id="ref104">3</reflink>]; Finkelstein & Mathers, [<reflink idref="bib14" id="ref105">14</reflink>]; Chang et al., [<reflink idref="bib9" id="ref106">9</reflink>]; Bernhardt et al., [<reflink idref="bib1" id="ref107">1</reflink>]; Romo-Barrientos et al., [<reflink idref="bib49" id="ref108">49</reflink>]; Lempp, 2005; Goss et al., [<reflink idref="bib22" id="ref109">22</reflink>]; Olejaz, [<reflink idref="bib45" id="ref110">45</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref111">50</reflink>]) in two significant ways. First, building on prior studies, we found that ontological ambiguity is a source of distress in the lab (Hafferty, [<reflink idref="bib23" id="ref112">23</reflink>]; Goss et al., [<reflink idref="bib22" id="ref113">22</reflink>]; Prentice, [<reflink idref="bib48" id="ref114">48</reflink>]; Olejaz, [<reflink idref="bib45" id="ref115">45</reflink>]; Stephens et al., [<reflink idref="bib50" id="ref116">50</reflink>]), but linked this distress to a different conceptual framework drawn from different sources and with different implications. Distress arises from the cadaver's ambiguous status, not simply as a dead body, but as a body, and thus as an entity ambiguously identified with personhood and thinghood. Importantly, this ambiguity reflects a general ambiguity around the body's status in Western societies; in other words, the ambiguity and distress experienced in the lab are not specific to the lab, but indicative of biopolitical concepts that inform everyday moral responses to different entities. Cadavers and dissection present their own ontological and moral challenges to students, but they do so within an existing set of categories. Refocusing analysis on these categories represents a novel investigation into the sources of ambiguity and distress.</p> <p>Our framework's derivation from philosophical research demonstrates how dissection can be usefully analyzed through humanities perspectives. This study provides one example of how the humanities can be applied to understand morally distressing and paradoxical situations in medical education, lending support for the FRAHME Report's claims to this effect (Howley et al., [<reflink idref="bib27" id="ref117">27</reflink>]).</p> <p>Second, our results put into fresh perspective the distressing effects of cadaveric dissection for some students. The framework demonstrates how dissection and the ambiguous status of the cadaver challenge norms fundamental to our moral understanding. Because some students perceived dissection as requiring them to treat persons as things, these students experienced the practice as a violation of the moral assumptions that guide everyday behavior. And as our results indicate, some internalized this perception of immorality, identifying themselves as perpetrators, and initiating strong maladaptive feelings. This may explain why, more than one year after completing dissection, some students continued to grapple with distress, often expressing strong emotions about their experiences. Indeed, we decided to designate the distress reported by students in the lab as "moral" because it seemed linked not merely to strong negative experiences with dissection, but to ontological categories that govern general moral decision making outside the lab. Although we are not arguing that moral distress in the lab is identical to what healthcare providers experience with their patients, that some students perceived dissection as a violation of moral norms suggests that their distress deserves to be regarded as a potentially significant harm.</p> <p>Reframing distress in these terms raises questions about how student coping strategies initiate patterns that may affect future practice. A study by Goss et al. ([<reflink idref="bib22" id="ref118">22</reflink>]) found that students approached dissection and their relationship to the cadaver as both a "moral challenge" (<reflink idref="bib356" id="ref119">356</reflink>) and "training ground" for clinical practice (<reflink idref="bib354" id="ref120">354</reflink>). Some students compared the cadaver to a person and identified the lab as a space to cultivate empathy and emotional sensitivity; other students approached the cadaver as an impersonal specimen and used their experience to develop detachment and emotional regulation (<reflink idref="bib354" id="ref121">354</reflink>). Prentice ([<reflink idref="bib48" id="ref122">48</reflink>]) argues that dissection helps students learn what she terms "tactical objectification," a critical technique of medical practice, described as "the ability to objectify the body or call forth the person as needed" (<reflink idref="bib35" id="ref123">35</reflink>). In contrast, Humm ([<reflink idref="bib28" id="ref124">28</reflink>]) contends that medical training prepares the student to respond to bodies as objects to prevent overwhelming empathetic response. Similarly, Goss et al. ([<reflink idref="bib22" id="ref125">22</reflink>]) found that students who approached the cadaver as a specimen did so in part to shield themselves from "emotional burden" (<reflink idref="bib354" id="ref126">354</reflink>). While the skill of "tactical objectification" may be invaluable in practice, these studies– and our own findings– suggest that some students may struggle to develop this practice, and with significant consequences. Building on the findings of Goss et al. ([<reflink idref="bib22" id="ref127">22</reflink>]), we wonder if some students who approach the cadaver as a person find themselves so overwhelmed by moral distress that they become less, rather than more, prepared for the emotional challenges of clinical practice. Although speculative, it may also be the case that some students who approach the cadaver as a specimen do so to avoid the same intense moral distress. Without substantial opportunities for contextualization and reflective practice, the use of objectification to cope in the lab may also initiate problematic patterns the student will apply in practice. Of course, many students likely develop adaptive approaches to bodies in and through dissection—approaches that help to prepare them for sustainable clinical careers. However, given our framework and findings, concern about the experience and responses of some students seems warranted and should prompt further scholarly attention and targeted interventions.</p> <hd id="AN0191807139-15">Interventions and further applications</hd> <p>Educational interventions explicitly focused on moral distress in human dissection and grounded in our theoretical framework could better prepare students for human dissection. Implemented prior to and during participation in the lab, such interventions might alleviate the moral distress caused by ambiguities surrounding the cadaver's ontological status. Discussing the framework and describing the body's ontological ambiguity in Western society does not dispel the distress that may arise in the anatomy lab. However, preparing students to experience distress, and providing a common set of useful concepts with which to discuss and reflect on it, might offer personal relief and new opportunities to communicate distress with peers.</p> <p>Introducing the framework at this early stage of training could also better prepare students to understand the ontologically ambiguous situations they will face in medical practice and the moral distress occasioned by them. The same binary that creates confusion and distress in the lab, the binary of person and thing, also influences experiences of moral distress in healthcare (Blain-Moraes et al., [<reflink idref="bib2" id="ref128">2</reflink>]). For example, moral distress and ethical debate frequently ensue in situations where the body's connection to personhood suddenly comes into doubt (Fins, [<reflink idref="bib16" id="ref129">16</reflink>]) as in the case of disorders of consciousness (Byram et al., [<reflink idref="bib7" id="ref130">7</reflink>]), such as a persistent vegetative state (PVS) (Jennett and Plum, 1972; Keuhlmeyer et al., 2014; Owen & Coleman, [<reflink idref="bib47" id="ref131">47</reflink>]; Monti et al., [<reflink idref="bib43" id="ref132">43</reflink>]). The moral distress arising from these and similar disorders (Blain-Moraes, 2018) might be reinterpreted as responses to bodies we struggle to classify and treat as persons or things. In everyday practice, healthcare providers confront the divide between persons and things as they make medical decisions, often finding themselves forced to emphasize the body's relationship to thinghood. These decisions may result in unresolved moral distress with potentially damaging implications. As more literature registers the cumulative negative effects of moral distress on healthcare providers (Mewborn et al., [<reflink idref="bib41" id="ref133">41</reflink>]), further research should investigate what might link seemingly disparate experiences of distress. How distress from dissection influences students throughout medical school, and how it might influence their experiences of moral distress and identity formation beyond training, requires further investigation. The framework discussed here provides one tool for identifying and analyzing distressing experiences and their similarities.</p> <hd id="AN0191807139-16">Limitations</hd> <p>An important study limitation pertains to our reliance on participants to self-select and share their anatomy lab experiences. Despite our intention to sample broadly and include diverse viewpoints, sampling students one-year post-anatomy coursework might have led to an overrepresentation of individuals who had difficult or distressing experiences. However, the stories of those less "affected" by dissection reassures us that our participants encompass a spectrum of experiences. Additionally, the use of a single study site may limit the transferability of findings, as alternative settings with varying contexts and dissection practices might yield differential outcomes and viewpoints. Lastly, our study used a novel theoretical framework to guide our analysis. Although this approach facilitated a rich interpretation of our data, it carries the potential of overlooking subtleties that may not neatly align with the framework's confines.</p> <hd id="AN0191807139-17">Conclusions</hd> <p>Some medical students experience intense distress consequent to cadaveric dissection. In this study, we investigated the nature and causes of this distress, identifying confusion about the cadaver's ontological status as a significant source. Using a framework derived from the humanities, we found that distress arose when students perceived dissection as treating persons like things. Because they perceived dissection as violating basic moral norms of Western society, some students responded by developing strong negative perceptions of their personal and professional identities. These findings yield two conclusions: (<reflink idref="bib1" id="ref134">1</reflink>) given that dissection may challenge norms fundamental to our moral understanding, the potential severity of distress and its consequences for trainees deserves greater scrutiny from medical educators; (<reflink idref="bib2" id="ref135">2</reflink>) interventions based on our framework and other humanities-based frameworks hold promise in alleviating distress but require further research to verify this potential.</p> <hd id="AN0191807139-18">Acknowledgements</hd> <p>The authors wish to acknowledge Susan Dodge-Peters Daiss' support for this project.</p> <hd id="AN0191807139-19">Author contributions</hd> <p>All authors made significant contributions to the study design and interpretation of data. All authors contributed to drafting and revising the work and approved the submitted manuscript. E.L. composed several sections of the manuscript, implemented revisions, and acquired data. C.M. composed a section of the manuscript, analyzed data, and oversaw study design and data analysis. N.R. acquired and analyzed data and assisted in the composition of several sections of the manuscript. M.H.S. composed a section of the manuscript and analyzed data.</p> <hd id="AN0191807139-20">Data availability</hd> <p>No datasets were generated or analysed during the current study.</p> <hd id="AN0191807139-21">Declarations</hd> <p></p> <hd id="AN0191807139-22">Ethical approval</hd> <p>The University of Rochester Medical Center's Research Subjects Review Board approved this study (STUDY00003059).</p> <hd id="AN0191807139-23">Competing interests</hd> <p>The authors declare no competing interests.</p> <hd id="AN0191807139-24">Publisher's note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0191807139-25"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Bernhardt, V, Rothkotter, H. J, & Kasten, E. (2012). Psychological stress in first year medical students in response to the dissection of a human corpse. 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  Data: The Anatomy of Ontological Ambiguity: Exploring Moral Distress in Cadaveric Dissection
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  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Erik+Larsen%22">Erik Larsen</searchLink><br /><searchLink fieldCode="AR" term="%22Christopher+Mooney%22">Christopher Mooney</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-2881-2169">0000-0003-2881-2169</externalLink>)<br /><searchLink fieldCode="AR" term="%22Natercia+Rodrigues%22">Natercia Rodrigues</searchLink><br /><searchLink fieldCode="AR" term="%22Margie+Hodges+Shaw%22">Margie Hodges Shaw</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Advances+in+Health+Sciences+Education%22"><i>Advances in Health Sciences Education</i></searchLink>. 2026 31(1):87-101.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
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  Label: Publication Date
  Group: Date
  Data: 2026
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  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Human+Body%22">Human Body</searchLink><br /><searchLink fieldCode="DE" term="%22Donors%22">Donors</searchLink><br /><searchLink fieldCode="DE" term="%22Laboratory+Procedures%22">Laboratory Procedures</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Coping%22">Coping</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Attitudes%22">Social Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Moral+Values%22">Moral Values</searchLink><br /><searchLink fieldCode="DE" term="%22Philosophy%22">Philosophy</searchLink>
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  Data: 10.1007/s10459-025-10436-5
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  Data: 1382-4996<br />1573-1677
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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.
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  Data: 2026
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  Data: EJ1508908
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      Pagination:
        PageCount: 15
        StartPage: 87
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      – SubjectFull: Human Body
        Type: general
      – SubjectFull: Donors
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      – SubjectFull: Laboratory Procedures
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      – SubjectFull: Student Attitudes
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      – SubjectFull: Stress Variables
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      – SubjectFull: Coping
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      – SubjectFull: Social Attitudes
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      – SubjectFull: Moral Values
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      – SubjectFull: Philosophy
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      – TitleFull: The Anatomy of Ontological Ambiguity: Exploring Moral Distress in Cadaveric Dissection
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