More than a month after his death, the body of MM Lawrence, a veteran Communist and trade unionist who expressed his wish to donate his body for anatomical study, is still lying at the Kalamassery Medical College in Kochi after being caught in a bitter dispute,
Though the Kerala High Court dismissed the plea of his daughter - Asha Lawrence - challenging the move for donation of body for medical research, uncertainty looms as she is set to file an appeal seeking a religious funeral for her deceased father.
Lawrence, when he made the decision, joined a small but growing tribe of Indians choosing science over ritual but the legal wrangle that ensued has brought to fore the complexities that arise when religious and family sentiments clash with end-of-life personal choices.
Unfortunately, such disputes are not a rarity in families of non-believers, post their deaths, in Kerala. That is precisely why the Kerala Yuktvadi Sangham (KYS), a forum of rationalists, and AT Kovoor Trust are fighting for - to protect the rights of individuals over their dead bodies.
The HC dismissed the petition after taking into account the statements of two witnesses to whom Lawrence had expressed his desire to donate his body for medical research. Among his three children, Asha had objected to the donation, while his son ML Sajeevan and another daughter Sujatha Boban agreed to it. Later Sujatha took a U-turn in favour of the church funeral, further complicating the issue.
For the past few days, members of the KYS have been petitioning state Law Minister P Rajeev, requesting his intervention to bring legal sanctity to the ‘letter of consent’ for body donation. In the petition, they call for a strict implementation of the Kerala Anatomy Act 1957, which allows individuals to express their willingness via a written consent or orally in presence of one or two individuals during her/his last illness. According to KYS general secretary TK Shakitdharan, the authorities of Medical College Hospitals in the state often refuse to accept the bodies if there is any opposition from the part of family members or relatives during donation.
In its recent order, the Kerala High Court gave emphasis to the Section 4 of the KAA, despite Lawrence’s two children taking a stand in favour of religious funeral. “The statement of the 6th respondent (Sujatha) that, in October, 2021, her father had expressed his desire to be buried in the Church, even if accepted, is of no avail since, for the purpose of Section 4A(1), only the expression of request made by the deceased during his/her last illness can be taken into consideration,” the bench of justice V G Arun observed.
The section states that, if any person, either in writing at any time or orally in the presence of two or more persons during his last illness, has expressed an unequivocal request that the body be used for anatomical examination and dissection after death, the wish be honoured.
Challenges for body donation
Though the Kerala High Court prioritised the oral consent of the deceased, KYS said the challenges are manyfold even when there are written and oral depositions. In most cases, section 4A(2b) of KAA, which prevents takeover if ‘the surviving spouse or any near relative of the deceased objects to the body of the deceased being so dealt with’ is given a weightage.
“Body donation can be done by handing over a consent letter signed by the spouse, children and two external witnesses to the principal of the medical colleges concerned. However, if someone in the family raises an objection, the letter will be useless. Some years ago, I was helping the family of a deceased rationalist with the body donation. The wife and children were in favour of donation. Then a relative, who had no association with the family over decades, raised an objection and demanded a church funeral. We finally managed to ensure the will of the deceased. However, in certain cases, opposition of a random relative can disrupt the plans,” he said.
The rationalists’ organisation also demanded proper procedure to take over the body. Except in the case of private medical colleges, the families or witnesses are expected to hand over the body to the nearest Medical College hospital. “Recently, a family in Idukki had to spend Rs 10,000 to arrange an ambulance to send a body to Government Medical College in Kottayam. In one case, the hospital asked us to bear expenses to keep the body in mortuary as there was some delay in receiving it due to some voltage issue at the hospital,” said Sukumaran.
Shaktidharan pointed out instances where the hospital authorities displayed lack of dignity towards the dead bodies. ‘Place it somewhere here,’ they said once, he added. There are also complaints against hospital staff of complicating the process of takeover in the name of minor issues and their uncompassionate attitude towards bereaved families. Such discouraging moves happen even when medical colleges are struggling to find enough cadavers for their anatomy departments.
There is also a lack of uniformity in the value of stamp paper. ‘In Thiruvananthapuram, the letter of consent can be given to MCH principal in a stamp paper of Rs 200. In Thrissur, it is Rs 100 and stamp paper of any value, even Rs 50, is acceptable at Kozhikode medical college,” he said.
In the absence of written consent of the deceased, Shaktidharan said that a letter from close family members - spouse or children - will be considered for donation. “Earlier, a statement by a prominent person - may be an elected representative of the local body, is given to confirm that the person died of natural causes. Now most MCHs do not insist on that,” he said.
With the support of KAA, medical colleges usually take over unclaimed bodies to meet the demands of cadavers in anatomy departments. Following a huge demand for cadaver by private medical colleges, the Kerala Health and Family Welfare Department issued an order in 2008 allowing medical colleges and general hospitals to sell unclaimed bodies to private medical colleges at a rate of Rs 40,000. According to a report, the government collected Rs 3.6 crore through sale of 1122 unclaimed bodies to private medical colleges since 2008.
As per studies, the ideal cadaver student ratio is 1:10, which many medical institutes struggle to ensure.
As part of a decades-long awareness campaign, the KYS and AT Kovoor Trust, founded in the memory of rationalist Abraham Thomas Kovoor, have been able to arrange 164 human body donations in Kerala since 1980. Rationalist and secretary of AT Kovoor Trust Dhanuvachapuram Sukumaran said that they started the campaign to ensure enough cadavers for medical studies and also to end the superstitions around ghosts and spirits.
According to Sukumaran, the first donation in Kerala happened in September 1980 when former general secretary of KYS Iringal Krishnan handed over the body of his mother K Kalyani to Kozhikode medical college. “Since then donations of 164 bodies and 360 pairs of cornea have been arranged by KYS and Kovoor trust. With an intense campaign in Thrissur district, 55 bodies were donated to Thrissur medical college alone,” he said.
Private bill in Kerala Assembly
There was an unsuccessful bid to address these concerns at the Kerala Assembly in 2010 when the late CPI(M) member Simon Britto Rodrigues moved a private Bill. Titled ‘Non-Religious Corpse Cremation Assurance Bill’, the Bill was then set aside by the Assembly. Britto, an Anglo-Indian member at the Assembly, envisaged a proper mechanism to register the will of individuals to dispose of their bodies. It also proposed to appoint an executive for non-religious funerals. According to KYS, the bill never materialised due to the pressure from religious bodies.
When Britto died in 2019, his body was handed over to MCH, Ernakulam, for medical studies.
A unique ‘funeral ceremony’
In 2023, a unique event was held at a mini auditorium in Neyyattinkara, a municipality in Thiruvananthapuram district. Dr CV Jayakumar, 74, retired headmaster, rationalist and state general secretary of Environment Protection Programme, observed it as his 'sanchayanam' (a funeral rite) while alive. Jayakumar invited around 500 people, including his friends, colleagues and relatives. "The event was planned as a meeting of friends and family members. More than 800 came. The achievements of my career and social activities were displayed at the event. The main aim was to raise awareness about donation of organs and body after death. Around 15 persons were arranged to declare their consent for body donation. In addition to this, eight persons too agreed to donate their organs and body at the function. I am planning a similar event in 2025 too," he said.
“The aim is to be of some use to the society even after death. That is more valuable than giving to worms or turning into ash,” Jayakumar said.