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. 2026 Jul 8;190(3):e70291. doi: 10.1002/ajpa.70291

Negotiating Terminology: Peer Review and the Collective Shapes the Language of NonConsensual Anatomical Decedents

V E Gibbon 1,✉, A Alblas 2,3
PMCID: PMC13420992  PMID: 42420219

1. Introduction

During the development and peer review of our manuscript, Custodians of Controversy: Navigating Stewardship Challenges with NonConsensual Anatomized Human Skeletonized Individuals in South Africa, extensive feedback from reviewers, editors, bioethics committees, and other relevant stakeholders necessitated substantial revision and multiple iterative cycles regarding the terminology for deceased individuals whose bodies entered anatomical programs through mechanisms lacking informed consent. This process revealed that the terminology itself became an important point of intellectual collaboration and ethical negotiation. The dialogue among peer reviewers, journal editors, anatomists, bioethicists, instiutional ethics board and government stakeholders all contributed to evaluating and shaping the conceptual framework and final terminology adopted in the manuscript. In this sense, the terminology discussion became, in effect, “the paper within the paper.” We submit this letter in the spirit of continued scholarly dialogue and ethical reflection, recognizing that terminology will likely continue to evolve as anatomy engages more deeply with questions of consent, dignity, historical accountability, and humanization.

We believe documenting this process is important for several reasons. First, it contributes to ongoing international discussions concerning ethical anatomical practice, posthumous dignity, and the legacies of structural violence embedded within anatomical collections (Jones 1994; Champney 2019; de la Cova 2019, 2020a, 2020b, 2022; Campanacho et al. 2021; Zuckerman et al. 2021; Agarwal et al. 2024). Second, it illustrates how peer review can function not only as a mechanism of critique but also as a valuable collaborative process through which more ethically sensitive and conceptually rigorous scholarship emerges. Finally, it highlights the necessity for continued disciplinary reflection regarding the language used to describe unclaimed and nonconsensually anatomized individuals.

2. Background

Contemporary anatomical ethics increasingly emphasize person‐centered approaches grounded in autonomy, dignity, and informed consent. As anatomy continues to confront its historical entanglements with inequality, coercion, and state power, careful attention to terminology remains essential (Štrkalj 2014, 2024; Champney 2019; Cohen 2019; Štrkalj and Pather 2021; Goldina et al. 2023; Moxham et al. 2026). Naming practices are not neutral descriptors; they carry ethical, historical, and political implications (Cohen 2019; Watson et al. 2022; Chala et al. 2024; Štrkalj 2024; Moxham et al. 2026). Developing respectful and accurate terminology is not simply a matter of editorial preference, but an important component of responsible anatomical scholarship and stewardship. As anatomical science increasingly engages questions of language, ethics, and person‐centered description, longstanding terminology risks perpetuating outdated and insensitive practices. Increasing disciplinary and public scrutiny has highlighted the need for respectful, precise, and ethically grounded terminology within anatomy. Terminology functions not merely as descriptive nomenclature, but as a mechanism that disciplines construct, obscure, or reinforce ethical relationships between institutions and the individuals whose bodies contribute to anatomical education and research.

Consequently, establishing precise terminology for deceased individuals whose bodies entered anatomical programs lacking informed consent is not simply a semantic exercise; it is an ethical imperative. The historical foundations of anatomical science remain deeply intertwined with systems of structural vulnerability (Jones 1994, 2023; Nystrom 2017; Alves‐Cardoso 2019; Champney 2019; de la Cova 2019, 2020a, 2020b, 2022; Campanacho et al. 2021; Zuckerman et al. 2021; IFAA Guidelines 2022; Watkins 2022; de la Cova et al. 2023, 2024; Kim and Friedlander 2023; Stantis et al. 2023; Agarwal 2024; Agarwal et al. 2024; Smithsonian Human Remains Task Force Members 2024), including the use of unclaimed and state‐directed decedents for anatomical dissection.

Terminology risks perpetuating outdated institutional practices by linguistically conflating legally sanctioned transfer with ethically legitimate donation. Therefore, a critical distinction must be maintained between legal authority and ethical legitimacy. The state may possess legal authority to direct the transfer of unclaimed persons into anatomical programs through legislative mandate (Jones 1994; Richardson 2001; Hildebrandt 2008, 2022; Jones and Whitaker 2012; Champney et al. 2019; Billings et al. 2024; Alblas and Gibbon, in press). However, ethical legitimacy derives from voluntariness and informed consent expressed by the individual prior to death. Legal sanction alone does not constitute ethical donation. Conflating these concepts through terminology that implies consent, where none existed, risks reproducing systemic disrespect while obscuring the structural conditions through which these individuals entered anatomical institutions.

Within this framework, we propose the development of contemporary anatomical terminology should be guided by three intersecting principles: accuracy, respect, and ethical neutrality (Figure 1). First, terminology must accurately reflect the legal and structural mechanisms through which bodies entered anatomical programs without assuming facts not in evidence. Second, language must remain person‐centered and preserve recognition of the deceased individual beyond their anatomical utility. Third, terminology should avoid implicit ethical endorsement or assumptions of voluntariness where formal consent cannot be demonstrated.

FIGURE 1.

FIGURE 1

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The intersecting space of ethically grounded terminology between accuracy, respect, and neutrality is illustrated.

3. Terminology

The review process evolved into a broader negotiation concerning how anatomical disciplines should describe individuals whose bodies were incorporated into anatomical teaching and research without demonstrable informed consent. The process of refining terminology in this context necessarily involved broad interdisciplinary scrutiny. Several descriptors proposed through the preparation and review of the parent manuscript were ultimately challenged as conceptually imprecise, ethically problematic, or potentially misleading; some of these are in Table 1, which illustrates the complexity of this ethical and conceptual negotiation.

TABLE 1.

Dissecting and evaluating rejected terminology for nonconsensual anatomized unclaimed state‐directed skeletonized individuals.

Proposed term The implied meaning The reality Objection(s) by principle Alternative suggestion
Cadaveric A donor or donated body for anatomical education and research. Individuals entered programs through mechanisms lacking consent.

Accuracy: Erroneously implies a voluntary donation.

Respect: Depersonalizes the individual.

 Anatomized.
Remains/skeletons/collections Biological specimens or clinical materials for study. These are the physical bodies of individuals with unique histories.

Accuracy: Obscures the personhood and lived history of the deceased.

Respect: Objectifies the individual by reducing a person to their biological parts.

 Skeletonized individuals/decedents/persons.
State‐donated/state‐consented Voluntariness and informed consent of donation. Individuals entered programs through mechanisms lacking consent.

Accuracy: Conflates legal sanction with ethical, informed consent.

Respect: Fails to recognize the lack of personal autonomy.

State‐dictated.

State‐directed.

Nonconsensual.
Unethically state‐donated A formal ethical ruling has been established. Making an evaluative claim requires formal adjudication. Neutrality: Fails to meet the mandate for ethically neutral, descriptive phrasing in formal adjudication.

Nonconsensual.

Ethically sensitive.

Ethically concerning.
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The concept of the anatomized body as experienced in this conceptual narrative warrants particular attention. Anatomization reflects the transformation of the human body into an anatomical object and subject within institutional practice. In contexts of voluntary body donation, the donor's autonomous agency remains ethically central to that transformation. In contrast, where no consent exists, the process risks reducing the individual to an object through institutional direction rather than personal choice. Thus, the term anatomized acknowledges not only anatomical utilization but also the ethical implications of objectification within nonconsensual systems of anatomical acquisition. Alternative terminology, including cadaveric, was deemed insufficient as it increasingly conflicts with efforts toward person‐centered anatomical language, and it may even be considered inappropriate or unethical (Paciello and Ressel 2020; Štrkalj 2024). Words like remains, skeletons, and skeletal collections transitioned with an overall focus from objectification toward humanizing language for the body, such as human skeletonized or human body followed by a descriptor to denote the person such as donor, donors, individuals, persons, or decedent/s. State‐donated or state‐consented were rejected because they imply voluntariness, autonomy, and informed participation despite these individuals entering anatomical programs through mechanisms lacking autonomous authorization. To do so risks reproducing historically insensitive language that obscures the absence of consent and the unequal social conditions under which many individuals became anatomized. Although the state may legally authorize the transfer of unclaimed individuals for anatomical use, legal sanction cannot be conflated with ethical donation. One term suggested was state‐dictated; we settled on state‐directed where it was required to retain. However, they were more accurately referred to as nonconsensual. Similarly, unethically state‐donated was considered problematic because it presupposes a formal evaluative ethical adjudication that may not have occurred. Instead, recommendations for the adoption of ethically sensitive or concerning or ethically neutral terminology capable of describing the circumstances without presuming legal or moral judgment were advised.

Ultimately, nonconsensual anatomized unclaimed state‐directed (NCAU) skeletonized individuals was adopted and intentionally retained, despite its linguistic burden and complexity (Alblas and Gibbon, in press). Its length and specificity function as an ethical interruption against the normalization of structurally vulnerable individuals within anatomical discourse. Rather than permitting conceptual abstraction through simplified terminology, the phrase requires continual engagement with the realities and sense of nonconsensual structural vulnerability, destitution, state direction, and anatomical objectification embedded within these histories, while retaining an accurate description of biologically being skeletal and individuals chosen to provide the human and autonomous centered dignity afforded, it reinforces a person‐centered perspective.

4. Conclusions

As anatomical education increasingly embraces person‐centered ethics, disciplines must critically examine whether inherited terminology conceals or perpetuates historical inequities under the guise of neutrality. Collectively, these exchanges underscored the complexity of establishing anatomical terminology that is simultaneously accurate, respectful, historically conscious, and ethically defensible. Language shapes how anatomical disciplines and institutions recognize, remember, historicize, and ethically position (sense) decedents whose bodies have contributed to health sciences education and research under conditions where consent was absent, uncertain, or structurally compromised.

This process underscores the often‐unrecognized ethical role of peer review and scholarly collaboration in shaping disciplinary language. Even where contributors remain anonymous through editorial and review processes, their intellectual engagement materially influences the ethical refinement of scientific discourse. The development of ethically grounded anatomical terminology is not the product of a single authorial perspective, but of collective scholarly engagement and responsibility.

Author Contributions

V. E. Gibbon: conceptualization, investigation, visualization, writing – original draft, writing – review and editing. A. Alblas: writing – review and editing, investigation.

Acknowledgments

We acknowledge and thank all those who have influenced and shaped our thinking about ethics for deceased persons, especially the Ancestors, descendants, and community interested parties who have taught and guided us and all those who have contributed to the global perspective. We thank bioethics advisors and anonymous reviewers, and community groups who provided valuable insights that have grown and helped develop our conceptual and intellectual contributions. The National Research Foundation is acknowledged for funding this research. Opinions expressed and conclusions arrived at are those of the authors and not necessarily to be attributed to any of the individuals or institutions acknowledged.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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