Question of Consent

In class, the question of what constitutes exploitation was raised; in particular in regards to the issue of exploiting psychological states of the downtrodden.  Even with medical studies, I do not feel that the poor or prisoners should be excluded from being able to consent because of their situation. To claim that a poor person is not consenting to an experiment because they need the money seems cruel. They need the money, and as long as they are aware of the risks they should be allowed to participate and earn that money.  In the case of prisoners, as was discussed in class, although they may be more willing to participate in studies because they feel as if they owe society a debt, the truth of the matter is they do owe society a debt. I do not feel that they should participate without being aware of the consequences, but as long as they know what they are signing up for, I feel that they are giving valid consent. In both these cases the participants can be said to be vulnerable or desperate, but as long as they are adults, I feel it is worse to deny them the ability to consent than to let them participate in studies. This consent/participation, however, rests on the assumption that they have full disclosure and without such disclosure, no matter who the participant is, there is not an instance of valid consent

A note on Jurkat Cells

After all this talk about the HeLa cells this week, I decided to look into the concept of immortalized cells. There are a different type of immortal cells known as Jurkat cells. They are lymphocyte cells and are used in leukemia testing and cell signaling. They are considered important because of the cells' ability to produce interleukin 2.

The cell line was established in the late 1970s (decades after Henrietta) and originate from a fourteen year old boy with leukemia.

When I found this out, the first thing that came to mid was the child's age. Obviously there had to have parental consent, and surely the kid's name would not be released because he/she was a minor.

I know we play around with the what ifs, but a lot of the Henrietta Lacks debate stems from the lack of consent and the moral issue of the success of the cell in medicine. The Jurkat cells seem to have been consented and are only really known in the medical. But I imagined a scenario where this 14 year old was in Henrietta Lacks time. Would "experimentation" with a child's blood cells been just as controversial? Obviously it is hard to imagine, but it is very thought provoking.

Deborah and Skloot

It has been interesting to find that as Skloot searches and discovers things about Henrietta and in engaging with her family, Deborah has been able to face some unanswered questions. Deborah experienced a harsh childhood, without her mother, and it has been hard for hear to deal with information regarding her mother and her cells. But along with Skloot she has been able to accomplish more in discovering who her mother was and what this means to her. I feel that the book not only lays out issues regarding this woman and her immortal cells, but also the life and family that she left behind due to the cancer that provided an ability to work with and research the immortal cells.

Medical Reimbursement

In class we talked about whether or not the Lacks family should receive compensation for the medical breakthroughs that came about as a result of Henrietta's cell line. I feel that they do not deserve compensation but maybe as a good gesture maybe the medical bills should have been taken care of so the family didn't have to worry about them. David "Sonny" Lacks spoke last May at the California Center for the Arts in Escondido. He said himself that he feels the family should not be compensated for his mothers cells being taken. He felt that the family should have been informed that the cells were being taken, what they were being taken for, and the intent of the research. The only reimbursement he feel the family should have received is for the cells being sold to labs all over the world because medical companies did commercialized his mothers cells. Which to me seems fair.

HeLa Attention

During our discussion on Tuesday, I was trying to follow the discussion, with some difficulty, about the first section of The Immortal Life of Henrietta Lacks.  I was a little confused by the reading and what we were discussing.  As I understood it, Henrietta Lacks was admitted for surgery much earlier than African-American women tended to be during the time she first became sick.  This was nearing the rise of the civil rights movement, so anyone associated with a darker skin tone was sent to the colored section, which she initially was, and was taken into consideration at a later time.  The fact that she was admitted as early as she was and was operated on surprised me, although she had been sent home before when she came in complaining about a pain that ended up being a tumor.  I'm just curious as to why she was taken into care as quickly as she was at John Hopkins, and if she hadn't been admitted and operated on at that point, if she would have been at all, and if the HeLa cell line would have come to be known to us at all.

Prisoners vs. Lacks

Going off our conversation we had on Thursday, I wanted to talk about the use of prisoners as test subjects compared to Henrietta Lacks. Yes I do believe that both were taken advantage of and  weren't told all the information they could have but I'd like to point out that the prisoners had a choice while Henrietta did not. The prisoners were informed that some or of experiment was going on. They were put under certain conditions that made participating for the study seem like the right answer but they did have the choice to say not, and some did. Henrietta Lacks on the other hand had cells taken from her cervix specifically for experimentation. She never had the choice/chance to say, no I do not want to partake in the experiment. Even though I do believe she might have said yes if she was asked; simply taking the cells gave her no choice in the situation. 

Also adding on to the the prisoners being able to make the choice of partaking in the study idea ; I feel like several people wouldn't feel bad for the prisoners because they made the choice to put themselves in the place they are. I don't think its right experimenting on them if it is very dangerous  but if it is something that has very mild side effects then maybe it isn't 100% a bad idea. I know there are a lot of moral red flags that would turn up but if they are willing and it wouldn't seriously hurt them...why not? 

Medical Copyright?

As we were discussing the issues concerning Henrietta Lacks and her immortal cell line, the question arose as to whether or not her or her family deserved financial reimbursement due to the medical breakthrough resulting from her experience.  I had a bit of a problem with this, a lot because this concept goes hand in hand with the idea of copyright.  Although Henrietta was influential in the founding of the immortal cell line, she made no scholarly contribution to its founding.  She didn't even grant consent for the procedure, so she had no awareness of her cells even being taken from her.  Although I agree that Henrietta's story is significant in the history of medical science, I do not view her as an individual as significant.   If you reimburse her family, then every time someone's treatment requires her cell line, she would need more reimbursement and then you get into the idea of copyright and is medical copyright even ethical.  I just didn't see a need to financial reimburse them out of sympathy.  It could have been anyone.  Like I said in class, it's like hitting the lottery.

Gender Inclusivity

The Gender Inclusivity Forum took place on Wednesday to a smaller crowd than I expected. Gender inclusivity was the topic, but when push came to shove some of the biggest criticisms were quickly shut down by members of the administration. Even when a transgendered student stood up and told his story and the injustices he suffered while trying to just fit in, the ominous presence of the administration in the room was clearly felt.

The underlying problem I felt while in the forum was of the freshmen single sex buildings on our campus. Vice President Herman countered statements in support of this housing structure stating that several students who enroll enroll solely because of their parents penchant for the the single sex rooms. However, any student can sign into any other students room at night, so the separation created by this policy truly only extends so far. Of the parents if our students aren't progressive enough to accept this, then I feel that is a ridiculous notion.

SUNY Fredonia is in the category of "university colleges" of the SUNY system, setting them apart from university centers such as UB and UA, and community colleges and tech schools. Of these university colleges, Fredonia is the last school other than SUNY Maritime that has single sex freshmen buildings. We need to reassess this situation and change our course as an institution.

Johns Hopkins Hospital

In the discussion of Johns Hopkins Hospital being built in the African American neighborhood -was it for the sole purpose of having available test subjects or were the intentions to actually help those individuals? I think that after reading part two, Skloot explained and provided a letter from Hopkins himselfin which Hopkins' intentions were to benefit African Americans, not exploit or take advantage of them. In my opinion his intentions of placing the hospital where he did was to help those who couldn’t afford medical care. In his letter he expresses how he wants to help the poor and he even set aside money for the children who are orphaned. Do you think his intentions represent what actually occurred in the facility? Many African Americans were afraid to be near the hospital having the idea that they might be kidnapped for research and testing. I think he would have viewed what was happening as unethical treatment towards the black population.

-emothersell

What you don't know won't hurt you

Although I think that Henrietta Lack's family should have been told what was happening to her cells, I think it was a good thing that the Doctor did not release her name into the public.  Her name does not reveal her race and her race was not questioned when the magazines were inquiring about her name.  Henrietta's family was also not very educated.  If her name was released there could have been a possibility of other family members being exploited.  In Henrietta's case it was absolute chance that she had a cell line that would reproduce quickly.  She wasn't chosen from a pool of people for her cells to be taken, but her family could have been a target to see if other family members could produce cancer cells in the same way.  Being uneducated would have let the doctors do whatever they wanted to their bodies.  Full disclosure was not part of the doctors agenda.  By the end of the book, what the family didn't know ultimately hurt them.
Compensation was also a topic that was brought up.  Henrietta did not do anything to get paid however, the doctors did take something from her body.  The Lacks family could have used the money but the question of how much and exactly how the family would be compensated arises.  If the family was compensated with money, how much would be deemed appropriate and would they have been compensated in the first place because they were black?  I don't think we can honestly say that if they were white they would have been compensated unless we have a similar example.  Henrietta's story is unique because it was complete chance, so it is hard to make assumptions without bringing in what-if scenarios.

Do the Advancements Outweigh the Suffering?

            As we have been discussing the ethical and unethical opinions of medical procedures especially in regards to the Tuskegee study and Henrietta Lacks there are many things to consider.  Yet Henrietta was colored and many things Henrietta experienced were thought to be extremely unethical and if a white person were to ever experience the same things an out rage would occur. But, do you think if Henrietta happened to be white and they had continued treatment and discovered her immortal cells, would this information still have been released for sake of medical advancement, or maybe even made circumstances better because she was white? One of my main thoughts and questions is do you think even though individuals suffered from these treatments do you think the advancements in the medical field outweigh the suffering? Considering over time how many people there treatments have helped. Also as you read later in the book, Henrietta’s family wasn’t as upset about the fact of what the doctors did to Henrietta, taking her cells without consent, as much as they were about now knowing about what happened for years. Do you think if the family knew about the sampling and growing of Henrietta’s cells would things have been different? Below is a link from ABC news listing a few of the medical advancements of the HeLa cells and some comments from her family.

http://abcnews.go.com/WN/henrietta-lacks-woman-cells-polio-cancer-flu-research-medicine/story?id=9712579#.UUutRaW27zI

Part 2 of Henrietta Lacks Artifact-Nuremberg Code

Artifact Description: The artifact I chose was the historical principles of ethics called the Nuremberg Code, which was proposed in 1947. These ethical guidelines for human experimentation were a result from the trial of twenty-three Nazi Doctors who were charged with doing medical experimentation on Jewish prisoners in concentration camps without their consent. The Nuremberg Code was never a law, but was the first document to advocate informed consent and voluntary participation. It has been adopted as part of policies in research done today. These guidelines enforce the issue of ethics, consent, and full disclosure of information to the patients receiving treatment. I think that this artifact exemplifies how patients should be treated, and unfortunately the codes were not put into law. They were not even taught in medical schools after sixteen years of their creation when Henrietta Lacks was exploited. I also have included a timeline from 1951 to 2005, which categorizes various discoveries that resulted from Henrietta Lacks’ tissue sample.

Critical Analysis: In Part Two of The Immortal Life of Henrietta Lacks, called Death the issue of patient consent and racial inferiority in medical institutions continues. “Though no law or code of ethics required doctors to ask permission before taking tissue from a living patient, the law made it very clear that performing an autopsy or removing tissue from the dead without permission was illegal (pg. 89).” Henrietta was never asked by doctor if he could take her cancerous cells, but after she had died her husband was questioned in regards to an autopsy on Henrietta’s body. They never disclosed any information but that it would help his children and grandchildren in cancer research. So how could he say no to that? Even after Henrietta’s death the family was kept in the dark, but why were scientists keeping quiet about the source of the cells. Was it because Gey in a way knew it was unethical and that the family would be upset or did he not see it as a big deal since Henrietta received free treatment and in exchange he could take her cells? I think another possibility is that he didn’t want the public knowing the cells came from a black woman.

                  In 1951 Henrietta Lacks dies and a year later The Tuskegee Institute opens the first “HeLa factory” to supply cells to researchers and laboratories. Within a few years, Microbiological Associates began selling HeLa cells for profit, making a multibillion dollar industry. The troubling realization is that Henrietta’s family was struggling in poverty, barely able to afford medical care and they didn’t even know their mother’s cells were famous and making money for medical companies. As Skloot explains, “black scientists and technicians, many of them women, used cells from a black woman to help save the lives of millions of Americans, most of them white. And they did so on the campus- and at the very same time- that state officials were conducting the infamous Tuskegee syphilis studies (pg. 97).” This is just ironic that even though the authority of white scientists and doctors take advantage of the African American race, an African American woman is the source to the breakthrough in many scientific findings. The issue of race comes back into play in regards to using African American cells and that they must be the problem.

                  African Americans were viewed as ignorant and to instill fear in the patients would have been harder for the doctors to do what they wanted so they would not ask for consent or be completely truthful. Many doctors tested on slaves through drug use and surgeries, often without anesthesia. During this time with the Tuskegee Trials going on, after the abusive history of slaves by researchers, and many African Americans believing that the Johns Hopkins Hospital kidnaped black people for research were several reasons why they were afraid of medicalization. The authority of white males projects fear and mistreatment to African Americans. The Nuremberg Code should have been more widely used in policies, not just something to disregard. It was argued that the Nuremberg Code did not apply to the United States, but it was written by the International Military Tribunal, including the United States. I think this was an excuse some doctors used to get out of trouble when they didn’t follow guidelines.

 It wasn’t until 1957 that the term informed consent was used. An example from Skloot demonstrates a man under the impression he was having a routine procedure until he woke up paralyzed from the waist down. The doctor never divulged any risks to the procedure. Informed consent involves the doctor giving full knowledge of the procedure to the patients. In another instance, Chester Southam injected cancer cells into patients without their consent or knowledge was a violation of the Nuremberg Code and the rights of human beings. I think that American doctors did hear about the Nuremberg Code, but decided not to follow it because it wasn’t law. Thus, allowing them to continue in the course of finding success in their experimentations no matter the cost to the patient or subject in their eyes.

 The Nuremberg Code 

 1. The voluntary consent of the human subject is absolutely essential.

This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved, as to enable him to make an understanding and enlightened decision. This latter element requires that, before the acceptance of an affirmative decision by the experimental subject, there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person, which may possibly come from his participation in the experiment.

The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.

2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study, and not random and unnecessary in nature.

3. The experiment should be so designed and based on the results of animal experimentation and knowledge of the natural history of the disease or other problem under study, that the anticipated results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.

5. No experiment should be conducted, where there is an a priori reason to believe that death or disabling injury will occur; except, perhaps, in those experiments where the experimental physicians also serve as subjects.

6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.

7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.

8. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment.

9. During the course of the experiment, the human subject should be at liberty to bring the experiment to an end, if he has reached the physical or mental state, where continuation of the experiment seemed to him to be impossible.

10. During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject. 

 "Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10", Vol. 2, pp. 181-182. Washington, D.C.: U.S. Government Printing Office, 1949.]

The link for the time line is bellow as well:
http://www.wired.com/magazine/wp-content/images/18-02/st_henrietta_f.jpg

Questions:

1. Southam injected about a dozen cancer patients with HeLa cells, only telling them that he was testing their immune systems. What do you think about Southam injecting the malignant HeLa cells into individuals without any consent, and that he was only put on probation for one year?

Do you agree with the argument that “if the whole profession is doing it, how can you call it ‘unprofessional conduct’?

2. Why did George Gey decline to identify Henrietta Lacks for journalists? Do you think he felt guilty and knew what he did was unethical?

3.  Henrietta’s cells are replicated and sent all over the world, not many people stop to think these samples are from a human being. Her story was unknown to most at the time and scientists overlooked that aspect and thought of cells as tools in their experiment. Do you think the majority of doctors and scientists tend to see patients as specimens rather than as people?

4. Skloot explains how black residents near Hopkins have believed the hospital was built in their poor neighborhood for the benefit to the scientists, giving them access to research subjects. But, according to Johns Hopkins his purpose of the hospital was to help those who couldn’t get medical care. Do you think that Hopkins’s intentions of the hospital represent what occurred in the facility or would he have seen the treatment of the African American population as unethical?

-emothersell

Prisoners as test subjects?

In class today we talked about how the prisoners were volunteering to be part of the tests. Even though they were not being told exactly what test were being done i think this is fine. Yes prisoners may have only been agreeing to the test so that they could feel like they are giving back to society or so that they could get out of the hard labor that they would other wise have to do. But people who are in prison any way you look at it made the choice to put themselves there (yes i know some people are wrongly convicted but were not talking about them) When the person who is in jail gets put there they should have to do something to give back to society. I do not believe that there is a problem with testing drugs on people who are in jail because the people who are there usually have in some way affected the lives of one or more people in society and they should have to pay society back in some way or another.

Prisoner Volunteers for Study- Ethical or Not?

Part 2: Death discusses how Henrietta Lacks' cells were used for cancer research on inmates in Ohio. In class, we talked a great deal about whether or not it was fair to specifically target prisoners in jail cells to be subjects of this study. It is a complex argument and in my opinion, I think that because Southam only published an advertisement in the penitentiary newspaper, it is as if he is inferring that these prisoners are inferior and therefore, will be more likely to commit to being a volunteer, because they have no other option. It is interesting that some people brought up the fact that they are responsible for the crimes that they executed because that all goes back to what experiences they have gone through and the education that they received, which has a basis of what their race/ethnicity is and where they stand in terms of social stratification. For example, if an inmate was African-American living in an inner-city ghetto, he/she has been subjected to indirect institutional discrimination leading to the lack of high-quality education and a greater exposure to violence and drugs. The fact that we spend so much of federal/state money goes towards sustaining prisons and jails is appalling. We could be spending that money providing educational assistance and emotional intervention to prevent crimes from occurring, but instead we are in away, encouraging illegal crimes to persist. Back to the medical aspect of this study, I do not think what Southam did was ethical in any way, shape or form. Despite the fact that they are prisoners and have done injustice to others, does not mean that they aren't human and don't deserve their natural rights. I know that it was a voluntary study, but just by selectively choosing prisoners as participants, and failing to promote the study to non-prisoners, is a bit discriminatory and unethical in itself.

When Is Going Too Far?

Many people have brought up this questions in comments and during class. There are many instances and occasions where doctors have done things to expose people.With Henrietta Locks, her whole life is exposed and so is her family. This brought in general thoughts about exposing people. We know that in celebrity news and gossipy-type news, people are exposed left and right. Even though these people that are exposed are celebrities, it seems as though they are exposed for entertainment.

I'm not trying to say that Henrietta was exposed for entertainment. I do not think that. But when it comes to exposing in the medical field, of not only the patient but their family as well, do you think that medical professionals should be allowed to do that? Or should they be able to keep the patients personal information confidential in these terms? What's your opinion?

And if you think so, do you think that Henrietta's case was exploited for actual scientific research, or for entertainment purposes?

-Courtney O'Donnell

Artifact Presentation on Part 1 of The Immortal Life of Henrietta Lacks

Artifact Description

            As my artifact for the first part of Rebecca Skloot’s The Immortal Life of Henrietta Lacks I have chosen an article detailing the use of informed consent laws in abortion clinics. This article focuses in particular on South Dakota, who has recently amended their informed consent laws. The laws are designed to inform patients about the details and risks of an abortion, as well as make the patient wait 72 hours to proceed with an abortion after hearing the information. Proponents say the laws are designed to inform and educate patients, while critics say the laws are designed to scare women and intimidate them into deciding against an abortion.

Article: http://www.npr.org/2013/01/22/169975954/states-become-battlegrounds-for-nations-deep-abortion-divide

Analysis

            In Part One of The Immortal Life of Henrietta Lacks, the issue of informed consent is a major issue in Henrietta’s care, though not in the same manner as detailed in the above article. In her case, she was not informed that the medical care she was receiving was going to render her infertile. She was also not informed that samples of her tissue were taken from her for use in cell culture experiments.

            At issue here is the use of informed consent by those in power. Henrietta Lacks, like many poor African-Americans of her time, was simply grateful to receive free medical attention from the medical professionals at John Hopkins. She would not have questioned their actions and opinions even if she were capable of doing so. For some reason, Henrietta was not told she would become infertile if she received radiation treatment for her cervical cancer. While the book is inconclusive about why this happened, it is certainly possible that the doctors, perhaps intentionally, neglected to tell her a serious side effect of this treatment.

            Also at issue is the use of Henrietta’s cells without her permission. As the book mentions, the doctors at John Hopkins believed they were entitled to use patients in their public health ward as test subjects. They were performing high quality health care for free so they figured it was the least they could do. Their patients were in no position to protest, since the white medical professionals intimidated them. Therefore, the doctors did their research without informing their patients. In Henrietta’s case this became an issue when her cells spawned the HeLa cell line. It benefited millions of people and resulted in profits and prestige for many doctors and companies, but Henrietta’s family never received any recognition or monetary benefit. This is a clear case of the medical establishment exploiting an African-American patient.

            In the modern case of informed consent and abortion, politicians are attempting to use their legislative power to prevent a demographic, in this case women, from having abortions. It is almost the exact opposite of Henrietta’s case, but it showcases the same situation: a powerful group attempting to impose their will on another group through informed consent. While women can still receive an abortion after waiting, the law certainly seems to be designed to scare women away and intimidate them from making a choice about their own body.

Questions

           I.     1. Do you think the public health wards at John Hopkins were constructed to exploit the African-American population around it or to benefit them?

         II.     2. When beneficial medical advancement results from research on an unknowing patient, with no harm to them and a plausible excuse to do so, is the research invalid?

       III.     3. In the readings, much was made of Henrietta’s lack of medical knowledge and general education. The point was that African-American’s lack of knowledge impaired them in making informed decisions and in avoiding malicious medical professionals. Today, the public is told to bring up their own opinions and become educated themselves on their medical conditions. On the other hand, a medical professional may feel insulted if someone insinuates they do not value their advice. My question is: what role should patients and doctors play in their relationship?

       IV    4. While Henrietta received the latest operations and medical techniques, Rebecca Skloot criticized the overall patient care (time and length of treatment, fewer pain meds, higher mortality rate) of John Hopkins free medical wards. Do you think Henrietta would have fared better if she had received treatment in the white section of the hospital?

Research Legitimacy and Ethical Violations

Looking around to see if there were any recent news about Henrietta Lacks, I stumbled upon an article that talked about the sequencing of Henrietta Lacks’ DNA to see what complications they had. 

http://www.nature.com/news/most-popular-human-cell-in-science-gets-sequenced-1.12609 

The research that has been done on the sequencing has found many errors in the genome sequence. This can result in complications that arise from these errors in the genome. A problem arises that is due to the unavailable sequence of Lacks’ correct cells. The article further points out the success the cells have generated such as the vaccination for polio. In a contemporary example this brings up a question that can be applied to both the past and the present. Is the research that is generated from these cells legitimate?

Another question is the ethical violations that have not been addressed by the medical community. I may be wrong, but I have not seen an apology to the family like the Tuskegee Syphilis Case. I feel that so far in the reading, the family has been shut out of many benefits they should be receiving from the medical community for Henrietta’s contribution of more than 60+ years.

Darren Pope

Museum Studies

The issue we addressed in class about the Mutter Museum, I believe, is being over sensitized. We asked, is it truly people who care about the medical profession that are using this museum, or is it just people who want to see a modern day freak show. I feel as though the educational aspect of the freak show concept can be just as educational as sitting someone down and explaining how offensive they are. Truly, it cannot be denied that someone going to a museum to see the deformed remains of others is offensive, however, when one out of the ten people who go to see these remains learns something more about the disease or affliction, and generates sympathy for the person who was afflicted, I feel it is worth it.

If we want to get upset about people using the museum as a freak show, you're starting in on a discussion about morals and beliefs. Of course it is wrong for someone to go to simply gawk at a skeleton, but is it for us to decide they are therefore evil people for displaying the artifacts in the museum? I think not, and I whole heartedly agree that the owners of the museum are not at fault for displaying these remains, but rather that the people who come to gawk should respect the dead.