In October 2022, the Centre for Ethics of Yenepoya University hosted a national workshop entitled: “Respect for human dignity of the unidentified dead from mass disasters and other violence: strategies for the ethical management of biological samples and personal data”. The aim was to explore and share experience and ethical considerations regarding the management and identification of human remains from forensic casework, including in the event of disasters, considering that the successful identification of victims contributes not only to the state's obligations, but also to addressing humanitarian needs of victim families and communities. The workshop consisted of several short presentations followed by a general discussion involving all attendees as well as an exploration of the ambiguities regarding unidentified human remains in the Indian context. The purpose was to arrive at a general consensus about what constitutes the ethical foundation of the management of unidentified human remains in forensic practice and, in particular, contextualizing this in India.

For the majority of witnessed deaths that take place outside the setting of mass disasters, the processes of victim identification and subsequent death registration are relatively simple and based on routine protocols. Therefore, when death occurs in medical institutions, or is witnessed shortly after its occurrence by medical practitioners who have been involved in the treatment of the deceased, then death certification is straightforward. In these circumstances, the identification of the deceased as a particular person will often pass as a relatively unnoticed bureaucratic and expert task. However, not all dying is attended by medical practitioners and so its occurrence cannot be contemporaneously recorded. In these cases, the examination, authoritative identification, registration, and subsequent funerary treatment of such bodies involve more complex work in which forensic practitioners and police forces will be involved in determining a number of features of the person and its death that will, in turn, shape any investigative trajectory to follow.

The aim of this short communication is to present ethical considerations regarding the management and identification of human remains in the event of disasters. This represents the outcome of a national workshop in India on respect for the dignity of the unidentified dead following mass disasters.

Mass disaster situations often generate a large number of human casualties, as well as cause grave social and administrative disruption. Tracing the missing and identifying the dead are crucial to maintaining or restoring basic human rights and responsible relief activities.

In some cases, the bodies and body parts of dead persons thus remain the object and subject of a variety of forms of moral, legal, and scientific rulings for unexpectedly long periods of time. Sometimes bodies remain unidentified, anonymous case numbers that create what the United States National Institute of Justice calls a “silent mass disaster” because of its cumulative effect over time [1].

Identification is necessary to reduce uncertainty and as part of the mourning process of relatives and friends, as coping or developing resilience, considering that a “reverential” treatment of bodies is part of this important socio-psychological process. Identification is necessary for registration and subsequent efforts governing disaster impacts, including funerary rites, property disbursement, criminal or civil court actions, and possible economic compensation.

“Identification” is a general term for a collection of heterogeneous practices involving a number of stages and a variety of forms of knowledge. In a mass fatality incident context, the steps include the collection, documentation, and storage of found remains; the remains' examination and sampling; and the collection and analysis of information and missing person material from the family presumed to be related to the deceased. Thus, identification is not only an organizational and scientific achievement but, regardless of circumstances, also necessarily and always an activity with significant political, epistemic, and philosophical relevance and consequence [2]. The forensic investigation of human remains following a mass disaster has the dual objectives, and public forensic experts have a duty to try to accomplish both, of recovering and examining remains for criminal investigations—which includes establishing the cause and manner of death—and identifying the remains to return them to the family. The last objective helps family members by knowing the fate of their relative and allowing the remains to be handled in a culturally appropriate manner, thus enabling the families of the missing to mourn their loss [3].

As workshop participants asserted, biological death is not the same as social death and that there are posthumous interests of the dead, their families, and their communities to consider (what people care about is what happens to their bodies, and most of us think that people should be able to determine what others are allowed to do to their bodies) [4]. In fact, the physical death of people does not immediately mark the end of their personal and social identity trajectories [5]. The many ways in which we continue to interact with, or invoke, past persons and their material bodies continue to shape and answer to their postmortem identities. We can define “posthumous interests” as the interests that living people have in what happens after they die; however, the posthumous interests view is not the only potential foundation of an obligation to respect the dead [4]. Perhaps we should respect the dead as part of an intergenerationally advantageous scheme; if the living respects the wishes of the dead now, then later living people will be more likely to respect our wishes after we die.

Perhaps we should be more considerate of different cultural norms that may, depending on the culture, both require respect and set out what respect means. This means that, for the sake of posthumous interests or for other reasons, we do indeed have an obligation of respect for the dead, so that if we should respect the dead because of their posthumous interests, we should respect them by respecting their wishes, be they known or reasonably inferred [6, 7].

The concept based on this idea can be of interest—i.e. that we should change our language, which in the context of forensic work is often depersonalized and “cold” (e.g. cadaver, human remains), and find other definitions that may better reflect the needs and sensitivities of families and communities (e.g. deceased person), therefore enhancing the respect of the dignity of the dead.

In general, practices regarding the identification of human remains are governed by traditional practices and/or a general policy based upon regulatory foundations [8–10].

With regard to the regulatory sources, we could classify them, in general terms, in three categories.

The first one is represented by International Humanitarian Law (IHL) [11] and humanitarian assistance, i.e. a field of law that has been codified in a fairly comprehensive manner. The application of IHL is conditioned upon the existence of an armed conflict and upon persons belonging to specific categories. At any rate, the multifaceted layers of protection offered by IHL envisage the individual as the ultimate beneficiary.

The second one is covered by International Human Rights Law (https://www.ohchr.org/sites/default/files/Documents/Issues/Migration/36_42/TheLastRightsProject.pdf) that comprises rights and freedoms enjoyed by the individual by virtue of international law. In the context of disasters, a number of human rights are of particular importance. Examples of the rights that are pertinent in the event of a disaster include the right to life; the right to food; the right to health and medical services; the right to the supply of water; the right to adequate housing, clothing, and sanitation; and the right not to be discriminated against.

Lastly, international law on refugees and internally displaced persons and disasters has been developed against the background of displacement caused by persecution and destruction during armed conflict, in particular the Second World War, which led to the adoption in 1951 of the Convention Relating to the Status of Refugees, the cornerstone document of International Refugee Law (https://www.unhcr.org/media/convention-and-protocol-relating-status-refugees).

The three sets of rules described above determine in a general way the legal context in which the protection of persons takes place. However, a vast number of more directly applicable instruments are available, e.g. multilateral and bilateral treaties, and domestic legislation, which are specifically tailored to the operational component of protection and assistance in the event of disasters.

In India, however, it could be important to consider new legal provisions for the management of human samples so that this would provide a starting point for the treatment of human remains managed for forensic purposes with uniformity in the country. Much is governed at the State level, so practice varies greatly across the country and forensic experts need guidelines; a national system to support information exchange could increase identification rates as, e.g., with the construction of a database as a sort of network to definitively improve the power of identification of these bodies. Such a system would, for instance, compare the characteristics of the unidentified to those of the missing. This, in turn, would enable either a return of the remains to families for dignified funerary rites or for consent to using the body for research or teaching rather than simply assuming custody of an unidentified/unclaimed body. Although some systems are in place in some states, or on a voluntary basis, there is no universal mechanism to address the problem of the unidentified dead. The National Human Rights Commission in India, regarding cremation and undignified treatment of dead bodies, has requested reports from States and Union Territories to ensure the dignity of the dead through policy arrangements for dead bodies [12]. The right to dignity and fair treatment enunciated in Article 21 of Constitution of India is extended to include the body after death [13].

Furthermore, there are Anatomy Acts enacted by different States of the Country that provide provision for procurement of cadavers (both donated and unclaimed) by Medical Colleges in India. However, these Anatomy Acts are not uniform across the Country such as in their scope for authorized officer, handling of unclaimed bodies, disposal of dead bodies, and research purpose besides the utilization of bodies for academic purpose [14].

The Government of India came up with guidelines on management of dead in the aftermath of disaster in August 2010, mentioning strategies for identification of unknown bodies through fingerprinting, DNA analysis, and by developing a potential software that can identify by comparing dead body's biometric data with the Unique Identification Card (AADHAR card) database. However, the number of bodies being identified from the unidentified bodies is limited [15] and this becomes an obstacle in providing the last rites, which can align with the choice of the deceased.

Another important step in which governments should take part regards the involvement and education of the general public to develop their interest in this important goal. Undoubtedly, it will not be an immediately realizable project, but it would require a long process, as underlined by Roli Mathur from the Indian Council of Medical Research during the workshop discussion, who stated that “all of us have to follow cultural beliefs to have a dignified end”, a process that should be built to create trust in the community. Since the next of the kin have a responsibility of giving the last rites and fulfilling the wish of the deceased, if the relatives are not able to do so, it may result in their protracted grief and thereby cause them harm [16].

The religious last rites help in healing the grieving relatives. The cremation signifies soul reaching the heaven and ashes mixing with water (nature), and if bodies are buried instead of cremated, the relatives feel inconsolable grief that they could not take care of the dead body. India being a land of diverse religions with diverse funeral practices, proper identification is crucial to offer last rites, thereby body as well as the wish of the relatives are considered to have been respected.

Another aspect considered regards the application of artificial intelligence (AI) to the identification of skeletal remains. In the field of forensic sciences, AI applications could contribute to enhancing human experts' performance, overcoming the subjective bias limitations of the traditional approach taken in the forensic sciences [17].

In the field of forensic anthropology, AI can support, through the use of algorithms, the decision-making process that leads to the identification of the victim or its remains. Furthermore, they can be used to extract new knowledge from huge databases and shorten identification through computer automation of data binding activities.

Applying AI tools in forensic sciences to collect new information from massive datasets to enhance knowledge, and reduce human subjectivity and errors, provides a greater scientific basis that could improve the strength of the evidence and support the admissibility of expert evidence. Furthermore, the cognitive capabilities of human skills modeled using computational methods offer several new possibilities for forensic science, providing effective tools to reinforce the scientific method, to improve the professional competencies of the forensic examiner and to provide an alternative opinion on a case.

For these reasons, it is essential to reflect on whether the implications of AI are actually going to replace or complement and diversify or expand previous well-known solutions to forensic problems. In particular, forensic anthropology mainly deals with the reconstruction of the biological profile of deceased individuals in order to determine the identity of unidentified human remains (i.e. sex, age at death, stature, and ancestry). It also focuses on the age estimation of the living, the interpretation of traumatic lesions on bones, as well as the interpretation of taphonomically altered (e.g. charred) remains. Some studies have shown promising results for future applications even if this advanced technology is still far from being integrated into methods currently used in practice [18, 19].

One example is represented by facial recognition technology as a new form of AI technology in managing the dead and facilitating human identification needs especially in largescale disasters. The possibility of having the facial photos of disaster victims secured and captured within the first 48 h post-disaster, before decomposition commences, allows for the potential to match the victims' faces to any possible government database available, e.g. image data generated at the airport immigration gate, leading to positive identification. Khoo and Mahmood (2020) proposed the use of facial recognition for rapid identification [20] following mass disasters and argued that it would help ensure that disaster victims are treated with dignity and respect as advocated by the International Committee of the Red Cross. Despite this potential, risks of misidentification always exist and checks against errors must be implemented to ensure that further harm is not done to families. The paradigm shift of adopting facial recognition and AI technology in the identification process as a means of providing relief from ambiguous loss to families and protecting the dignity of the dead person could be a significant contribution to humanitarian applications of forensic science.

Following this perspective, one solution that has been proposed is the digitalization of human remains, to enable others to study a virtual copy, rather than actual remains.

Digitalizing human remains means acquiring images with various devices and various techniques including radiological ones, and processing them on the basis of algorithms developed with machine learning techniques starting from large datasets.

This introduces new questions about ethics [21], including whether presenting or widely sharing (may be different Country Authorities) images of remains also could represent an indignity situation in relation to how these images are managed [22]. Some have argued that showing the dead evokes empathy and mobilizes political will toward the dead and their families [23]. It can also work against denial of deaths, which can help families of the dead garner support and resolve cases of missing and unidentified members; on the other hand, lack of protection on the sharing of images, especially on different virtual digital platforms and shared by multiple systems, could lead to a breach of confidentiality, or forms of discrimination, or illegal use on the web. AI applications in forensic anthropology could, in the future, be a viable solution for the help and support of low-income countries in identifying deceased people without the biological material being transported outside the country where it is located, through digitalization of human remains. In this case, AI would enable us to study a virtual copy of human samples rather than actual remains. In this way, the cost of the technology would not be borne by the country directly involved in the disaster. It would, therefore, be interesting to create a form of internationally based external help in identification and to allow the material to be returned to families and handled in a culturally appropriate manner, thus enabling families of the missing to accept their loss.

Mass disasters are often humanitarian catastrophes. Managing the dead and successfully identifying victims contributes not only to the state's obligations, but also to addressing humanitarian needs of victim families and communities. In this direction, it is important to increase preparedness to respond to disasters, to enable the most effective action to be taken once disasters have occurred, to establish best practices for recovering and examining remains for establishing the cause and manner of death, and for identifying the remains to return them to the family. The last objective helps family members by knowing the fate of their relatives and allowing the remains to be handled in a culturally appropriate manner, thus enabling the families of the missing to mourn their loss. Taken together, we hope that they will provide a platform for further thinking and action to develop ethical and effective ways of priority-setting and disaster response preparedness.

In light of the general deficit in national/international guidance about ethical oversight for identification and care of human remains, the fact that regulations are frequently not adequate to govern ethical aspects, we hope that an internationally recognized body should develop such guidance in collaboration with relevant organizations.

The authors would like to thank all the Indian forensic doctors who participated in the workshop for their suggestions, comments, and ideas that have contributed to the development of this manuscript.

Vina Vaswani was responsible for the conceptualization, supervision, and project administration. Luciana Caenazzo wrote the original draft. Derek Congram revised the work critically for important intellectual content. All authors contributed to the final text and approved it.

No human participants were involved in this paper. No funding was granted for this article.

The authors declare there are no competing interests to declare.

The authors received no financial support for this study.