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Medical practices are unethical

Published: Monday, February 3, 2003

Updated: Wednesday, July 25, 2012 20:07

Since the 1970s, a widely-accepted but highly controversial practice has existed in the emergency rooms of many hospitals across the United States. According to The Wall Street Journal, residents, or doctors-in-training, are allowed to practice emergency medical techniques on newly-deceased patients under the supervision of a senior physician. In addition, some hospitals also permit young doctors to practice these techniques on patients who are technically still alive, but beyond the help of even extraordinary measures, reports The Journal.

There are many ethical issues that have the medical community divided on this topic. One is the fact that the patient's' family or next-of-kin often has no knowledge that these procedures are being performed. Another issue is the fact that the hospitals will sometimes bill the nearly dead patients' insurance companies for the procedures performed for medical training, according to The Journal. A third issue arises from questions about respect for the dead and their religious beliefs.

Training on dead or dying patients is a vital and extremely beneficial practice for both physicians and their future patients, but it is also one to which some changes need to be made, especially with respect to obtaining the family's consent and the inappropriate charges for such procedures.

The techniques practiced include inserting needles into major veins, drawing body fluids and performing endotracheal intubation, a technique for opening a person's airway, reports The Journal.

According to Ethics In Emergency Medicine, a medical trade magazine, procedures can also include thoracotomies, opening the chest, and performing venous cutdowns, surgically opening veins to insert catheters.

Doctors and residents who support the practice say it is the best way to learn life-saving emergency procedures, according to abcnews.com. As Dr. Kenneth Iserson said in The Journal, "If the doctors in the emergency room units don't know how to do these procedures, these patients die."

Society places a heavy expectation on the emergency room clinician to act quickly, professionally, and expertly to save lives when possible, states Ethics In Emergency Medicine. many times there is no adequate or affordable substitute, such as plastic models and preserved cadavers, for a live or recently dead human body for practicing and perfecting some of these skills.

While physicians need to be proficient in these life-saving techniques, a larger effort must be made to inform the patient's family and obtain their consent for these procedures, especially for the nearly dead. The training procedures on the nearly dead are currently listed in their medical records, but families are often unaware of that, according to The Journal. While the American Medical Association recently took the first step to resolve the issue by adopting a non-binding policy that no training is to be performed on dead patients without consent, it did not address the issue of nearly dead patients.

According to The Journal, the answer could be a simple consent form upon admission to a teaching hospital to perform these procedures. Drivers could also attach permission slips to their licenses, as with organ-donor cards, reports abcnews.com. Amednews.com suggests asking patients for their "blanket" permission upon entering a hospital.

Consent from patients or their family is extremely important and will also help make doctors aware of any religious beliefs the patient may possess.

The other issue that needs to be corrected is charging insurance companies for procedures performed on the nearly dead. According to Ethics In Emergency Medicine, nearly dead patients are sometimes not pronounced "dead" until trainees complete the procedures they are practicing, and this can be expensive for insurance companies and third-party payers, who must pay for all medical and surgical procedures done before the patient is officially pronounced dead.

Since health care costs are constantly on the rise and the health care and medical insurance systems have enough problems already, this is one practice that needs to end. Patients' families should not have to pay for procedures that likely had no impact on their loved one, and that "...fall into a gray area," as stated by Dr. Catherine Marco, chairwoman of the ethics committee of both the Society for Academic Emergency Medicine and the American College of Emergency Physicians.

Doctors need the hands-on experience and training that performing procedures on dead and dying patients offers. As Dr. Doug Smith, a third-year resident told The Journal, "We are doing this to help the next patient who comes through the door." However, until affordable alternatives can be developed, this practice must be done in the most ethical and respectful manner possible with regard to patients and their families.

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