procedures on dead people

EMTPTORN · May 27, 2002

speaking specifically about intubation practice on a manikin....one can learn to intubate a manikan with 100 percent accuracy in an afternoon....i could teach my nine year old to do this. what the manikan cannot teach you is what the oropharynyx really feels like when you slip the blade in... the manikan's trachea isn't full of vomitus, blood, their are no teeth to break...granted, a corpse will not offer the fluid obstacles, but it does give you a realistic ex-perience in the real life of intubating...

to those who have posted saying that manikan practice will make you proficient, i would not want to be your first guinea pig in real life.

it is a bad joke>> to think an intubation manikin, IV manikin, "gel pad" for injections, any of this fake #%$@#%$ will teach you about real life. also to those who say the knowledge base is what you need to do these skills...yes that is true, but you need practice, too.

i would be more appalled say if i went to surgery, the emergency room, or elsewhere and a student (doctor) was my primary caregiver. I would feel much more violated as i am still alive and kicking, and not gone to a better place without pain. however, that student has every right to assist in the care, and utilize every option to learn.

maybe it sounds too cruel, but the dead are dead, a corpse is a corpse...nothing more than an emtpy shell, the human soul, spirit and heart are free from this ravished body.

logically it seems to me that one should be able to improve their lifesaving skills, to better serve the public.

to the bleeding hearts who think the practice of learning procedures is not to be on corpses( iam not talking about prolonging codes for practice, nor charging pt's for supplies)...think about history, think about how EVERYBODY learned before the advent of plastic... and next time YOU GO for a procedure, make sure that a "no corpse safe" provider is providing your care!

Agnus · May 28, 2002

Originally posted by EMTPTORN
...
>> to think an intubation manikin, IV manikin, "gel pad" for injections, any of this fake #%$@#%$ will teach you about real life. also to those who say the knowledge base is what you need to do these skills...yes that is true, but you need practice, too.

maybe it sounds too cruel, but the dead are dead, a corpse is a corpse...nothing more than an emtpy shell, the human soul, spirit and heart are free from this ravished body.

logically it seems to me that one should be able to improve their lifesaving skills, to better serve the public.

to the bleeding hearts who think the practice of learning procedures is not to be on corpses( iam not talking about prolonging codes for practice, nor charging pt's for supplies)...think about history, think about how EVERYBODY learned before the advent of plastic... and next time YOU GO for a procedure, make sure that a "no corpse safe" provider is providing your care!

I have not read anyone who said, that practice should not take place on copses.

I have read that basic respect and dignity are being ingored. That the rights of the individual and the family are being ingored.

I understand the point that there are many living who will benifit from students practicing on corpses. This subscribes to the philosophy of the greater good.

However, just because the persons is dead and "thier spirit has left" does not mean that the medical community now owns the body and can do as they will. The family still has a legal claim to that body. INFORMED CONSENT is the only appropriate way to go here.

To ignore this is shameful. The fear that you won't get consent is no excuse to not ask. Would you just take something else from another persons because you are afraid they might say no if you asked? I hope not. We don't do procedures on live people without asking even if they might say no. The families of these dead people have the same rights.

I think the jury is out on the issue of spirit and what happens to a "spirit" after a body's heart PERMANENTLY stops. No one have prooven to have come back, and tell us. Have a little respect. At the very least have respect for the grieving family.

Because things were done in the past does not make them right. Nazi Medical experiments and the Tuskegee studies did indeed benifit others, but perhaps you have not heard of the Nurenber Code and the Belmont Report.

Both nurses and physicians have a code of conduct.

mario_ragucci · May 28, 2002

I talked about this today with a real life nurse. She talked about what happens anatomically, talked about the blade, and how yewd hafta get it past vocal cords. I am so new and unfamiliar with so much I shouldn't ofter any opinion, because, it sounds hard to get right, from the way she explained it.

My question is....How can doing it on a corpse be life-like or real, if the corpse has no reflex to breath? Sounds like the hard part is getting it in the right spot. I wish I knew more :-(

thisnurse · May 28, 2002

mario...does it hurt just as bad pulling the foot out as it did going in?

lol

i could NOT resist...and i didnt copy your words either

micro, RN · May 28, 2002

but if anyone is around that has legal control over my dying or dead body........we all know that my wishes may not be respected.......sad and angry to say that i would and will donate my body to medical science and research with a wide realm of whatever that might mean......... :rolleyes: and you ask, micro, duh, do you know what this may mean.........

YES, I DO!!!!!!!!! IT MEANS ORGAN DONATION #1 FOR THE LIVING, AND THEN IT MEANS ORGAN AND OTHER GRAFT DONATIONS FOR THE LIVING ALSO THAT HELPS TO CONTINUE AND PROLONG LIFE WHERE THERE IS HOPE!.................AND LAST , WHY BURY ME IN THE GROUND, I AM ALREADLY LEFT THE CARNAL BODY.............(will not go into my own belief system here), .............

but please, leave all pride behind.........like do i give a rat's butt' who is looking at my dead orifice'.................i ain't even there.............

but if the "dust" of my body can do somebody else some good, especially a medical student or other equivalent equal, then please.................

:rolleyes: LIFE IS FOR THE LIVING!!!!!!!!!

I love you all, and no flame wars here on this treacherous ground of death and life, please!!!!!!!!!

OBNURSEHEATHER · May 28, 2002

:chuckle thisnurse!

Heather

**canoehead, BSN, RN** · May 30, 2002

I think that so long as there is an alternative to using a body without consent then we should go with it. EMT's can spend a day in the OR intubating, what about ABG's and central line insertion, other than just waiting for a patient who needs one?

Don't insurance companies review charts to be sure that treatments are necessary, and wouldn't an unnedded line be fraud?

Home Health Columnist / Guide · May 31, 2002

Permission needed to practice AFTER death pronouncement...it shows respect.

Google found these viewpoints:

CASE: PRACTICING PROCEDURES ON THE NEWLY DEAD

Kenneth V. Iserson, M.D., MBA

From: Ethics In Emergency Medicine, Second Edition

http://www.galenpress.com/extras/extra20.htm

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Teaching resuscitation skills using the newly deceased

http://www.mja.com.au/public/issues/oct21/ginnifer/ginnifer.html

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Recently deceased as training tools

http://www.ama-assn.org/sci-pubs/amnews/pick_98/inta1221.htm

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MEd Student Questions:

http://eduserv.hscer.washington.edu/bioethics/topics/student.html#ques2

How should I respond when an intern asks if I want to practice a procedure on a patient who just died?How should I respond when an intern asks if I want to practice a procedure on a patient who just died?

Practicing procedures on newly dead patients is a highly contentious issue. For some procedures, like intubation, students can benefit from practicing first on a cadaver. Weighing the risks and benefits, the student is more likely to harm a living patient were she to try to intubate without practicing first. No physical harm can occur to the cadaver. However, some are appropriately concerned about the disrespect that "practicing" procedures may show to the deceased patient or to the patient's family. It remains your responsibility to assure that your interactions with the cadaver are respectful and only as invasive as necessary. Most likely, the time you take to practice a simple procedure will not add significantly to the usual amount of time needed to prepare the patient's body for viewing by the family if they are waiting nearby. This is important to be cognizant of, however. (See our reference list for further discussion of this difficult issue.)

References:

Ardagh M. May we practise endotracheal intubation on the newly dead? Journal of Medical Ethics. 1997; 23: 289-294.

Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a Doctor: Critical-Incident Reports from Third-Year Medical Students. NEJM 1993; 329 (15): 1130-2.

Christakis DA., Feudnter C.Ethics in a short white coat: the ethical dilemmas that medical students confront. Academic Medicine. 1993; 68: 249-54.

McNamara RM, Monti S, Kelly JJ. Regulating Consent for an Invasive Procedure in Newly Deceased Adults. JAMA 1995 (Jan. 25); 273: 310-312.

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From Emergency Room Ethics. Panel Discussion...

http://content.health.msn.com/content/article/1700.51133

....Moderator: What about medical students doing research on emergency room patients or dying patients?

Dr. Arthur Derse: It's so difficult to determine whether there is a terminal disease state or whether this is a reversible process.

Dr. Catherine Marco: That's a very important problem in medicine, not just in emergency medicine, that is, how medical students, interns, etc., should learn to do procedures. Many feel that when a patient is dying, that this is the ideal time for a student to learn. For example, intubation is a very important skill and could be learned on a patient that just died, but many feel that this is unethical without getting permission from the family.

Dr. Arthur Derse: The dead are not really treated as an individual, but there are still certain laws that apply to the remains of individuals. One hard issue is that if you're going to learn, why not learn on someone where it's not going to count, rather than someone who's life is at stake? What's really the harm in doing this to an individual who has now died, when you can benefit others by doing it? The people who donate their bodies intend for this to happen. If you never do procedures except for those alive and needing them done, then that's the only place you'll make mistakes and learn from your mistakes, which isn't as good as learning in a situation where an individual cannot be harmed. Having said that, I also think you can differentiate procedures that will mutilate or disfigure from situations where a tube is placed by a student who is practicing. If we were never able to show anyone how to do anything on someone who has died, two things would happen: 1) Either they would be done without talking about it; or 2) The person would not be declared dead and the student would do the procedure when it really would help. That is, this person is about to die, so why don't you try this procedure, when it really wouldn't help at all, with the theoretical possibility that it might be able to help in some small way. I don't intellectually agree with that and think that's it's dishonest.

Dr. Catherine Marco: Most patients would be willing to let a student practice inserting an IV (intravenous) line knowing it may take longer, but in a larger issue such as resuscitation, people have more objection to that type of thing. I think that the ethical argument is the same for either. That society is willing to allow the student to practice and learn in clinical situations.

**canoehead, BSN, RN** · May 31, 2002

Thanks Karen, although these are not opinions I agree with they help me understand others'. I guess the next thought I have is that MD's have an interest in making procedures on the dead morally justifiable so their arguments and conclusions are going to sway in that direction. I could argue that the fax has been put in charge of the henhouse, and their conflict of interest makes their opinions less usable.

Why can't intubations be practised on live patients in a calm controlled environment (like inductions in the OR) with experienced staff available. Seems like we could come up with better learning experiences than the end of a stressful code.

Are insurance companies aware of and willing to finance the extra equipment and time of caregivers? And what about the delay in calling/notifying family that their loved one has died?

Perhaps the measurement of whether doing a procedure is ethical should be whether we would be comfortable telling the family what we did after the fact. No cop outs of "well who does it hurt? or it will help others in the future" Our duty is to the family and patient in front of us at the time, and the responsibility to obtain and use proper learning tools lies with the caregiver, not the consumer.

Trying to find an equivalent- what if the dentistry students came over to practise mouth exams on the newly dead...would that be an invasion of rights?

Agnus · May 31, 2002

Originally posted by NRSKarenRN
Recently deceased as training tools
http://www.ama-assn.org/sci-

I have a number of objections to this argument
'It remains you" responsibility to assure your interactions with the cadavar are respectful and only as invasive as necessary"

These proceedures are NOT necessary.

Were do you get off calling a freshly deseased body a cadavar? Who made This writer the athority on whether there is spirit in this body still? I don't not speak as a religious person. If you will view some of my other post, you will see I have doubts about the existance of God. Yet, I do not pretend to know if and when all essence of a person has left a body, assuming it leaves at all.

The writer to the family, "waiting near by."

Would this writer dare do this proceedure with the family present? If not then what are they trying to hide? A conscious perhaps? A conscious which would not kick in if this were a proper thing to do.

Bottom line the body does not belong to the reaseacher unless it has been given to him. It belongs to the family. Even executed prisioners bodies are returned to the family, until the family chooses to release it to the state. Again I ask what are you afraid of that you won't ask the family?

"When a person is dying that is the ideal time to learn."

HUH!!! Need I say more to this remark?

"Why not learn where it is not going to court?"

Ask permission of the family. Don't act like the comensurate moral coward that you apear to be.

"the people who donate thier bodies intend for this to happen."

Ah, we are starting to see some light here. Yes, the people who donate. Not just anyone and not without donation.

"this person is about to die. So, why don't you try this proceedure that really won't help.?"

'Scuse me, cause they are ALIVE, they did NOT give consent to practice a procedure that was not aimed at their recovery. This is a living person that you are doing procedures on without consent.

Yes, I did read the entire post. With respect to the poster and the original writer. My arguements are therefore not against either of these. I am playing devils advocate here with a side of an arguement that was as unsavory to the writer as to me.

Bottom line. PERMISSION.

If you don't have the moral courage to ask permission, don't do it. If you are not asking for permission I suggest you look hard at the reason that you are not asking.
If you feel it is that the family may say no, and you still do not ask then I can only assume that you intend to do this with or without permission. This I find to be an act of cowardice, and theivery.

The family not the medical community has legal claim. If the individual is "dying" then the individual first, then the family have claim.
All sorts of atrocities have been performed without consent on the human body, dead and alive, without consent, in the "inerest of science" This does not make any of this right.
There was a time when many things could not be practiced effectively except on a living or dead body. Today many of these learing opportunities and practing of skills are more effectively done by other means due to the growth of technology. True technology cannot make up for everything but in time it can grow to do just that. "because we've always done it that way" is and arguement that keeps comming up here. That sentence is in fact counter to scientific thought.

There have been many experiments done with no ethics considered. With great benefit to mankind.
The Nurnburg Code, developed not by a few, said in essence that all the good that comes of such experimentation does not out weigh the harm.

I am very much science minded. Ethical science. These words are not opposit. We have done more good with the results of ethical science that without.

micro, RN · May 31, 2002

agnus very well thought out and very well spoken

my public regards to your intellect and writing,

micro

CATHYW · May 31, 2002

originally posted by micro
agnus very well thought out and very well spoken

i would be on your side in debate, any time! found out in speech that you don't have to agree with a thought to defend it. you exemplified exactly that with your comments on how and when the spirit leaves the body. the bible says, "absent from the body is present with the lord," but no one yet knows when we are totally absent. i always talked to the patients i was gving pm care to-i was always taught that "hearing is the last sense to go"

and i never knew when that had actually been accomplished.

btw-they were still my "patient" until the funeral home rep came, or they were transferred to the morgue-they didn't suddenly become my "cadaver!" according to my mosby's medical, nursing, and allied health dictionary, a cadaver is 'a corpse used for dissection and study." a corpse is "the body of a dead human." quite a distinction, i think!