procedures on dead people

[canoehead]

How many hospitals allow practising procedures on dead people by students? Do you prolong codes in order to allow the students lots of time to be successful? Do you charge for those procedures that are done after the code is obviously going to be unsuccessful (ie asystole since found 40min ago).

And even worse...Do you open the morgue so students can practice on newly dead during slow times?

I think that all these are insane but I am a minority of one at my hospital, because

"how else will they learn,

it leaves no permanent mark on the body,

it doesn't hurt the patient,

and if the public needs practitioners with excellent skills in an emergency situation they have to tolerate (and pay for) procedures on the dead"

So who is right? I need input from both sides so I can decide what MY response will be in these situations.

[bobstein]

I've read with interest the posts in this thread as I have published on this particular question. Many are suggesting that the practice is illegal and unethical. Without trying to introduce humor into this serious subject, I must point out that the law has nothing to do with ethics!

To clarify the discussion, we are debating the ethics and legality of practicing procedures on the recently deceased WITHOUT consent from the next-of-kin.

Ethically, the practice makes me a bit uneasy. The argument that we need to learn skills to save other lives makes sense. Anyone who has intubated a rubber manikin will tell you that it is FAR different than intubating a human body. The weakness in the argument is that it does not address why we feel a need to do it without consent. Research studies have shown that the majority of families will give consent if permission is sought.

Legally, however, there are no federal or state laws to prevent the practice. Most localities have laws prohibiting the mutilation of a corpse, but intubation does not mutilate the body. The doctrine of autonomy and informed consent does not apply because there are no rights after death. A few states have ruled that the next-of-kin has a property interest in the body, but even that would not necessary prevent the practice of procedures on the recently deceased.

While there may be ethical and liability issues, there are no laws to be broken by the practice. Hospitals need to enlist the assistance of their ethics committees to help draft a policy and procedure on how the issue is to be handled in their institutions.

While I have researched the topic, I am not an attorney and cannot provide legal advice. As with many subjects, the hospital policy should be reviewed by legal counsel to assure compliance with applicable code and case law.

References:

Stein, RW, III (2002). "Legal Issues", In P. G. Zimmermann (Ed.), Nursing Management Secrets. Philadelphia: Hanley & Belfus.

Stein, R.W., III (2001). Practicing on the Newly Deceased. Journal of Emergency Nursing, 27, 598-590.

[canoehead, BSN, RN]

Great Robert, I am unhappy with the legal implications you have described. If my family member was practiced on I would be furious, and would follow up legally, no doubt in my mind.

What do you say about delaying the ending of a code so that students can practice while the family waits in tears in the next room?

[mozart]

procedures on dead people....why don't just go to the OR? its the same...we can see the internal organs...yes i know...'maintain sterility'......

[disher]

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[disher]

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[disher]

bobstein, "Law has nothing to do with ethics??"

Do you mean law and ethics are separate disciplines but are also interconnected? Ethics has to do with what is morally right and the law may or may not have to do with what is morally right. Often they are interconnected, abuses of moral rights have led to legislation. I think the deceased family could have grounds for cival action for interferring with religuos freedom.

[ceecel.dee, MSN, RN]

Some of our new docs like to practice intubation on the newly called code, but I agree with the concept of inviting the family in to see what we are doing...it usually gets called sooner if the family see's what actually is being done and you get more professional behavior from all involved. We do need to practice, but without permission?????

[bobstein]

Ideally, ethics and the law would always be interrelated. Most of the time, what is "right" is legal and what is "wrong" is illegal. I believe we would all agree, however, that the daily headlines provide proof that at times what is wrong isn't necessarily illegal. This, in my opinion, is one of those cases.

Civil liability is not the same as being criminal (reference the OJ trial). Civil liability only allows for monetary payment to someone to "make right" a harm done to another. As I referenced in my original post, there may be some civil liability in practicing procedures on the newly deceased without consent of the next-of-kin, but it is not criminally illegal to do so.

If you were unhappy to learn that a non-disfiguring procedure was performed on a family member without your consent I would understand. If I were in that position, I would be too. Your burden (or mine) would be to prove that a harm was done. But, what harm would have been done? Unnecessary mental distress??? That, by itself, probably isn't sufficient for you to find an attorney willing to take your case. Delaying ending a code to allow for skill practice probably falls into the same category.

Much of what I have posted is what I have learned while doing research for the article and textbook chapter that I authored. Personally, I feel that the practice is objectionable and morally wrong. I do understand the need for education and skill practice, but given the research that shows approximately 50% of families would consent to the practice if asked, I cannot justify the practice "for the greater good".

The references that I posted previously are not available online. For those wanting to learn more, I recommend the AACN continuing education article

Medical and Legal Implications of Cardiac-Arrest Protocols

Scroll down the page to the "Ethical and Legal Ramifications of Waived-Consent Protocols and Postmortem Procedures" section and then specifically to the "Postmortem Procedures" part. The article additionally has a great reference list for further reading.

[disher]

bobstein, re proving what harm was done. Hypothetically, the harm done could be connected with a families spiritual beliefs. What if for generations a familiy's practice was to leave the mouth of the newly deceased open because they beleived that the soul escaped from a persons mouth? If the physician inserted a tube in the deceaseds mouth, then he/she would be interferring with the deceased's passage to the afterlife. This could cause unecessary mental distress for the surviving family members. Distress which could have been prevented had the physician just asked for tbe families permission instead of assuming that no harm could be done.Just a thought on one way families could pursue civil litigation.

[bobstein]

disher: Theoretically, you are correct. The problem is that damages are still limited to mental distress. Our justice system only allows for monetary payment to "make right" a non-criminal civil wrong. Juries do not award much for mental distress without any other damages. As a result, I believe that you'd be hard pressed to find an attorney to take the case to trial. Remember that plaintiff attorneys pay for all the expenses of going to trial (upwards of $100,000) out of pocket in hopes that they will win. If they lose, they have to eat all the expenses they paid. If you could somehow add losing an arm / leg / eye to the scenario in addition to the mental distress you would have no problem finding an attorney. Again, I don't make the rules and I'm not saying that this is how it OUGHT to be ... only how it IS. Even though the practice is not criminally illegal and makes for a weak (at best) civil case, I feel that it is inexcusable to perform procedures on the newly deceased when research shows that approximately 50% of families would consent if only they were asked.