comment 1

Gray Matter


While watching one of my favorite television medical shows recently, I came across a line — uttered fast and so obviously not meant to draw attention — yet it had the opposite effect. I heard one of the attendings tell a resident or student, “Continue if you’d like.”

I think my fixation is a bit more understandable if I set the scene:

There was a trauma in the ER. A patient was carted in on a stretcher, wounded in some unknown way. After what seemed like a substantial amount of time, energy, resources, and thought, the person was pronounced dead following repeated attempts to massage his or her heart back to a normal rhythm. Then, “Continue if you’d like,” meaning that the resident or medical student would be allowed to practice a procedure on a person who was officially deceased.

Such a procedure contradicts a couple major pillars regarding patient rights. First is autonomy; there was probably no autonomy in this scenario. In fact, given the emergent situation, the patient definitely wouldn’t have been able to decide on the spot to donate his or her body to medical education. The patient clearly did not consent to having doctors use his or her body for medical education purposes before entering the hospital on a stretcher. Therefore, prior consent was not met, and due to the comprising circumstances regarding his or her unconsciousness in the ER, he or she did not have autonomy in the decision. To compound the impossibility of this particular patient giving autonomous consent, opt-out programs simply don’t exist for such informal procedures like they do for organ donation.

Furthermore, the second major issue here is justice; those physicians abused a patient who was vulnerable (it’s hard to imagine someone more vulnerable than one lacking neocortical brain function). When evaluating the justice of these actions, harm is often brought into focus. While the decision to use the patient’s body as a tool for learning did not impact his or her outcome, there may have been harm in other ways. Patients often have wishes for what happens to their bodies, and it’s equally probable that families of patients have wishes too. Moreover, it follows that caregivers listen to patients’ desires because a person’s body remains private even after declared dead. But, in this case, no one was there to stop the caregivers, to remind them that a patient’s body is still his or her own body despite the circumstances.

Now, I don’t think those doctors should be taken to court.  Rather, I think this kind of injustice requires more awareness than malpractice litigation. This sort of issue is more common than people realize and it was recently captured on a nationally-televised program, NY Med. Since student physicians, residents, and attendings will come across it at some point, they should be prepared. That said, regarding any kind of medical treatment, there is only one aim, to which healthcare professionals are ethically bound, and that is providing benefit to the patient. As I alluded to earlier, it’s up to caregivers to uphold patients’ right to justice. So, while using a deceased patient’s body without consent for medical education may seem like a gray area of patient rights, try to remember this question: Is this what is best for my patient?

Samuel Jacobowitz Samuel Jacobowitz (1 Posts)

Contributing Writer Emeritus

Northeast Ohio Medical University

Sam is a first-year medical student in the Class of 2016, third-year Ohioan, eighth-year distance runner, and 21st-year brother. He enjoys a little reading, a bit of writing, and plenty of social media and ted.com. But most of all, he likes to spend his free time being goofy with close friends and family.

  • Patrick McCabe

    I enjoyed your article, which showed that I do not know much about the ethics of medical practice. Foremost, I would be at a loss about how to respond to a resident making such a statement. Secondly, I suppose the purpose of a maneuver or test changes its ethical character. I did not see the show. However, the chest compressions when doctors thought the patient could be saved are ostensibly the same to chest compressions given after the declaration of death. But the latter I could see function as a more self-serving endeavor. I do wonder what moral conundrums arise if the patient were to revive. Remote likelihoods though probably should not dictate practice.