Ethics seminars: the ethical debate on practicing procedures on the newly dead

Teaching Without Harm: The Ethics of Performing Posthumous Procedures on the Newly Deceased

Physicians must be proficient in and efficient at various lifesaving and life-sustaining procedures. Multiple methods exist to teach these skills to inexperienced medical professionals, ranging from lectures to practical models to live patients. Proficiency and prior knowledge are especially important when novice medical trainees first perform these procedures because of the increased risk of harm in these high-stakes scenarios. To mitigate inherent risks, many medical centers controversially advocate and allow the use of newly deceased patients to practice, teach, and perfect these procedures. As a result, this type of experience facilitates medical training and competency while simultaneously avoiding physical harm to living patients. Nonetheless, it raises numerous ethical and legal considerations, including concerns of damage to the doctor-patient relationship.

This manuscript aims to comprehensively review the ethicality of practicing postmortem procedures and its current debate regarding the role and type of consent. This is followed by examining scenarios where the prior patient or postmortem surrogate consent is required for procedures that do not benefit the patient, including organ donation, cadaver donation, and brain tissue donation. Using these scenarios as a framework, best practices for gaining permission to use the newly deceased for medical training purposes are offered.

Procedures on deceased patients should always be done under competent supervision in a structured manner, with comprehensive explanations to encourage accountability and professionalism and prevent misuse. Informed consent for all educational procedures must be obtained by individuals separate from the treatment team. However, exceptions to this standard could be made in pediatrics (especially in the neonatal intensive care unit) given the intimate relationship between providers and parents. Depending on the situation, consent should be obtained from the patient and/or their family, with separate documentation provided to create awareness. All relative parties should be consented after receiving appropriate time to process to prevent further emotional compromise. If there are concerns about jeopardizing the family and creating further burdens, they should not be approached.

Moving From Organ Donation to Knowledge Donation: A Novel Opportunity for Surgical Education Following Organ Donation

The objective of this article is to share how our institution implemented the use of organ donors for surgical education following organ recovery. Despite technological advances, realistic surgical simulation models are lacking, leaving little opportunity to practice a procedure prior to performance on a living patient. Utilization of organ donors following organ donation offers an opportunity for life-like surgical simulation. We developed a pathway to use organ donor tissue in the post-recovery period for robotic simulation. We obtained support from our local Institutional Review Board, Ethics Committee, and organ procurement organization to create a "knowledge donor" program. Our knowledge donation program provided learners hands-on experience with a novel procedure and also provided organ donors another opportunity to express their altruism. We found that the process was well accepted by donor families and learners. We implemented a knowledge donation program at our hospital that provides valuable surgical experience. We discuss future directions for knowledge donation at our institution.

Death, dying, and last wishes

Issues regarding patient care near the end of life can be challenging and rewarding for emergency physicians. Knowledge of the patient's wishes is essential, and may be accomplished by advance directives or communication with patients and surrogates. Resuscitative efforts are appropriate for many patients, but inappropriate for others. The goals of medicine remain the following: providing optimal health care, provision of the best possible symptom control, communication, empathy, and caring. As death approaches, provision of the best possible medical care, in accordance with the patient's wishes, can be rewarding for patients, families, and health care providers.

Ethical dilemmas in training tomorrow's doctors

This article describes some of the challenges that face trainers and trainees in medical education. There are ethical issues surrounding the use of real patients - particularly children and young people. How much can a young trainee "practise" on a patient? How can they best learn practical skills or gain experience of intimate examinations? The requirements of professional behaviour of trainers towards trainees and of both towards patients are described. Patients involvement in teaching, assessment and formal examinations is discussed.