Update
Volume 13, Number 2 (July 1997)
Medical students and resident physicians need to absorb and learn an awful lot of information from books, lectures, and practical interaction with live patients. In addition to the gaining of knowledge, they must also become proficient at many technical procedures. Some of those procedures are important, but not a matter of life and death. These procedures may be learned methodically at a pace appropriate to the procedure and the individual. They may even be learned by trial and error! For instance, a medical student may make an error in performing an electrocardiogram, such as switching the placement of the limb leads, without causing any danger to the patient--only the inconvenience of having to have the procedure repeated.
However, some of the procedures which must be mastered are life-saving. Students and residents must learn them quickly and expertly so that, when they become practicing physicians, they will be able to perform them accurately and with confidence. Examples include endotracheal intubation, placement of central venous lines, insertion of drainage tubes into the chest, or needles into the heart, etc. And once learned, it is important for trainees and physicians alike to maintain proficiency in them. If they do not perform them frequently, but will be in clinical situations where they must be able to perform them at a moment's notice, they must somehow practice to retain their skill.
How are trainees to become adept at such procedures? One suggestion--a suggestion which has been used at some institutions---is that the trainees practice on newly dead bodies. When a patient dies, before the body is taken from the emergency room, intensive care unit, or even the hospital ward, it is possible for several students to practice procedures for a few minutes. Such practice offers advantages over practice on mannequins--the anatomy is accurate and realistic. It also offers advantages over practicing on preserved cadavers--the tissue tone remains normal for a few hours after death. And such practice is usually better than practice on anesthetized animals, again because of anatomical correctness.
If the answer to the pragmatic question is that practicing on newly dead bodies would be the best way for trainees to learn procedures, the ethical question becomes should it be done? Would this be showing disrespect to the dead? If it is to be done, is it necessary to obtain consent? And if it is done without consent, would this be considered assault on a corpse? If it is done without consent, should the practice be kept secret so that the public does not become upset with or come to mistrust the medical profession? If consent is necessary, from whom should it be obtained? Who has authority over the dead body? Should consent be sought from family members? Would requesting consent be too emotionally difficult for the recently bereaved?
Not everyone in medicine or medical ethics agrees on the answers to these questions. Some feel it is appropriate and even vitally necessary. Others believe it is permissible only with consent. Still others believe that those procedures which do not change the appearance of the corpse (such as endotracheal intubation) are okay, but those which leave tell-tale marks (such as the insertion of needles or tubes) should not be done.
We have invited comments from two individuals who have thoughtfully addressed this issue and have come up with different answers--individuals who have gained national reputations for taking clear positions on the issue of practicing on newly dead bodies. *
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