X-Message-Number: 13056 Date: Tue, 04 Jan 2000 20:56:37 -0500 From: Jan Coetzee <> Subject: Informed consent. Maybe.. I suppose you can sign as many papers as you like. In the end you may still have bad luck. Doctors urge end of controversial practice By Denise Mann NEW YORK, Jan 04 (Reuters Health) -- Researchers are calling for an end to the controversial practice of performing an invasive and unnecessary procedure on dying patients just for training purposes. In the interest of education, doctors-in-training may be asked to thread a tube into the femoral vein in the groin of a patient in cardiac arrest who is not responding to cardiopulmonary resuscitation (CPR). Such tubes or catheters can supply a patient with intravenous fluids or blood transfusions. But in dying patients, the procedure is unnecessary, invasive and performed just for practice without the consent of the patient, the researchers report in the December 30th issue of The New England Journal of Medicine. The investigators found that close to 26% of 234 interns and residents from five Connecticut hospitals had seen it done, 16% had done it themselves, 13% had been asked to do it, and 6% had asked a colleague to do it. In the survey, 34% of residents stated that the practice is ''sometimes appropriate'' because it is not harmful and helps them to hone their skills. Others believe that it is medically unnecessary and it violates patient rights. ``The performance of involuntary, nontherapeutic invasive procedures, including those performed during CPR, should be recognized as an unacceptable departure from a system of medical ethics that emphasizes the centrality of the patient's well-being and the need for informed consent,'' write Dr. Lauris C. Kaldjian of Yale University School of Medicine in New Haven, Connecticut, and colleagues. ``Residency training programs should review how house officers learn to perform invasive procedures. Training programs should consider how aspects of (medical) education may unintentionally reinforce attitudes that can reduce patients to mere objects of use in education,'' they add. ``There should be informed consent,'' study co-author Dr. James F. Jekel, director of the department of preventive medicine at Griffin Hospital in Derby, Connecticut, told Reuters Health. ``The practice doesn't seem to do any harm, but there is also no benefit. We need to find ways to practice without dehumanizing a living person,'' he said. SOURCE: The New England Journal of Medicine 1999;341:2088-2091. Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=13056