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

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.

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