Junior doctors 'practice' on dying patients

Encouraging junior doctors to acquire skills by 'practising' on dying patients has been condemned by many physicians in a new US study (BMJ, 2000; 320: 137).

The study aimed to gauge the feelings of a number of physicians about performing unnecessary procedures on the dying.

In a questionnaire, respondents were presented with a scenario in which an elderly patient was not responding after 20 minutes of cardio-pulmonary resuscitation and appeared to be dying. The question asked was whether it was then appropriate for a junior doctor to gain experience by inserting a femoral vein catheter.

Two thirds of the respondents said they were opposed to such a procedure, mostly on the grounds of patient autonomy. Other reasons for opposing the procedure were "a violation of human dignity and "lack of informed consent". Of the third who approved of working on dying patients, the need to improve clinical skills to benefit future patients was the most cited reason.

Despite this, the practice was relatively widespread, with 42 per cent of respondents saying that they had done it themselves or watched others do it.

The authors' concluded that "clinical education may...reinforce attitudes that can reduce patients to mere objects of use in education".

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