Virtual Mentor. January 2005, Volume 7, Number 1.
Case 4.2: Practicing a Procedure on the Newly Deceased—Mrs. Milos's Pericardiocentesis
Performing procedures on the newly deceased for training purposes without gaining permission from the family violates the norm of respect for deceased patients and their families. It also threatens to undermine the trust in the medical profession that is so pivotal to its relationship with the community. Because the patient receives no benefit, the traditional concept of presumed consent does not apply here, and there can be no waiver of informed consent.
This opinion challenges the claims put forward by both the President's Commission  and the American Heart Association  regarding intubation—both have argued that this non-invasive procedure can be performed without consent. This will remain a contentious issue, but the primacy of respect for patient and family preferences suggests that even these non-invasive procedures require permission. Similar to the views on organ donation in the United States, there should be a presumption of refusal which can only be overcome by previously expressed preferences or family permission.
Regardless of Dr. Desai's decision about attempting a pericardiocentesis, in Opinion 8.18, "Informing Families of a Patient's Death," the Code is clear that Lydia and Carl should not be asked to inform Mrs. Milos's son of her death. If Dr. Desai has some prior experience informing families of a patient's death as the treating physician in the ER, she may be in the best position to inform the patient's family. Outside of the ER, it is much more likely that the resident on the case would not be primarily responsible. Instead, as Opinion 8.18 explains: "Physicians in residency training may be asked to participate in the communication of information about a patient's death if that request is commensurate with the physician's prior training or experience and previous close personal relationship with the family."
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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