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When Teachable Moments Become Ethically Problematic

Published online by Cambridge University Press:  25 May 2017

ELIZABETH DZENG
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Abstract:

There is frequently tension in medical education between teaching moments that provide skills and knowledge for medical trainees, and instrumentalizing patients for the purpose of teaching. In this commentary, I question the ethical acceptability of the practice of providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to dying patients who would be unlikely to survive resuscitation, as a teaching opportunity for medical trainees. This practice violates the principle of informed consent, as the patient agreed to resuscitation for the purpose of potentially prolonging life rather than to futile resuscitation as a teaching opportunity. Justifying futile resuscitation in order to practice normalizes deceptive and nonconsensual teaching cases in medical training. Condoning these behaviors as ethically acceptable trains physicians to believe that core ethical principles are relative and fluid to suit one’s purpose. I argue that these practices are antithetical to the principles espoused by both medical ethics and physician professionalism.

Keywords

end-of-life caremedical educationfutilityresuscitationinformed consenthidden curriculum
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 26 , Issue 3 , July 2017 , pp. 491 - 494
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

I thank Alexander K. Smith, MD, MPH for his insightful comments to the manuscript and Stephen Barclay, Bm, BCh, MD; Michael P. Kelly, PhD; David Levine, MD, MHS, ScD; Martin Roland, Bm, BCh, DM; and Thomas J. Smith, MD for their mentorship during the doctoral project from which the data from this article were obtained. The data cited in this study were funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant and the Gates Cambridge Scholarship. Ethical approval was granted for the study by the Johns Hopkins School of Medicine Institutional Review Board (NA_00080529, 1/28/2013).

The aim of this section is to expand and accelerate advances in methods of teaching bioethics.

References

Notes

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