When Teachable Moments Become Ethically Problematic

Camb Q Healthc Ethics. 2017 Jul;26(3):491-494. doi: 10.1017/S096318011600116X.

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 care; futility; hidden curriculum; informed consent; medical education; resuscitation.

MeSH terms

  • Advanced Cardiac Life Support / education
  • Advanced Cardiac Life Support / ethics*
  • Cardiopulmonary Resuscitation / education
  • Cardiopulmonary Resuscitation / ethics*
  • Curriculum
  • Education, Medical / ethics*
  • Ethics, Medical
  • Humans
  • Informed Consent / ethics*
  • Medical Futility / ethics*