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What If We Were to Ask?

Rumm M. Morag, MD; Sylvie DeSouza, MD; Petter A. Steen, MD, PhD; Ashraf Salem, MD; Mark Harris, MD; Oyvind Ohnstad, MD; Jan T. Fosen, MD; Barry E. Brenner, MD, PhD

Arch Intern Med. 2005;165:92-96.

Background  Performance of procedures on the recently dead for physician training is controversial. It has been suggested that permission be obtained. We investigated whether patients and family members would grant such permission or if even this request might anger the recently bereaved.

Methods  Physicians administered identical surveys to adult emergency department patients and family members in Brooklyn and Oslo to determine their willingness to consent for teaching of specific invasive techniques in the event of their own death or that of a family member. Demographic factors and location (culture) were assessed for effects.

Results  Willingness to consent was directly related to age of decedent and inversely related to perceived invasiveness of the procedure at both sites. In every scenario, respondents in Brooklyn were much less willing to grant permission (2- to 2.5-fold) than were those in Oslo. In Oslo, respondents were more willing to consent for their own bodies to be used as training tools than that of a relative. In Brooklyn, 48.5% would be angry if approached for permission compared with only 8.4% in Oslo (P<.001).

Conclusions  Asking for permission to perform procedures on the recently deceased for physician training purposes may often anger the bereaved. The emotional response to the consent request may be culturally determined. Increased willingness of individuals to permit the use of their bodies in the immediate postmortem period suggests that a preauthorization program similar to organ donor cards might be acceptable, successful, and ethical.

Author Affiliations: Departments of Emergency Medicine, Emory University, Atlanta, Ga (Dr Morag); The Brooklyn Hospital Center and Weill Medical College, Cornell University, Brooklyn, NY (Drs DeSouza, Salem, and Harris); Department of Anesthesiology, Ulleval University Hospital, Oslo, Norway (Drs Steen, Ohnstad, and Fosen) and University of Arkansas for Medical Sciences, Little Rock (Dr Brenner).

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