Mr. Ellsworth, who was 87 years
old, was brought into the emergency room by the local rescue squad in a complete
cardiac arrest. All emergency procedures were performed, including the
establishment of an airway, peripheral intravenous lines, urinary
catheterization, and more. After resuscitation attempts had been performed for
45 minutes, the patient was pronounced dead by attending physician and family
members were notified. At that time the family arrived at the emergency room.
Mary Pope, the evening staff nurse, found the attending physician teaching
incubation techniques to five medical students and they were using Mr.
Ellsworth’ corpse for practice. She quietly notified the attending physician
that the family had arrived and wanted to talk to physician. They also wanted to
see their loved one’s body. The attending physician, however, said that he would
be busy teaching the medical students for another 15 to 20 minutes. When Ms.
Pope asked weather Mr. Ellsworth had given permission for his body to use to
teaching purpose, the attending physician ignored Miss Pope and asked her to
tell the family that he would be busy with another patient for few more minutes.
In the above scenario we have seen that the attending physician is teaching an
invasive procedure using a deceased body and ignoring the respect and dignity of
it. I was shocked with the doctor’s attitude towards Mr. Ellsworth’s corpse, his
family members and the nurse as well. While reflecting on this incident, I was
thinking about the rights of dead body. Is this legally and ethically right?
Being Muslim what about the rights of human body after death explained in the
Holy Quran and other religions. I felt very upset for this incident. What about
the family, who did not know that what happened to Mr. Ellsworth and what, is
going on now? They wanted to see the doctor and the doctor was replying them to
wait outside with disrespect to the family members. This incident has great
significance towards the family members, and for all paramedical practitioners.
Evaluation
This incident stood out for me because first of all it was an ethical issue.
Physician showed disrespect towards the corpse of Mr. Ellsworth by not following
the rights of dead body. Secondly physician should have consent from the family.
Thirdly, physician should respect family members as they wanted to talk to the
attending physician and he asked nurse to give excuse to them. Fourthly what
about the religion does clients or any other religion allowed this kind of
practice. Finally what was the role of nurse, why she did not firmly stop the
physician from practicing such heartless behavior?
Analysis
When I reflect back the situation many questions start revolving around my mind.
Such as, why doctor was practicing on the dead body? Is it ethically or legally
right to practice on a dead body? Why he did not take permission from the family
first and then uses the corpse of Mr. Ellsworth? Why he asked family members to
wait and did not gave respect to them? What about religion is it allowing us to
use dead body for our own practice purpose? Moreover why nurse in that situation
was mute and did not advocate for patient’s body right? She could stop the
physician if she feels that what is going on is not legally or ethically right.
I was thinking if there was my family instead of Mr. Ellsworth then how do I
feel or what could be my reactions? While analyzing critically many assumptions
appear on the screen of my mind. Such as, for physician might be the importance
of educational value of practicing procedure for medical students are more
important than the dignity and respect for the deceased patient. Although is it
ethically and legally not right but this practice could safe many other patient
from death. The physician did not ask for consent because he might think that
the family will refuse him to use Mr. Ellsworth’s corpse for practicing purpose.
The physician did not answer the family members because he did not want to waste
his time because if the process of rigor mortis starts he could not teach or
practice with his students.
If we talk about religion, it never allows us to perform such practices. Every
religion explicitly bans any manipulation of dead body. If we put our self in
the physician’s shoes and think that intubation is one of the essential
procedures one needs to perform before putting a patient on ventilation. If
physician is not expert in this procedure he might fail to safe others as well.
The physician who worked to safe Mr. Ellsworth’s life (and failed) now is using
the patient’s shell to horn his skills which might benefit to other critical
patient. Marry Pope; the evening shift nurse was not able to stop the physician
firmly as she had knowledge that what is happening is not right. Might be she do
not have enough guts to stop a physician after all having enough knowledge. If
we assess the practice of other hospitals in Karachi, it is more wore than this
situation. In newspaper we daily read some news about the mal practicing on dead
body or abusing it without known to family members.
Synthesis
After critical analysis I start wondering that what literature says to have
better solution of this situation. According to the American Medical Association
it is recommended that practicing on deseeded body is important for the medical
student and should perform with dignity; with permission of family and within
the supervised environment (AMA, 2002). If we review from the religious point of
view it is there in Quran and Bible as well that after death the body should
buried as soon as possible with all its dignity and full parts. Whereas,
according to Iserson 1995, if respect means paying homage and bestowing owner,
this procedure is more respectful than many of the other procedures performed in
our society after death. After reviewing the literature I came to know that
religion is absolutely not allowing us to practice on dead body. Whereas
practicing of the invasive procedure is important for physician to work in
critical care area but for this permission from the family is essential. Now
day’s different manikins are available in the market which can utilize for
practicing purpose. After critically analyzing and have literature knowledge, in
future if I came across the same scenario I could act differently. I know that I
have to advocate for the patient’s right, if I will see any physician practicing
on the dead body I should find out that he has taken the permission from the
family or not. If not then I could stop the physician firmly in order to
maintain the dignity and respect of the dead body. In order to know that what
the thinking of general population is I interviewed some of my neighbors. The
question was if any of your family members die and a doctor comes to you and
asks if we can teach a procedure on the dead body what will be your response. I
came to know that 6 out of 10 families answered that if we have proper
explanation that why medical staff is using the body we might offer them to
practice.
In conclusion, first of all paramedical persons should know that without
family’s consent they could not perform any practice on a dead body. Secondly
they should keep respect and dignity of family decision and their religion as
well. Thirdly as a professional nurse we need to adapt the role of an advocator
in order to maintain patient’s autonomy. For this purpose I will educate other
nursing staff by discussing ethical concepts with them. In addition ongoing
sessions could arrange to discuss how to become assertive for patient’s right.