An issue relevant to procedural skills in Emergency Medicine and other specialties is allowing learners to practice invasive procedures on the recently deceased.1,2 This often occurs immediately after the pronouncement of death and is a controversial practice. The use of the bodies of the dead for education has a long tradition in medicine. The use of the recently deceased is considered by some as a valuable resource because it improves the ability to save others in the future. Others believe consent is required from family members to preserve autonomy despite the uncomfortableness of asking for consent.
Teaching procedures have used various techniques (e.g., animals, cadavers, lectures, live patients, manikins, simulation, and videotapes). Each technique has advantages and disadvantages. These include cost, lack of reality, space, and time. The opportunity to practice lifesaving procedures is limited. This is especially true for realistic training.
Performing procedures on the recently deceased has been a topic of discussion over the past two decades and debated within the medical community. This chapter attempts to present a balanced overview of this topic and offer suggestions for best practices.
HISTORY AND CURRENT PRACTICE
Physicians and healers have been learning from the dead for millennia. The earliest-known description of circulatory anatomy is the Edwin Smith Surgical Papyrus from 1600 BC. Contemporary cadaveric dissection in the first year of undergraduate medical education training is a practice with a long precedent that has never been without controversy.
Various authorities (e.g., governments and religions) have restricted the practice of cadaver dissection for studying anatomy. A commonly cited belief is that the study or dissection of the dead without curative intent is tantamount to desecration of the corpse. There is a long intellectual and spiritual tradition of believing that the human body is sacred. This belief continues following death, and some reject dissection or manipulation as a form of desecration. This has been studied in the context of the autopsy. Some cultural or religious belief systems have requirements that the corpse of a decedent be buried whole and undisturbed. These beliefs may result in the reluctance of families to allow procedures or investigations on their loved ones after death.
An interesting footnote regarding the history of ambulance services is that they originally carried the dead to mortuaries in exchange for payment. The bodies of some patients were bought and sold to medical schools as teaching aids. Recently deceased bodies may offer the most lifelike opportunity for practicing new surgical procedures or learning anatomy.
Performing procedures on the deceased (e.g., central venous catheter placement or endotracheal intubation) is a long-standing tradition in medicine. Numerous authors have described the prevalence of this practice in the United States and abroad. This prevalence varies between specialties. More than 70% of neonatology training fellowships allowed trainees to practice endotracheal intubation and umbilical vein ...