Anaesthetised patients 'routinely abused during medical training'

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Routine abuse of patients during the training of medical students is exposed today by a survey which found that patients were subjected to unpleasant examinations and unnecessary procedures without their consent.

Routine abuse of patients during the training of medical students is exposed today by a survey which found that patients were subjected to unpleasant examinations and unnecessary procedures without their consent.

Training the next generation of doctors means that students must be given the chance to practise procedures and techniques. But the survey concluded that all too often the normal ethical boundaries defining good practice were transgressed.

Internal examinations of the vagina and rectum were carried out on patients while they were anaesthetised without their knowledge, and patients were subjected to medical procedures solely for educational, not therapeutic, reasons.

In one case, a student was invited to practise a "femoral stab" in which a catheter is inserted into the femoral artery, on a terminally ill patient near death. As the patient was in a vegetative state (awake but not responding), he was not in a position to give consent - nor to resist, object or complain.

Nearly half of the 100 medical students in the survey said they often felt under pressure to act unethically during their training and almost two-thirds said they regularly witnessed a teacher behaving unethically.

Although the study was carried out at the University of Toronto, the British Medical Journal, which publishes the findings today, says they are likely to be relevant to medical schools across the world.

In a separate article in the journal, two British doctors and a researcher from Oxford say the practice of performing internal examinations on anaesthetised patients without consent continues, even though it has been condemned.

Andrew West, a psychiatrist, and Christopher Bulstrode, an orthopaedic surgeon, together with Victoria Hunt, a researcher, say: "How would you feel if you knew as you were wheeled into the anaesthetic room that you would be stripped of your rights the moment you fell asleep and your body would be fair game? Many of us might consent to students practising a rectal examination on us while awake, but most would be incensed if the same act was performed on us unconscious and without our knowledge or consent?"

After the Alder Hey organ scandal and the Bristol baby deaths, both of which revolved around issues of informed consent, they warn that if the practice of training students on unconscious patients becomes widely known, trust in doctors will be further undermined. "The medical profession urgently needs to learn respect for the living and for the dead, and thereby earn the public respect that is its life-blood," they say.

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