December 8th, 2008
08:55 AM ET

A question of consent

By Caleb Hellerman
CNN Medical Senior Producer

I’ve been working on a project called “Another Day: Cheating Death” that you’ll hear more about in 2009. It’s about medical innovations, especially in the realm of emergency medicine.

When it comes to emergencies, doctors face a dilemma: how do you test a new treatment?  Take cardiac arrest: for decades, emergency responders have given victims a shot of epinephrine – adrenaline – to help re-start the heart.  But there’s a new study, from Norway, which says the drug actually doesn’t make a difference. How do they know? The only way you can: by testing it.  About half the patients, who suffered out-of-hospital cardiac arrest over the five-year study period, got a shot of epinephrine along with CPR and defibrillation.  The other half got no epinephrine.  

None of the patients gave consent to be part of the study.  They couldn’t; they were unconscious, and resuscitation efforts had to start right away. The study was approved by an independent oversight board – but when Norwegian reporters found out about this in January, there was a scandal. The doctors were accused of withholding lifesaving treatment. The study had to be cut short, although by that point, it was nearly finished, anyway.

Dr. Kjetil Sunde, one of the lead authors, is still upset.  He told me, “People only think you’re a good practitioner if you give a lot of drugs. If you just cure him with traditional doctor’s wisdom, they think you’re bad.”

It makes me uneasy to think I might not get the “standard of care” in such a crucial situation. At the same time, how else are we going to find a better way of doing things?

Would you be upset if you found a hospital had tested a new emergency treatment on you or a loved one, without getting consent?

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