Does proficiency creativity solve legal dilemmas? Experimental study of medical students' ideas about death-causes.

The aim of the present study was to compare and examine how medical students on term one and nine understand and adopt ideas and reasoning when estimating death-causes. Our hypothesis was that compared to students in the beginning of their medical curriculum, term nine students would be more inclined to adopt ideas about causality that allows physicians to alleviate an imminently dying patient, without being suspected for manslaughter--a practice referred to as proficiency creativity. We used a questionnaire containing two similar cases describing an imminently dying patient who receive a drug in order to treat seizures. The treatment has the foreseen effect of shortening the patient's life. In one version of the vignette the patient dies immediately and in the other one the patient dies 5 h after having received the drug. We asked medical students in their first term (n = 149) and ninth term (n = 106) to fill in the two randomly distributed questionnaires. We used a χ2 test to examine our hypothesis and choose as significance level 0.05. A majority of term-one students (53%) stated that the patient died because of the provided drugs when dying immediately after and 32% stated it when the patient died 5 h after providing the drug. The difference was significant (p = 0.007). A minority of term-nine students (20 vs. 16%) stated the patient died because of the provided drug. The difference was not significant. The study indicates that term-nine students have espoused the idea that death-causes in such cases should always be classified as the underlying disease--even though another straightforward explanation could be the drug provided. To clinicians this might be a proficiency-creative strategy for managing a difficult legal dilemma. As hypothetical explanation we suggest that experienced clinicians might have transformed a normative issue of shortening life into an empirical issue about death-causes and tacitly transferred this strategy to term-nine students. If our hypothesis is supported by future studies, this kind of transferring proficiency creativity tacitly might impede changing the Penal Code even though it may be needed.