TORONTO (CP) - When it comes to teaching medical students about ethics, hospitals might consider hanging signs saying: Do as they say, not as they do.

A survey of medical students at the University of Toronto found nearly half had been put in situations where they were pressured to act unethically by their teachers.

Examples of abuses:

- Groups of students who are instructed to perform rectal or vaginal examinations on patients under general anesthesia who have not given consent to the procedure.

- A student is taught to do a procedure called a femoral stab - taking blood from the femoral artery in the leg - on a comatose patient.

- A student is instructed to get a woman's consent for a procedure, even though hospital policy forbids medical students from doing so.

The British Medical Journal, which published the survey on Friday, said such practices aren't unique to the University of Toronto and threaten the profession by persuading the bad doctors of tomorrow that they need not concern themselves with ethics.

"There may have been a time when doctors could get away with being trustworthy in public but despicable in private, but this is an age when no secret is kept for long and really all doctors should know better," psychiatrist Andrew West, of Park Hospital for Children in Oxford, England, wrote in a commentary accompanying the survey.

"As soon as the practice of students practising examination technique on unconscious and unconsenting patients becomes widely known, what remaining trust the public has in the medical profession will be further undermined."

The Toronto survey was conducted by a group of then junior medical students prior to beginning the clinical portion of their education.

One of the authors, David Robertson, explained that he and his fellow authors were worried about the stresses they were going to face in clinical practice so they organized a panel discussion to pick senior students' brains on the issue.

"What we heard, somewhat to our surprise, was that most of the problems and stressors senior students were talking about were ethical dilemmas," he said in an interview Thursday.

The surprising anecdotal evidence prompted them to carry out a formal study, which consisted of a survey of 108 students followed by four focus groups, each of which contained 20 students.

Nearly half - 46 per cent - reported that they had been put in what they felt to be unethical situations by instructors at least occasionally and 61 per cent said they'd witnessed a clinical teacher acting unethically.

Ethical violations included: instructing patients to return to a clinic for follow up visits and not informing them that the visits were entirely for teaching purposes; ordering a student to do a procedure he didn't know how to do; giving a woman who wanted a drug-free delivery intravenous narcotics without her knowledge.

One recounted being taught how to do a procedure called a femoral stab on a comatose patient who didn't need the procedure.

"The patient was not expected to (recover) from his current condition and wasn't in a position to argue and I think there was a very thinly veiled excuse that we could do it," the unnamed student is quoted as saying.

"It was more or less an exercise in education on a non-consenting patient."

West, who co-wrote his commentary with surgeon Christopher Bulstrode and lay-person Victoria Hunt, said doctors must understand that they owe the same respect to unconscious and even dead patients as they do to conscious ones - or perhaps even more.

" 'What the eye does not see the heart will not grieve' may have seemed valid at a time when most people were treated as if they had neither the knowledge nor the sense to make rational decisions for themselves," they wrote.

"The medical profession will not survive if it continues to assume that this attitude is acceptable in a sophisticated democracy."

An editorial on the matter which also ran in the journal noted that in 1996, students at St. Bartholomew's and the Royal London School of Medicine insisted on drawing up a policy on the rights of patients in medical education.

The policy was a reaction to the "distressing ethicolegal practice of some of their clinical teachers," wrote Len Doyal, a professor of medical ethics at the school.

The policy requires students and teachers to get a patient's consent before doing a physical examination and reminds them that they should never perform an exam under circumstances that would be embarrassing to the patient.

It forbids performing examinations on unconscious patients unless they have consented beforehand.