Considering the ethics of live tissue training in trauma surgery

'Live tissue training', using an anaesthetised live animal substituted for a human patient for the practice of surgical skills, is a controversial topic. Although simulator technologies have developed significantly for inclusion in many areas of surgical education, it is contested that training to manage traumatic injuries requires a model that can bleed and has a dynamic circulation. This article uses the published literature to explore the values at stake regarding live tissue training in the context of trauma with the aim of considering whether such training is ethically justifiable, to any degree. We present criteria for the ethical evaluation of live animal use in trauma simulation alongside descriptions of the pro- and contra-arguments present in the literature. Our conclusion is that justification is challenging and must be considered on a case-by-case basis-it is important that the difference gained from using a live animal compared with the best alternative simulator has to be greater than the clear ethical downside of using animals.