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Lol I feel these questions have so many assumptions and I don't think you would get these type of questions at interviews. You are more likely to get the 14 year old pregnant, terminally ill patient, HIV patient, etc. But it's still good practice to think about these things.
 
This is a great exercise but you might be better off asking ethical questions and then applying them to situations rather than giving situations and presuming and ethical question because there might not be one....


1. The question presumes this man has insurance (likely of course). Thus, yes. Easiest claim in the world on the side of the insurance company as it is clear how the accident came about, the family will not lose anything other than time in getting it processed and I, as an insurance holder myself, have an obvious self interest that does not harm others. To earn "nice guy" points (which have nothing to do with an ethical burden, actually, which I feel this question might be confusing as the ethically ideal and ethically necessary are not the same all of the time) I would tell the family to take their time dealing with the insurance.

2. No brainer. Yes I would ask them about his disease risk. I don't even see an ethical dilemma here. It is not an affront to human dignity to ask someone about their, or their family member's, disease risk. In fact, I am almost certain it would be standard protocol here and that a sample would be sent to the lab to be tested for HIV and HepB anyways. Again, you may be confusing "sensitivity" with ethical burdens.

3. Also not an ethical dilemma. The question has three premises: 1) We have a duty to protect the environment. 2) We have a duty to keep patients alive as long as is reasonable. 3) The resources required to care for these patients is putting a significant environmental burden on our planet.
1 is true and 2 is debatable so it needs qualification. Let's say 2 is true and I defined some terms on which it is true. Then there's 3. 3 is an empirical question. I will hazard to guess that 3 is false and that the impact this patient care has on the environment is very small in comparison to other human endeavors (argument by analogy, argument from utility) and that we have a duty as a healthcare system to protect the sanctity and dignity of life as long as is reasonable (pretend I rigorously defined this, I know this is more complicated than I make it; argument from humanity, see Kant "Groundworks"). Thus, I would say the question assumes an unsound argument to be sound which invalidates it immediately, but even if that argument were to be true (that's the strongest position you can take in an ethical argument, btw, "This is false but even if it was true...XYZ..") there are competing duties that favor the care of the patient.

The economic question is a different one entirely, also empirical and thus requires an empirical argument with an ethical groundwork; the real question you want to ask in Question 3 is: to what extent is healthcare a right at the end of life and how do we define that extent and under what assumptions and with what justification? That's an actual ethical dilemma and it would take a really long time to answer, so I won't, but it's the question you should actually be asking.

Here's an ethical question (an oldie but a goodie):

Should you only consider the outcomes of an action when deciding between actions and, if so, should you only act in service of the common good?


If yes to the above: Ought we then round up the homeless and harvest their organs in order to save countless more, productive lives?

If no to the above: What should help us decide between actions? Why and how should we act or be a certain way?

Follow up to second question above: Under that system what kind of duties do healthcare providers have to patients, communities, hospital systems; how do they differ?


Also, in the context of ethical arguments, I am going to provide a qualified definition of "rights" because I see the word misused (philosophically) a lot on these forums without an explanatory definition being given with it. For my purposes a "right" is inalienable and it also constitutes a duty that no one can ever take it away from you. This means that if you have a right to life then I have a duty not to kill you, etc.
 
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Also, in the context of ethical arguments, I am going to provide a qualified definition of "rights" because I see the word misused (philosophically) a lot on these forums without an explanatory definition being given with it. For my purposes a "right" is inalienable and it also constitutes a duty that no one can ever take it away from you. This means that if you have a right to life then I have a duty not to kill you, etc.
You've only defined negative rights. Wanna take a stab at positive rights? They're much more likely to come up in the context of an ethical debate....
 
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For everyone applying this coming cycle I want to try out a little activity; let's get some mock ethics questions going that can prep us for our interviews. Some medically related, some not.

First one: An elderly gentlemen has a heart attack and dies behind the wheel of his car. He hits your car causing some substantial damage. Do you file a claim with his insurance knowing that it will possibly end up being an issue his family has to deal with?

Second: You're an EMT responding to a call of a motorcycle vs. car crash. The motorcycle operator was pretty severe when you picked him up and you start CPR on the way in. After a few chest compressions he shoots blood out of his mouth, splattering you and the other EMTs. He ends up passing away. Do you go to the family and question them regarding his disease risk after they arrive? (Let's assume he is high-risk; prison tattoos and "thug" appearing.)

Third (For anyone with an interest in finance or ecology): How do you feel about the disconnect between the increasing ability to keep people alive, especially those who can not function independently in society, and the worsening state of our planet. Do you feel that as an industry, healthcare is playing a role, however substantial, in accelerating our destruction of the planet due to the increased resource burden due to these types of patients? How do you feel about this issue in terms of economic stress on the United States? Given these arguments, how does this affect your stance on euthanasia and assisted suicide?

#1 Yes, and it isn't close. Not an ethical question.
#2 Yes, and it isn't close. Not an ethical question. ps. wear your ****ing PPE
#3 There is a line somewhere. On average, we keep people alive too long and it is destructive to the patient/family as well as society.
 
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I think this is a great thread!

This is one I hear often thrown around.

1) If you saw someone cheating on a test, what would you do?

I think the answer is fairly obvious.

2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...
 
I think this is a great thread!

This is one I hear often thrown around.

1) If you saw someone cheating on a test, what would you do?

I think the answer is fairly obvious.

2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...

Well the answer (at least the one you should say at an interview) is that in both cases you should report them. That's what the rule (honor code) says and it's best to abide by that.
 
Well the answer (at least the one you should say at an interview) is that in both cases you should report them. That's what the rule (honor code) says and it's best to abide by that.

So, tell them what they want to hear?

Reporting a bestfriend is tough. How many of you all would personally not do it and try to talk to the best friend first but still tell interviewers that you would report them anyway?

I have a friend who says she will be honest and tell them that she would report it if she sees it but if it was best friend she realistically won't report them. "If they don't like my answer, then I don't like that school and I'd rather not go there."
 
So, tell them what they want to hear?

Reporting a bestfriend is tough. How many of you all would personally not do it and try to talk to the best friend first but still tell interviewers that you would report them anyway?

I have a friend who says she will be honest and tell them that she would report it if she sees it but if it was best friend she realistically won't report them. "If they don't like my answer, then I don't like that school and I'd rather not go there."

Yes, of course you tell them what they (likely) want to hear.

In reality, maybe not (for a variety of reasons that can vary by situation). But I think it's easier to defend the importance of the honor code and being fair (treating everyone the same).

With regard to the bolded, how do you know that one person would represent the entire institution? Maybe he/she is just an outlier?
 
I was just throwing a couple questions out there that I have come across during my time working with docs. As for the second question, I witnessed this happen and the family made a huge deal out of it, seeing as their son had only died a few minutes before. I know that some of them may not be "ethics" per se, but real issues you might come across that may or may not have a clear answer under different contexts.

Just trying to get the imaginative juices flowing and see if some really good questions come up.

One that I've thought about in regards to anti-vaxxers; when people are presented with what they would do if a patient refused to get their vaccines or vaccinate their children, I've heard people say they would refuse to serve that patient. If all of the docs in your area have the same viewpoint wouldn't that put the patient at risk of even more unnecessary harm?

Let's see what everyone can come up with!
The patient is already putting themselves at unnecessary harm by refusing vaccine. What is the point of being THEIR doctor if they don't trust me? What will happen if I tell them due to your family history you might get X? Chances are, they will doubt me and trust the hibbe that told them vaccine is harmful.
The only concern is if they need emergency care, which is easily taken care of with our connected society. One call away and the whole hospital comes to you.
 
Yes, yes, that's a weird question
 
I was just throwing a couple questions out there that I have come across during my time working with docs. As for the second question, I witnessed this happen and the family made a huge deal out of it, seeing as their son had only died a few minutes before. I know that some of them may not be "ethics" per se, but real issues you might come across that may or may not have a clear answer under different contexts.

Just trying to get the imaginative juices flowing and see if some really good questions come up.

One that I've thought about in regards to anti-vaxxers; when people are presented with what they would do if a patient refused to get their vaccines or vaccinate their children, I've heard people say they would refuse to serve that patient. If all of the docs in your area have the same viewpoint wouldn't that put the patient at risk of even more unnecessary harm?

Let's see what everyone can come up with!

If you don't vaccinate then you will not receive treatment or sympathy from me. We can only help those who are willing to help themselves.
 
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Here's another question to think about:

You are an RN providing post-surgical care for a 53-year-old former football coach with diabetes. The patient recently had several toes amputated as a result of poor foot care. While you initially had a good relationship with this patient, he has become increasingly demanding, unappreciative, and sometimes verbally abusive. One day, as you enter his room, you find him eating from what appears to be a large-sized bag of M and M's. He pushes the bag under the bed clothes, responding defensively that he’s had “just a few.” You are concerned as the patient’s last A1C was 7.3. When you ask him how he’s doing, he snaps, “Leave me alone; there’s nothing you can do.” He refuses to allow you to change his foot dressings. He aggressively demands that you “Get out.”

You’re tired, having worked overtime the day before. You’ve had it with the coach’s ill-temper and lack of gratitude. Like most of the healthcare team, you’re fed up with the verbal abuse. You are also concerned that this patient really is not doing well. You think maybe someone else would have more success with this patient.

Should you ask to be taken off the case? * What are your other options? * What role might other members of the team play? * What ultimately should be done?
 
If you don't vaccinate then you will not receive treatment or sympathy from me. We can only help those who are willing to help themselves.

Ehhh be careful. I see how this applies to anti-vaxers, but what about the pt. that refuses to quit smoking/drinking/etc. or pts that are overweight and don't fix up their diet/increase physical activity?


Also, for anyone who has signed a confidentiality form during their MMIs, be cautious of what questions you share here...
 
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I'll be stealing 1 and 2. They're great! #3 is a poor question because I don't think anyone in their right mind would put the abstract Fate of the Planet ahead of a patient's life, comatose or not.


Lol I feel these questions have so many assumptions and I don't think you would get these type of questions at interviews. You are more likely to get the 14 year old pregnant, terminally ill patient, HIV patient, etc. But it's still good practice to think about these things.
 
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Here's an ethical question (an oldie but a goodie):

Should you only consider the outcomes of an action when deciding between actions and, if so, should you only act in service of the common good?

If yes to the above: Ought we then round up the homeless and harvest their organs in order to save countless more, productive lives?

If no to the above: What should help us decide between actions? Why and how should we act or be a certain way?

You seem to like philosophical analysis. Here's my take. This oldie is supposed to be a "gotcha" setup which gets people to say they support consequentialism/utilitarianism when they actually have slightly different ideas about intrinsic value. I'll bite and say yes, you should act only on outcomes/consequantialist and always in service of maximal common good/utilitarian.

Ought we harvest homeless people's organs to save more productive lives? Well first I'd clarify and say productivity doesn't very directly equate to the common good in a system which places intrinsic value in maximal happiness/minimal suffering - a more direct scenario would be harvesting the organs of the clearly low-happiness high-suffering people (maybe people with severe, treatment-resistant chronic depression) to save high-happiness low-suffering patients (normal people who happen to have failing organs).

But the answer can still be no, because it is beneficial for people to feel safe and have evidence-based belief that life is respected and not taken involuntarily from some individuals to be given to others.

Now, if it was all being done in secret somehow, so that the recipients never knew the source of the organs and nobody noticed the disappearing donors, then it would come out as morally correct by consequential/utilitarian positions. Definitely an initially uncomfortable realization for subscribers to that school of thought.

Another good thought experiment to challenge utilitarians is what to do with the worst criminals in a world with excess resources - it works out that the morally best system is to tell the public they're off being isolated/punished (to discourage future crimes) while in fact giving them a comfortable existence and maximizing their health and happiness just like everyone else's.

In any case the idea with these questions is to make people backpedal and place value in things like sanctity of life, just reward and punishment, etc as an ends in themselves rather than a means towards max happiness/min suffering. If you really subscribe to consequentialism/utilitarianism with the hedonist ideal of happiness as the only intrinsic good, a very defensible philosophical position, then despite sounding outrageous to most you actually do support things like coups de grace or, in the universe of thought experiments, secretly redistributing organs.

/rant
 
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You seem to like philosophical analysis. Here's my take. This oldie is supposed to be a "gotcha" setup which gets people to say they support consequentialism/utilitarianism when they actually have slightly different ideas about intrinsic value. I'll bite and say yes, you should act only on outcomes/consequantialist and always in service of maximal common good/utilitarian.

Ought we harvest homeless people's organs to save more productive lives? Well first I'd clarify and say productivity doesn't very directly equate to the common good in a system which places intrinsic value in maximal happiness/minimal suffering - a more direct scenario would be harvesting the organs of the clearly low-happiness high-suffering people (maybe people with severe, treatment-resistant chronic depression) to save high-happiness low-suffering patients (normal people who happen to have failing organs).

But the answer can still be no, because it is beneficial for people to feel safe and have evidence-based belief that life is respected and not taken involuntarily from some individuals to be given to others.

Now, if it was all being done in secret somehow, so that the recipients never knew the source of the organs and nobody noticed the disappearing donors, then it would come out as morally correct by consequential/utilitarian positions. Definitely an initially uncomfortable realization for subscribers to that school of thought.

Another good thought experiment to challenge utilitarians is what to do with the worst criminals in a world with excess resources - it works out that the morally best system is to tell the public they're off being isolated/punished (to discourage future crimes) while in fact giving them a comfortable existence and maximizing their health and happiness just like everyone else's.

In any case the idea with these questions is to make people backpedal and place value in things like sanctity of life, just reward and punishment, etc as an ends in themselves rather than a means towards max happiness/min suffering. If you really subscribe to consequentialism/utilitarianism with the hedonist ideal of happiness as the only intrinsic good, a very defensible philosophical position, then despite sounding outrageous to most you actually do support things like coups de grace or, in the universe of thought experiments, secretly redistributing organs.

/rant

You are right in that it's a gotcha but an important one and it should show that there is some intuitive, natural value on life that supersedes utility or necessity. It's not just to make people backpedal, it should get you to think about the way we make ethical decisions about health policy because you can tone down the consequences (it doesn't have to be harvesting organs) and have a similar discussion based on identical principles on organ donations, the cost of higher education, welfare, etc, anything that requires the sacrifice of some for the benefit of another in some ordinal way.

Your analysis is identical to Mill's when he defends Utilitarianism's ability to respect rights but as far as being tenable I would say Utilitarianism is limiting and limited and would go on to say that Kant was probably more correct than Mill when it comes to how we should make decisions. Although I don't completely agree with either and I think the categorical imperative is way over emphasized in lieu of the more useful Kantian ethics.
 
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For everyone applying this coming cycle I want to try out a little activity; let's get some mock ethics questions going that can prep us for our interviews. Some medically related, some not.

First one: An elderly gentlemen has a heart attack and dies behind the wheel of his car. He hits your car causing some substantial damage. Do you file a claim with his insurance knowing that it will possibly end up being an issue his family has to deal with?

Second: You're an EMT responding to a call of a motorcycle vs. car crash. The motorcycle operator was pretty severe when you picked him up and you start CPR on the way in. After a few chest compressions he shoots blood out of his mouth, splattering you and the other EMTs. He ends up passing away. Do you go to the family and question them regarding his disease risk after they arrive? (Let's assume he is high-risk; prison tattoos and "thug" appearing.)

Third (For anyone with an interest in finance or ecology): How do you feel about the disconnect between the increasing ability to keep people alive, especially those who can not function independently in society, and the worsening state of our planet. Do you feel that as an industry, healthcare is playing a role, however substantial, in accelerating our destruction of the planet due to the increased resource burden due to these types of patients? How do you feel about this issue in terms of economic stress on the United States? Given these arguments, how does this affect your stance on euthanasia and assisted suicide?

yes
yes and you test him too
waste of space and money
 
Another: If you consider yourself atheist or otherwise non-religious and therefore do not believe in the concept of a "soul", how do you justify that a human life is inherently more valuable than a lab animal or animals raised for slaughter? To anyone who replies that humans do indeed have a soul no matter what your religious or spiritual beliefs, then I say unto you, you believe in so-called "hippie" medicine like TCM and homeopathy by extension, a big no-no from what I've seen on these forums. :alien:

These have more to do with shooting down poorly-created strawmen than answering actual ethical questions.
 
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I think this is a great thread!

This is one I hear often thrown around.

1) If you saw someone cheating on a test, what would you do?

I think the answer is fairly obvious.

2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...

@Goro @gyngyn I'm sure that neither of you would ever ask this, but in theory... If I were to answer this question saying that I wouldn't report them to the professor in either situation, would that look really bad on my part?
 
@Goro @gyngyn I'm sure that neither of you would ever ask this, but in theory... If I were to answer this question saying that I wouldn't report them to the professor in either situation, would that look really bad on my part?

I would be likely to probe with other examples of bad behavior and ask if you would report a fellow student who was selling their personal supply of a prescription drug or a fellow volunteer who took pictures of drunk ER patients and posted them on social media. I'd keep going until I could find something you'd be willing to report and then ask why that was different than the other behaviors. Mostly I'd be looking for your thought process...
 
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@Goro @gyngyn I'm sure that neither of you would ever ask this, but in theory... If I were to answer this question saying that I wouldn't report them to the professor in either situation, would that look really bad on my part?
What do you think?
 
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I would be likely to probe with other examples of bad behavior and ask if you would report a fellow student who was selling their personal supply of a prescription drug or a fellow volunteer who took pictures of drunk ER patients and posted them on social media. I'd keep going until I could find something you'd be willing to report and then ask why that was different than the other behaviors. Mostly I'd be looking for your thought process...

@LizzyM thank you. Selling prescription drugs would be another story for me, because it's dangerous and illegal. volunteer taking pictures I would say something because that violates patient confidentiality does it not?

Worst case scenario 1 - a student cheats, and gets an A when he didnt deserve one. maybe even messes with the curve a bit
Worst case scenario 2 - a student sells painkillers to a peer, peer takes painkillers, has an adverse reaction and gets hospitalized. that's how I would try to explain I think?
 
What do you think?

@gyngyn I would assume it would vary from adcom to adcom, maybe some people feel that it is another student's duty to report cheating. some could argue that it is the professor's responsibility (and their TAs or exam proctors) to prevent cheating? As I mentioned in the previous comment, the worst that happens is that the student gets a better grade than he/she deserves... unless there were some crazy circumstances
 
A physician has access to secrets that would make a priest blush.
We have a special place in society in which we are often the only ones that have access to our fellow physicians' lapses of supportable conduct. If we do not have the commitment to report wrongdoing, our whole profession suffers almost as much as those who would trust us.
 
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@gyngyn I would assume it would vary from adcom to adcom, maybe some people feel that it is another student's duty to report cheating. some could argue that it is the professor's responsibility (and their TAs or exam proctors) to prevent cheating? As I mentioned in the previous comment, the worst that happens is that the student gets a better grade than he/she deserves... unless there were some crazy circumstances
Nope, not much.
Lying, cheating, stealing and turning a blind eye to those in a position of privilege who do them are contrary to the standards to which I hold myself, my colleagues and my students.

Patients do all of these. We still care for them. Standards for professionals are higher.
 
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A physician has access to secrets that would make a priest blush.
We have a special place in society in which we are often the only ones that have access to our fellow physicians' lapses of supportable conduct. If we do not have the commitment to report wrongdoing, our whole profession suffers almost as much as those who would trust us.

Nope, not much.
Lying, cheating, stealing and turning a blind eye to those in a position of privilege who do them are contrary to the standards to which I hold myself, my colleagues and my students.

Patients do all of these. We still care for them. Standards for professionals are higher.

Makes sense, thank you @gyngyn. I would just be afraid to answer "OF COURSE I would rat him out in a heartbeat!", seeing as there is such a negative connotation associated with "narcs" in other situations.
But your view makes much more sense for the medical field.
 
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I think this is a great thread!

This is one I hear often thrown around.

1) If you saw someone cheating on a test, what would you do?

I think the answer is fairly obvious.

2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...
I had this question at a top school and said that I would talk to the person rather than report them (at least the first time it happened), but indicated that my response could change based on how much the cheating impacted other students. The interviewer was satisfied with my response and I was accepted.

The one problem that I can see with this approach is that by reporting the student, I could potentially keep a fundamentally dishonest person from becoming a doctor and potentially harming patients. However, that's a rather big leap, and I'm not sure it would justify reporting them before talking to them first.
 
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If I interview with you you can bet that I'll call you out on stealing my questions haha. I understand that the environmental impact is a bit of a stretch but it's not completely out there. The economic impact is a much more tangible consequence and you can't argue that it isn't true.

Another: If you consider yourself atheist or otherwise non-religious and therefore do not believe in the concept of a "soul", how do you justify that a human life is inherently more valuable than a lab animal or animals raised for slaughter? To anyone who replies that humans do indeed have a soul no matter what your religious or spiritual beliefs, then I say unto you, you believe in so-called "hippie" medicine like TCM and homeopathy by extension, a big no-no from what I've seen on these forums. :alien:

First of all, it is the natural response of humans to care for humans above other animals, and we have specially developed senses of empathy and altruism for other humans, just on an evolutionary basis. There are multiple reasons why humans are often considered above animals, including capacity for rational thought, capacity to think about the future, art, music, deeper emotions, etc. I personally value that, and that is part of why I am pursuing the business of helping others.

I would also argue that belief in the soul does not necessitate belief in homeopathy, as homeopathy, due to evidence (lots of evidence), will not help the body. Allopathic evidence based medicine will.
 
I'm not fond of this one either. I can think of several easy answers to parry the thesis.

Another: If you consider yourself atheist or otherwise non-religious and therefore do not believe in the concept of a "soul", how do you justify that a human life is inherently more valuable than a lab animal or animals raised for slaughter? To anyone who replies that humans do indeed have a soul no matter what your religious or spiritual beliefs, then I say unto you, you believe in so-called "hippie" medicine like TCM and homeopathy by extension, a big no-no from what I've seen on these forums. :alien:[/QUOTE]


I've tried this and the answer I got was 100% "I'd tell him to turn himself in or I'd do it for him".

Not that I believe that. Also see gyngyn's answers above. 100% agree.


2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...[/QUOTE]
 
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@Goro @gyngyn I'm sure that neither of you would ever ask this, but in theory... If I were to answer this question saying that I wouldn't report them to the professor in either situation, would that look really bad on my part?

I personally think people approach cheating way too casually. I've heard it among premeds (my own classmates) that it's just a test, and doing poorly will hinder them from getting into medical school, and they want to help people as a doctor. My personal view is cheating robs everyone and harms others beyond those just in the classroom. If you cheat (let's not even get into the whole idea of integrity or character), you possibly screwed up the curve and robbed some other non-cheating student a grade which would affect their admissions medical school and/or their scholarships, on which they possibly rely (the very thing which you were worried about). You robbed the patient of the better physician (the non-cheater, who actually learned and mastered the material), society of a decent member (Who knows, maybe your cheating was one of many factors that prevented them from matriculating or whatever) and you robbed yourself (of the knowledge you ought to have had, and the character which you destroyed). I abhor cheaters. I see anyone cheat, I discuss it with them and I report it. If I don't, I rob you of the chance to learn a lesson with lower stakes. So, you cheat in lab, maybe you fail that lab, maybe you fail the course. You cheat as a scientist, and your reputation is ruined, you're done. Game over. It's not about judgement, but it is about consequences. Better curb bad behavior earlier. For Pete's sake, people. Grow up.

End rant (can you tell there's some baggage attached to that one?)
 
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Nope, not much.
Lying, cheating, stealing and turning a blind eye to those in a position of privilege who do them are contrary to the standards to which I hold myself, my colleagues and my students.

Patients do all of these. We still care for them. Standards for professionals are higher.


nailed it.
 
New question I encountered during shadowing (in a foreign country): What should you do when the family tells you not to tell the patient that they have cancer? Why?
 
I've tried this and the answer I got was 100% "I'd tell him to turn himself in or I'd do it for him".

Not that I believe that. Also see gyngyn's answers above. 100% agree.


2) If you saw or knew your best friend was cheating on a test, what would you do?

Now that's a tough one...
[/QUOTE]

I had some cheating reported to me by a classmate and I was asked to "handle it". I didn't know the names of the accused but I did know the mechanism. What I ended up doing was reporting the mechanism to staff and then telling my classmates the mechanism had been reported. My goal wasn't to get people punished, it was to get them to stop cheating.

I have to agree with goro that almost no one would actually do the "turn yourself in or I will" to a classmate or friend. I think a lot would do, "if it happens again, I'll turn you in" but almost never on the first offense if people are honest with themselves.

Not saying that's right, but it's accurate
 
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Here's another question to think about:

You are an RN providing post-surgical care for a 53-year-old former football coach with diabetes. The patient recently had several toes amputated as a result of poor foot care. While you initially had a good relationship with this patient, he has become increasingly demanding, unappreciative, and sometimes verbally abusive. One day, as you enter his room, you find him eating from what appears to be a large-sized bag of M and M's. He pushes the bag under the bed clothes, responding defensively that he’s had “just a few.” You are concerned as the patient’s last A1C was 7.3. When you ask him how he’s doing, he snaps, “Leave me alone; there’s nothing you can do.” He refuses to allow you to change his foot dressings. He aggressively demands that you “Get out.”

You’re tired, having worked overtime the day before. You’ve had it with the coach’s ill-temper and lack of gratitude. Like most of the healthcare team, you’re fed up with the verbal abuse. You are also concerned that this patient really is not doing well. You think maybe someone else would have more success with this patient.

Should you ask to be taken off the case? * What are your other options? * What role might other members of the team play? * What ultimately should be done?

I want to work at the hospital where I can asked to be assigned to a different patient..
 
New question I encountered during shadowing (in a foreign country): What should you do when the family tells you not to tell the patient that they have cancer? Why?


I always find this scenario interesting. Not long ago, a patient presented with N/V/jaundice. Dx cancer, stage IV (terminal metastatic pancreatic adenoca). The patient was a non-English speaking elderly Asian woman who lived with one of her several children. Her children stated they did not want their mother to know her diagnosis. Her physician complied (I believe), despite the fact that typically, dx/tx are shared with the patient and not with the family (unless pt permits). The discussion from the ethics committee was quite interesting (given the potential legal ramifications under more "normal" circumstances). Many factors go into making such a decision (competence, informed consent etc etc), but in the aforementioned case, one argument for not disclosing the dx to the pt directly had to do with the identity of the "autonomous unit". In this case, it was felt the autonomous unit was the family as a whole, and not the pt as an individual. To act in the best interest of the pt meant to act in according to the family's wishes., from whom the patient derived strength and meaning. It was an interesting case.
 
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I'll be stealing 1 and 2. They're great! #3 is a poor question because I don't think anyone in their right mind would put the abstract Fate of the Planet ahead of a patient's life, comatose or not.

I tend to agree with mimelem -- the answer to both 1 & 2 in the OPs original post is yes and no ethics at all involved here -- at most just a matter of tact in how you make the ask in number 2, which you absolutely can and should do. So I don't know if I'd call them "great". A great ethics question has two debatable answers.
 
Better ethical questions 1. Demented patient with periods of Lucency executed a durable power of attorney indicating they wanted to pull the plug and a spouse, who stands to inherit a lot wants to comply. Rest of family opposes this. They turn to you for guidance.
2. Pre-Teen having high risk sex or pregnant and on drugs doesn't want you to breach confidentiality and talk to parents. What do you do?
3. Psych patient confides in you that he has dreams of killing his spouse but insists they are only dreams and he'd never do anything. Do you tell spouse? Take action somehow?
4. Patient in chronic pain wants you to administer dangerous but non lethal level of narcotics. Do you do it?
5. Potential Kidney donor funds out in screening that she has cancer and can't donate. Wants you to lie for her as to why she won't give her sister a kidney.
6. A dad finds out he has Huntingtons. Doesn't want to tell ex wife to have the kids tested.
Etc
 
Better ethical questions 1. Demented patient with periods of Lucency executed a durable power of attorney indicating they wanted to pull the plug and a spouse, who stands to inherit a lot wants to comply. Rest of family opposes this. They turn to you for guidance.
2. Pre-Teen having high risk sex or pregnant and on drugs doesn't want you to breach confidentiality and talk to parents. What do you do?
3. Psych patient confides in you that he has dreams of killing his spouse but insists they are only dreams and he'd never do anything. Do you tell spouse? Take action somehow?
4. Patient in chronic pain wants you to administer dangerous but non lethal level of narcotics. Do you do it?
5. Potential Kidney donor funds out in screening that she has cancer and can't donate. Wants you to lie for her as to why she won't give her sister a kidney.
6. A dad finds out he has Huntingtons. Doesn't want to tell ex wife to have the kids tested.
Etc


1-6. Don't do anything


Is this acceptable in the medical world? Every question of ethics reminds me of that situation where there is the switch to the tram and if you pull it, it will only run over 1 person versus 6 or whatever hell it was.
Ethics are subjective and any decision made can and probably will be regarded as being in the wrong.
 
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Ethics are subjective and any decision made can and probably will be regarded as being in the wrong.

Um, that's kind of the point of an ethics question -- if there's one right answer there's no dilemma and nothing to discuss. That's why OPs first two questions were NOT ethics questions. There's one universally accepted answer to those - so it's not a question worthy of debate. The ones I described require taking a position that may be wrong regardless of which side you take.
 
Um, that's kind of the point of an ethics question -- if there's one right answer there's no dilemma and nothing to discuss. That's why OPs first two questions were NOT ethics questions. There's one universally accepted answer to those - so it's not a question worthy of debate. The ones I described require taking a position that may be wrong regardless of which side you take.

How would you respond if someone asked you: why take a position and not remain neutral, if you know you "may be wrong regardless of which side you take"?
Because of course there is a chance that every decision we make will always be wrong.*
 
Other popular ethics question --seventh day Adventists who won't accept transfusions, requiring a significant risk surgery. Any change in you decision if it's one parent refusing transfusion for their two year old?
 
How would you respond if someone asked you: why take a position and not remain neutral, if you know you "may be wrong regardless of which side you take"?
Because of course there is a chance that every decision we make will always be wrong.*
Well do you want to get into med school or take the neutral role? If I'm the interviewer I want someone to take a stand. If they won't play, you can bet I hold it against them. Because this IS the kind of stuff that gets debated in medicine. We want leaders not abstainers
 
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Other popular ethics question --seventh day Adventists who won't accept transfusions, requiring a significant risk surgery. Any change in you decision if it's one parent refusing transfusion for their two year old?

I've also heard this is common with Jehovah's Witnesses. I would think the doctor would try his or her best to convince the parent otherwise explaining all the risks involved but ultimately when a patient is under 18, one would have to respect the parent's decision. If the patient is over 18, the doctor would have to respect whatever decision the patient makes after making him or her well aware of the risks.

What's your stance on this?
 
Well do you want to get into med school or take the neutral role? If I'm the interviewer I want someone to take a stand. If they won't play, you can bet I hold it against them. Because this IS the kind of stuff that gets debated in medicine. We want leaders not abstainers

Point taken. I wouldn't personally play the role of a neutral doctor during an interview, but I was just trying to put an ethics question inside of an ethics question. Ethiception if you will.
 
Point taken. I wouldn't personally play the role of a neutral doctor during an interview, but I was just trying to put an ethics question inside of an ethics question. Ethiception if you will.
Ah but it's not an ethics question for the interviewer. If you don't play his game he just takes his ball and goes home. Easy peasy -- the next interviewee will do better. He won't even sweat it.
 
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I've also heard this is common with Jehovah's Witnesses. I would think the doctor would try his or her best to convince the parent otherwise explaining all the risks involved but ultimately when a patient is under 18, one would have to respect the parent's decision. If the patient is over 18, the doctor would have to respect whatever decision the patient makes after making him or her well aware of the risks.

What's your stance on this?
I don't force treatment on unwilling adult competent patients but certainly think there's some merit in pushing the issue on behalf of the toddler.
 
Actually, it's Jehovah's Witnesses. I ask a variation of this question. No, kids, I'm sharing either.

I'll disagree with my learned colleague on the OP's #1 . I'd tailor it to imply that actual financial ruin might affect the family. Keep in mind that clinicians often have insider knowledge, and interviewees don't. I get plenty of answers from interviewees who are ignorant of the legalities concerning blood transfusions and kids.


Other popular ethics question --seventh day Adventists who won't accept transfusions, requiring a significant risk surgery. Any change in you decision if it's one parent refusing transfusion for their two year old?
 
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