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[deleted922750]

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[IsleyOfTheNorth]

Yes. HIV PEP prophylactics are very effective now.

 

[imbesrs]

I would like to get your opinion on a situation I came across with while reading a book: If you're in an accident with a person who you know is HIV positive, would you help him knowing that you don't have any protective equipment?

If theres blood spilled no? Im sorry but i need to have my barriers/PPE. Its not an ethical dilemma its quite literally the protocol in many situations healthcare related.

 

[DNAJB6]

Define "help." I would do everything I could do to help to the extent I could do so without infecting myself. If it came to me potentially getting HIV or the other person dying, I would pick my safety over his life.

 

[DNAJB6]

Of course if this was a hypothetical for a medical school interview, I would advise against being candid. Instead the answer should be that you should help, risk comes with the job, you are a selfless and virtuous individual, and that you would load up on PREP and other drugs that could prevent you from getting it.

 

[star-lily]

Of course if this was a hypothetical for a medical school interview, I would advise against be candid. Instead the answer should be that you should help, risk comes with the job, you are a selfless and virtuous individual, and that you would load up on PREP and other drugs that could prevent you from getting it.

I feel like it wouldn't be considered unreasonable at all to acknowledge the need to look out for your own safety too, though. You'll have many patients to look after, and you won't be able to help any of them if you don't look out for your own safety first. I know they emphasize this for EMTs

 

[ToeTag1999]

I feel like it wouldn't be considered unreasonable at all to acknowledge the need to look out for your own safety too, though. You'll have many patients to look after, and you won't be able to help any of them if you don't look out for your own safety first. I know they emphasize this for EMTs

no. It is always best to err on the side of caution.

If this question comes up in a job interview they are probably testing to see if you will lie. No person, especially a valuable doctor, should risk his/her life to save someone who is already hanging on by a thread. Nobody would believe you if you seem overly selfless.

Would you sacrifice your life for your child? If your answer to this is no then you are heartless because obviously a baby has more to live for.

Would you sacrifice your life for a grandparent? If your answer here is yes then you are a fool.

 

[IsleyOfTheNorth]

no. It is always best to err on the side of caution.

Ethical questions aren't that clear cut - that's why they're questions.

Would you sacrifice your life for your child? If your answer to this is no then you are heartless because obviously a baby has more to live for.

What if your child has a terrible disease? What if you are the sole provider for your family and others depend on you?

Would you sacrifice your life for a grandparent? If your answer here is yes then you are a fool.

What if your grandmother was on the verge of curing cancer, or was the President? What if you had a terminal disease and your early death mean that she could get a transplant she needed?

The point of an ethical question in an interview isn't always the answer, but to see if/how you think about things... or if you are likely to say things like:

If your answer here is yes then you are a fool.

 

[Blueprint Med School]

I would like to get your opinion on a situation I came across with while reading a book: If you're in an accident with a person who you know is HIV positive, would you help him knowing that you don't have any protective equipment?

Oh man, you brought a good one.

For me, it would come down to risk, benefit and cost of doing nothing. Anything could be used as PPE in a pinch including clothing.

If it was a small injury and resources were coming and plentiful, and they were well controlled, I would do my best to make some psuedo PPE and do my best.

If the person was uncontrolled and belligerently trying to bite me, then aight imma head out. The risk is too high and the #1 rule of emergency care is provider safely comes before anything else. In this hypothetical case, you would be protected legally as well.

Now, those two were extremes for obvious reasons, but an answer which shows nuance and critical thinking (for me) would go farther than "oh yeah, I would rub my open wound on his open wound, no prob fam"

Just one persons opinion,

David D MD - USMLE and MCAT Tutor
Med School Tutors

 

[ToeTag1999]

Ethical questions aren't that clear cut - that's why they're questions.


What if your child has a terrible disease? What if you are the sole provider for your family and others depend on you?


What if your grandmother was on the verge of curing cancer, or was the President? What if you had a terminal disease and your early death mean that she could get a transplant she needed?

The point of an ethical question in an interview isn't always the answer, but to see if/how you think about things... or if you are likely to say things like:

I disagree I think 90 percent of ethical questions have a clear cut right/wrong objective answer, most of which fall in line with legal ethics.

My point here was that the more valuable life should always be the one saved and the less valuable the sacrificial lamb. In your examples the baby life has no value as it is diseased and terminal. The Grandmother is exceptional and/or your life has almost no value as a terminally ill person.

So in your extreme examples my statements would need to flip around, but for most cases the baby life is most important and grandparent is expendable.

But again, the most valuable life should always be protected. So going to OP question, the doctor must operate on self preservation over self sacrifice because his/her life is objectively MUCH more valuable

PS life "value: is 100 percent an objective measure, they can be legally determined

 

[IsleyOfTheNorth]

I disagree I think 90 percent of ethical questions have a clear cut right/wrong objective answer, most of which fall in line with legal ethics.

My point here was that the more valuable life should always be the one saved and the less valuable the sacrificial lamb.

The 90% won't come up. The question is going to be the 10%. How do you decide who's life is more valuable - a 70 year old triathlete or a 20 year old drug addict? The point is to both make you think and to reveal your biases.

 

[notsobabydoc]

I disagree I think 90 percent of ethical questions have a clear cut right/wrong objective answer, most of which fall in line with legal ethics.

My point here was that the more valuable life should always be the one saved and the less valuable the sacrificial lamb. In your examples the baby life has no value as it is diseased and terminal. The Grandmother is exceptional and/or your life has almost no value as a terminally ill person.

So in your extreme examples my statements would need to flip around, but for most cases the baby life is most important and grandparent is expendable.

But again, the most valuable life should always be protected. So going to OP question, the doctor must operate on self preservation over self sacrifice because his/her life is objectively MUCH more valuable

PS life "value: is 100 percent an objective measure, they can be legally determined

draw the bright line between more valuable vs less valuable, then define clear cut.

 

[theKingLT]

I would like to get your opinion on a situation I came across with while reading a book: If you're in an accident with a person who you know is HIV positive, would you help him knowing that you don't have any protective equipment?

Gonna need more info on the scene for that. For the vast majority of accidents, having trauma field treatment a few minutes earlier (ie. Before EMS arrives) is not gonna make a life or death difference. Now if the dude's got a severed limb but otherwise relatively unscathed from what you can see, then hell ya I'm going to jump in and tourniquet him, because you're taking his odds of survival from zero to quite good. Otherwise nah, not worth the risk of infection. Situations when you're under no obligation to treat (ie. This one) generally come down to a risk-reward/cost-benefit analisis pretty easily

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[DNAJB6]

draw the bright line between more valuable vs less valuable, then define clear cut.

The words "more valuable" and "less valuable" in reference to human lives would give a medical school interviewer pause (at least I would think).

 

[DNAJB6]

I feel like it wouldn't be considered unreasonable at all to acknowledge the need to look out for your own safety too, though. You'll have many patients to look after, and you won't be able to help any of them if you don't look out for your own safety first. I know they emphasize this for EMTs

I agree with you, but I could see me having an interviewer with a different perspective. When in doubt, I would try to qualify any response and find the exception or loophole. Be as vague as possible without sounding like you're intentionally dodging the question, and pivot as quickly as possible to a closely related easier topic. Basically lawyer it, and respond like a politician.

 

[theKingLT]

I agree with you, but I could see me having an interviewer with a different perspective. When in doubt, I would try to qualify any response and find the exception or loophole. Be as vague as possible without sounding like you're intentionally dodging the question, and pivot as quickly as possible to a closely related easier topic. Basically lawyer it, and respond like a politician.

I would not do this. If you get ethical questions like this it will most likely be part of an MMI. In MMI's the evaluators are trained to be unbiased and assess your logical reasoning skills, the fact that you addressed certain ethical points, ability to see multiple perspectives, etc. They will not penalize you for supporting a certain position but they will penalize you for not answering the question

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[Icebird]

HIV cell has a limited life cycle outside of the body due to oxygen exposure. Semen, vaginal/seminal fluids, breast milk, and blood are the main methods of transportation.

Even at the most dangerous transmission rate (direct blood to blood contact) the risk of transmission is still less than 1%. I would still help the person and take PEP as fast as possible in a 72 hr period for precaution.

 

[theKingLT]

HIV cell has a limited life cycle outside of the body due to oxygen exposure. Semen, vaginal/seminal fluids, breast milk, and blood are the main methods of transportation.

Even at the most dangerous transmission rate (direct blood to blood contact) the risk of transmission is still less than 1%. I would still help the person and take PEP as fast as possible in a 72 hr period for precaution.

Sure but there is also very little risk of the patient dying as a result of lacking your care since we dont know more about the accident. Less than 1% of car accidents produce a fatality and the vast majority of these would be no different in outcome just from having a medical professional on scene 10 minutes earlier.

Also since you were in the accident, its likely that you have some sort of cut or abrasion as well, increasing infection risk so we likely are looking at the worst case scenario of exposure

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[Icebird]

Sure but there is also very little risk of the patient dying as a result of lacking your care since we dont know more about the accident. Less than 1% of car accidents produce a fatality and the vast majority of these would be no different in outcome just from having a medical professional on scene 10 minutes earlier.

Also since you were in the accident, its likely that you have some sort of cut or abrasion as well, increasing infection risk so we likely are looking at the worst case scenario of exposure

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It's all about how you phrase it since there weren't specifics. We could say just as much that the victim would die in this hypothetical scenario if help isn't provided and that this car accident in particular was the less than 1% of cases where there would be a fatality. Note that just as less than 1% is a very low statistic the less than 1% of direct blood to blood transmission risk this scenario could hypothetically produce is just as low as well (and this is not counting the chances if one would take PEP right after.)

I think as long as you phrase your response with statistics and facts you'll be fine in any ethical prompt.

 

[Icebird]

Then the interviewer can also give you the follow up question... What if this scenario is one of those 1% situations you mentioned. What are you going to do?

They most certainly can. So just pick with what you're comfortable doing and supporting with facts and you'll be set.

 

[theKingLT]

Then the interviewer can also give you the follow up question... What if this scenario is one of those 1% situations you mentioned. What are you going to do?

Then ya im treating the patient. PEP is pretty powerful nowadays

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[DNAJB6]

HIV cell has a limited life cycle outside of the body due to oxygen exposure. Semen, vaginal/seminal fluids, breast milk, and blood are the main methods of transportation.

Even at the most dangerous transmission rate (direct blood to blood contact) the risk of transmission is still less than 1%. I would still help the person and take PEP as fast as possible in a 72 hr period for precaution.

There are many variables including the extent and duration of exposure. With that said, your numbers are probably reasonable for limited contact with the virus. I read a study once of researchers/clinicians who accidentally pricked themselves with a contaminated HIV+ needle. Out of 1000 incidents, only 1 later presented with HIV. With that said, HIV can remain latent in the system for several years and undetected except to some of the newest methods (RNA based). Most of the statistics I have seen cited are from periods when ELISA assays were still used and the risk of false negative/delayed detection was higher. Few studies would do follow ups several years later.