a question in medical philosophy

[asharma11]

Assume for a moment that you have gone through medical school, completed a residency, and have developed an incredible ability to heal a patient regardless of the complexity and severity of the disease. Your healing ability is solely based on your intense desire to cure the patient's unique illness.

Let's say that you've begun a private practice. It has been remarkably successful and the people you've helped truly appreciate the quality of personal care you provide. Every patient who has visited you has been perfectly cured.

Governments and international organizations have asked that you leave your practice and help train physicans in developing countries to improve their quality of healthcare, and you comply.

Now, imagine that you are serving in a rural clinic in Afghanistan. Tomorrow you discover that the newest patient rushed to the clinic is Mr. bin Laden, of current infamy. He is suffering from a critical injury and will surely pass away without your immediate help. If you treat him, he will recover.

If you do help him, there is no guarantee that he will be captured. Regardless of what action you take, news will quickly spread of what you did and you will personally face the world's reaction.

What would you do under these circumstances?

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[cabruen]

Sure. I would charge him US$1B (in cash since my practice will be fee-for-service, no PPO plans accepted). I would then happen to also make an appointment for a Navy Seal just before Mr. Laden's, and have a NYFD skin cancer screening just after. I am sure they all just might run into each other in the lobby. C'est la vie.

 

[dl2dp2]

This is a very easy question. As a physician, your duty is to save lives using medical knowledge. So regardless of who the patient is, you have the responsibility to save him (except perhaps in the case where lives of your or others are in immediate danger.) Whether the patient deserves punishment from society at large is determined, at least in a democratic society, through the legal court. It is not your job as a physician to decide what is right and what is wrong.

Hence, you must save bin Ladin. Hell, you must save Hitler if you ever get the chance. Of course, you can kill them and people prolly wouldn't hate you for it. But strictly from an ethical perspective there is a right answer to that question. And even then, think about this, by just killing someone like bin Ladin do you think you can solve the problem? Others will mushroom after he dies. Killing an individual only resolves the symptom, it is never the cure.

 

[MacGyver]

With your premise, I can think of a much harder (and more interesting) ethical dillemma.

With such awesome curing skills, does that mean that the public has an automatic RIGHT to be treated by you for free without charge if they cant pay?

In the hypothetical situation that you become a victim of your own success, does that mean that the fruits of your labor are no longer your own but instead part of the public domain?

 

[asharma11]

I've edited my initial post, in hopes of making the stakes a little higher.

 

[Street Philosopher]

just flash the "i reserve the right to refuse service" sign.

just because i want to serve, it doesn't mean people have the right to demand treatment from me.

if i'm wrong, well who cares? i'm a human being first, doctor second. i'm not a robot.

 

[KU Brendan]

This happens all the time, especially in the ER. Not with bin Laden, of course, but with murderers, drunk drivers who killed people, etc. Physicans cannot make value judgements on patients, even if they know or suspect the worst in them. Something that makes this country great is our legal system--where people are innocent until proven guilty. Do what you can for patients and let the law do the rest (despite the problems there are with the system). I don't think that makes you a robot; I think that's the most human thing there is--to be able to value human life and put your own personal feelings aside to help out another person. THAT takes self control, not a computer program.

--Brendan--
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[Street Philosopher]

maybe you are right. i'll have to consider this more thoroughly. but as of now, if bin laden comes to me for help, he'd better have bodyguards.

 

[cabruen]

Well...we have two differenet discussions going on now since the OP was changed.

As a physician said a long time again, "Do unto others as you would have them do unto you." This leads us to act compassionately towards others and treat them, despite their actions. This gives them the opportunity for redemption, and allows us to demonstrate mercy and forgiveness. However, the instant soeone declares a RIGHT to my service, I will hang up my shingle, quit, and move to a gultch in Colorado. No one can place a demand on my life without my consent.

 

[Caffeinated]

For me, this represents a conflict of 2 oaths: the Hippocratic and my oath I took as an Army officer. Until we are no longer at war against terrorism, Mr. BinLaden is a combatant hostile to the US. As such, I would assist him in his quest to assume room temperature, by whatever means necessary. If this banishes me from the practice of medicine, so be it. If it's a matter of defending my Country, not to mention saving the lives of all the future "patients" that might have been harmed had he lived, I would give up my license for that.

Or perhaps I could refer him to a colleague across town, Dr. Kevorkian. Doc K will fix him right up--really cheap and darn successful.

 

[cdreed]

Caffeinated, I cannot possibly agree more. As an Armed Forces officer, our first duty is to serve the President of the US and Americans- then we are physicians.

If confronted with this scenario for real, I'd have to let bin Laden fend for himself. In this case, utilitarian deeds best serve our call to protect and defend. The many saved is well worth the life of one insidious terrorist.

 

[dl2dp2]

once you changed your story, it becomes much much less realistic. I'm sure if you were hold at gun point then people would understand if you treat Bin Ladin and his entourages. However, of course your nobility would be broadcasted if you refused and got shot. Clearly ethically you are under no obligation to sacrifice your life for the greater good of the society.

However, by change your story, you made the situation much much less realistic. Chances are, such decision would NEVER be made by ANY healthcare professional in United States for an INDEFINITE amount of time in the future.

 

[KU Brendan]

Originally posted by sluox
However, by change your story, you made the situation much much less realistic. Chances are, such decision would NEVER be made by ANY healthcare professional in United States for an INDEFINITE amount of time in the future.

My point, however, is that situations similar to this DO happen all the time--just not on such a grand scale. When you have to treat a drunk driver who just killed a bunch of kids, the same type of emotions come about--but part of being a physician is going beyond that.

--Brendan--
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[USeF]

This is precisely what I was going to say until I saw it.

Originally posted by KU Brendan
This happens all the time, especially in the ER. Not with bin Laden, of course, but with murderers, drunk drivers who killed people, etc. Physicans cannot make value judgements on patients, even if they know or suspect the worst in them. ...
--Brendan--
<"}}}}}><

Everytime I reflect upon this attribute of a physician, I am reminded of the noble profession I'm about to be inducted into (White Coat ceremony is tomorrow night!!)

The idea of serving people to the best of your ability without regard to the individual's past is indeed a very lofty goal. One that even the highest religious leaders set their entire lives to strive for. I'm going to cross into a faith that is not my own to bring this line, so sorry if I misquote: "Whosoever amongst you hath no sin, cast the first stone.." is a fairly well-known line by Jesus (peace be upon him) that teaches me this very lesson- we are not in a position to make judgement calls and persecute as physicians, rather, we are to do the best dang job we can do