Ethical Dilemma II Thread

[weanprednisone]

What were some of the ethical dilemma roleplays you were asked during your II?

I had an admissions officer present:
A kid came to your office with their parents to get a doc's note to skip HS PE class. You're not particularly clear if the parent agrees/disagrees with the kid. How would you handle this situation.

Sharing is caring, thanks in advance!
No need for answers if you're uncomfortable.

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[P0ke]

What were some of the ethical dilemma roleplays you were asked during your II?

I had an admissions officer present:
A kid came to your office with their parents to get a doc's note to skip HS PE class. You're not particularly clear if the parent agrees/disagrees with the kid. How would you handle this situation.

Sharing is caring, thanks in advance!
No need for answers if you're uncomfortable.

Unless they have some sort of legitimate medical condition that prevents them from participating in PE, you tell the kid "no". They are trying to see if you are easily manipulated(a pushover)/where your moral compass stands. If you say "yes" to some random kid, why why would you say "no" to favors for friends/family and/or bribes?

 

[Officer Farva]

What were some of the ethical dilemma roleplays you were asked during your II?

I had an admissions officer present:
A kid came to your office with their parents to get a doc's note to skip HS PE class. You're not particularly clear if the parent agrees/disagrees with the kid. How would you handle this situation.

Sharing is caring, thanks in advance!
No need for answers if you're uncomfortable.

I typically respond ask me in ten years when I actually have on the job experience.

 

[Goro]

Here are some very common ones:

You practice in a state where physician-assisted suicide is legal. You have a severely depressed patient who wants to end her life. What do you do?

You have a 14 year old female who wants to go on birth control. What do you do?

You have a 15 year old female who is a pregnant and wants an abortion. What do you do?

What were some of the ethical dilemma roleplays you were asked during your II?

I had an admissions officer present:
A kid came to your office with their parents to get a doc's note to skip HS PE class. You're not particularly clear if the parent agrees/disagrees with the kid. How would you handle this situation.

Sharing is caring, thanks in advance!
No need for answers if you're uncomfortable.

 

[idontwatchgreysanatomy]

Here are some very common ones:

You have a 14 year old female who wants to go on birth control. What do you do?

You have a 15 year old female who is a pregnant and wants an abortion. What do you do?

Are these really ethical dilemmas? In my state, they are considered basic rights.

 

[weanprednisone]

I typically respond ask me in ten years when I actually have on the job experience.

My thoughts, sometimes

Are these really ethical dilemmas? In my state, they are considered basic rights.

Good points, I think "Ethical Dilemma" maybe was the wrong wording. Maybe Roleplay/Ethical Dilemmas
I think this thread would be a good resource for what has been asked this cycle.

 

[Officer Farva]

My thoughts, sometimes


Good points, I think "Ethical Dilemma" maybe was the wrong wording. Maybe Roleplay/Ethical Dilemmas
I think this thread would be a good resource for what has been asked this cycle.

I always thought these were the laziest questions on the part of the interviewer. Isn't medical school supposed to teach us about some of the issues facing clinical practice? All I did in undergrad was memorize cellular respiration and write programs.

 

[P0ke]

You are an attending plastic surgeon and your 18 year old daughter comes into your office saying she wants breast implants. She states that her boyfriend has offered to pay for the procedure. What do you do?

 

[Goro]

Believe or not, some people are against abortion, or physician assisted suicide. As an interviewer, I'm not judging their beliefs, just their ability to articulate their position.

A more challenging interviewer will ask you to list the pros and cons of X dilemma.

Here's another one: your 10 year patient has a treatable neuroma. His parents will only treat him with herbs and prayer. What do you do?

You can find a lot of these in the Interview Feedback section of this website.

Are these really ethical dilemmas? In my state, they are considered basic rights.

 

[LizzyM]

I do believe that medical school and residency provide the training to answer the "ethical questions" posed here which very much depend on state law and so forth.

If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

 

[njtrimed]

I do believe that medical school and residency provide the training to answer the "ethical questions" posed here which very much depend on state law and so forth.

If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

But for a question like that, isn't there only one reasonable answer? Who could possibly make an ethical argument FOR writing that note, particularly for someone who is that wealthy? At least for abortion type questions there is a legitimate argument for both sides, even if I'm unquestionably on one side. I felt like the Casper test similarly asked ethical questions for which the correct answer was glaringly obvious.

 

[deleted482591]

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

But for a question like that, isn't there only one reasonable answer?

Yeah that's pretty one-sided. I would not write the note. The only good argument I can see someone making is Utilitarian/Teleological in the case of the donor's daughter.

What are the drawbacks for the note? If you are aware it's fraudulent, I'd expect that you could be punished for writing the note but I don't really see physicians being punished for "massaging the truth" in their notes. It's not very easy to prove and I have no idea what law you could be sued under and what your medical board would say.

On the other hand, the benefits for the note may be enormous. If the donor's daughter badmouths your hospital to the donor, he may not donate to the hospital in the future. However, by maintaining the relationship with the donor, your institution could be looking at, let's say, $1 million dollars in the future. That $1 million can be put to use giving care to the uninsured or otherwise helping save people's lives. You could say that he might just choose to donate that money to another hospital where it will have the same effect anyways but that may or may not happen.


So if we assume there's very low risk to the doctor personally and the donor will not donate to another hospital, then the net benefit (for writing the note) to the local community and society as a whole looks pretty good.

 

[LizzyM]

But for a question like that, isn't there only one reasonable answer? Who could possibly make an ethical argument FOR writing that note, particularly for someone who is that wealthy? At least for abortion type questions there is a legitimate argument for both sides, even if I'm unquestionably on one side. I felt like the Casper test similarly asked ethical questions for which the correct answer was glaringly obvious.

There is more than one reasonable answer if the question is "what would you do?" Saying "I wouldn't write the note." is what you would NOT do. How do you tell someone that you will not write the note? How are you going to handle a call from the development office asking that you do so?

 

[Officer Farva]

What were some of the ethical dilemma roleplays you were asked during your II?

I had an admissions officer present:
A kid came to your office with their parents to get a doc's note to skip HS PE class. You're not particularly clear if the parent agrees/disagrees with the kid. How would you handle this situation.

Sharing is caring, thanks in advance!
No need for answers if you're uncomfortable.

You should do an M. Night Shyamalan twist and flip the question on the interviewer. Ask if it is ethical for someone with zero experience in medicine to make these medical decisions for patients?

It might show you are humble enough to say, I don't know. That would make you an asset in my opinion.

 

[frosted_flake]

Here are some very common ones:

You practice in a state where physician-assisted suicide is legal. You have a severely depressed patient who wants to end her life. What do you do?

You have a 14 year old female who wants to go on birth control. What do you do?

You have a 15 year old female who is a pregnant and wants an abortion. What do you do?

The first I would be comfortable with answering. The second two, I am lost!

 

[ridethecliche]

There is more than one reasonable answer if the question is "what would you do?" Saying "I wouldn't write the note." is what you would NOT do. How do you tell someone that you will not write the note? How are you going to handle a call from the development office asking that you do so?

Dammit you're good.

 

[Goro]

Yup, you could do that, and then I'd ask you "Is it ethical for me to reject right now for not being able to answer a question?"

Hint: the answer is yes.

Saying "I don't know" is a cop out. People should be able to have some moral clarity on an issue, even if they don't have insider knowledge.

Go for the programming job, Farva.

You should do an M. Night Shyamalan twist and flip the question on the interviewer. Ask if it is ethical for someone with zero experience in medicine to make these medical decisions for patients?

It might show you are humble enough to say, I don't know. That would make you an asset in my opinion.

Here' yet a different variation: You're on the transplant ethics decision team of a hospital. A liver is available but there are two patients in need: a 15 year who tried to commit suicide by overdosing on Tylenol, and a 67 year old alcoholic, who has been sober for 10 years. Who gets the liver. Any copping a Farva-style attitude gets an instant rejection.


If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

 

[frosted_flake]

Yup, you could do that, and then I'd ask you "Is it ethical for me to reject right now for not being able to answer a question?"

Hint: the answer is yes.

Saying "I don't know" is a cop out. People should be able to have some moral clarity on an issue, even if they don't have insider knowledge.

Go for the programming job, Farva.






Here' yet a different variation: You're on the transplant ethics decision team of a hospital. A liver is available but there are two patients in need: a 15 year who tried to commit suicide by overdosing on Tylenol, and a 67 year old alcoholic, who has been sober for 10 years. Who gets the liver. Any copping a Farva-style attitude gets an instant rejection.


If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

Personally I would choose the former alcoholic who has been sober for 10 years. They have (seemingly) turned their life around.
In my experience in healthcare, I have seen patients who have attempted suicide continue the same behavior patterns of self-destruction (whether that is due to lack of medication compliance, lack of access to care/therapy I do not know.)

That would be a tough one though. @Goro would you mind providing your thoughts on this?

 

[P0ke]

Personally I would choose the former alcoholic who has been sober for 10 years. They have (seemingly) turned their life around.
In my experience in healthcare, I have seen patients who have attempted suicide continue the same behavior patterns of self-destruction (whether that is due to lack of medication compliance, lack of access to care/therapy I do not know.)

That would be a tough one though. @Goro would you mind providing your thoughts on this?

In that scenario, you just pick one and give your reasoning. They wanna see that you're decisive and your thought process. There really isn't a right answer, just pick one and don't be swayed to change your choice.

 

[frosted_flake]

In that scenario, you just pick one and give your reasoning. They wanna see that you're decisive and your thought process. There really isn't a right answer, just pick one and don't be swayed to change your choice.

I would hate to come off as judgmental towards one or the other. It is obviously a difficult choice either way.

Thanks for the input!

 

[Lawpy]

You are an attending plastic surgeon and your 18 year old daughter comes into your office saying she wants breast implants. She states that her boyfriend has offered to pay for the procedure. What do you do?

Is it incorrect to say "Nothing. Refer her to a fellow plastic surgeon."? Because i read somewhere that physicians can opt out of doing procedures involving family members.

Or would i be countered by a claim that i'm somehow the only attending plastic surgeon in the entire region?

 

[Goro]

👍

In that scenario, you just pick one and give your reasoning. They wanna see that you're decisive and your thought process. There really isn't a right answer, just pick one and don't be swayed to change your choice.

 

[Ismet]

There is more than one reasonable answer if the question is "what would you do?" Saying "I wouldn't write the note." is what you would NOT do. How do you tell someone that you will not write the note? How are you going to handle a call from the development office asking that you do so?

Exactly. It's a more theoretical "what would you do" for med school admissions, but I had an MMI style interview for residency and I actually had to play out the role of what I would say to the patient/family as the interviewer threw different wrenches in the scenario. Obviously can't go into detail about what the scenarios were, but they were believable and a couple had to do with the patient/family's belief system in regards to the medical treatment we were suggesting. How you answer their questions and how you deal with the follow-up is more important than if you would simply do or not do something.

 

[LoveBeingHuman:)]

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

I'm a bit confused. So the patient is at the hospital and doing just fine but the daughter wants the doctor to exaggerate his condition?

 

[LizzyM]

I'm a bit confused. So the patient is at the hospital and doing just fine but the daughter wants the doctor to exaggerate his condition?

No, the elderly patient is at home and doing fine despite being 85 years old. Will Dad's primary care provider go along with the plan?

 

[terra330]

Is it incorrect to say "Nothing. Refer her to a fellow plastic surgeon."? Because i read somewhere that physicians can opt out of doing procedures involving family members.

Or would i be countered by a claim that i'm somehow the only attending plastic surgeon in the entire region?

I think it would be perfectly reasonable to refuse doing the operation on grounds of her being family. I would hold my ground even with that counter, since breast implants are not a life saving procedure and there wouldn't be any harm that comes to the patient by not receiving the implants. On the contrary, there is a potential for harm doing the procedure since it is difficult to maintain objectivity when working on family.

I probably would tell her to see another plastic surgeon, and I wouldn't pull any strings to get a quicker appointment.

 

[LoveBeingHuman:)]

Yup, you could do that, and then I'd ask you "Is it ethical for me to reject right now for not being able to answer a question?"

Hint: the answer is yes.

Saying "I don't know" is a cop out. People should be able to have some moral clarity on an issue, even if they don't have insider knowledge.

Go for the programming job, Farva.






Here' yet a different variation: You're on the transplant ethics decision team of a hospital. A liver is available but there are two patients in need: a 15 year who tried to commit suicide by overdosing on Tylenol, and a 67 year old alcoholic, who has been sober for 10 years. Who gets the liver. Any copping a Farva-style attitude gets an instant rejection.


If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

What I don't really like about that question is that you can't play God. I mean, isn't there a waitlist? A doctor would almost never be in a position of choosing who gets it.

 

[Goro]

Transplant ethics panels do. Do you think that they don't have doctors on them????

While you're at it, go look up the definition of triage.

What I don't really like about that question is that you can't play God. I mean, isn't there a waitlist? A doctor would almost never be in a position of choosing who gets it.

 

[LoveBeingHuman:)]

Transplant ethics panels do. Do you think that they don't have doctors on them????

While you're at it, go look up the definition of triage.

Gotcha. I was actually told that it's a trick question and you shouldn't choose one and you should just say "I'll give it to the one who needs it urgently and/or to the one who was on the waitlist first"

 

[LizzyM]

Transplant ethics panels do. Do you think that they don't have doctors on them????

While you're at it, go look up the definition of triage.

It isn't quite as simple as a transplant ethics panel.
See http://www.organtransplants.org/understanding/unos/

 

[bananafish94]

I don't want to add anything specific because of non-disclosure agreements, but I will say that it's a good idea to read up on the laws in your home state and whatever state you're interviewing in regarding common ethical scenarios. For example, a 15-year old girl wants to get an abortion but doesn't want to tell her parents. In my state, parents don't have to give consent, but it's law that an "adult family member" has to be notified without a judicial waiver. Why doesn't she want her parents to know? Is there a more trusted/reliable family member that could be notified? Might you consider pointing her in the right direction for a judicial waiver if you see fit? And always present both sides of the argument before answering the question with your own opinion.

 

[Law2Doc]

Is it incorrect to say "Nothing...

In real life the answer is to go have a little talk with the boyfriend...

 

[deleted482591]

So what's the logic behind triage?


Devote resources to save the most save-able? Then devote resources to save people who have others that depend on them? Then the young?

 

[thatwouldbeanarchy]

So what's the logic behind triage?


Devote resources to save the most save-able? Then devote resources to save people who have others that depend on them? Then the young?

It might be more complicated than this depending on the setting (hospital, at the scene of a mass casualty, etc). But generally, the way I understand it is that the most acutely ill patients are given priority. In certain contexts (like in a disaster situation where you lack resources), you might prioritize the patients who are most likely to survive as a way to conserve limited resources.

 

[starspells]

I do believe that medical school and residency provide the training to answer the "ethical questions" posed here which very much depend on state law and so forth.

If you want "moral compass" questions ask, "your 14 year old cousin, or your roommate, comes to you and wants your help doing xyz."

Here's one that doesn't really require any medical or legal knowledge. "A patient's daughter wants a doctor's note saying that her father is severely ill so she can cancel a planned trip without having to pay a penalty. What would you do? would you handle it differently if the request came by way of the hospital development office because the daughter is a major donor to the hospital? "

There is more than one reasonable answer if the question is "what would you do?" Saying "I wouldn't write the note." is what you would NOT do. How do you tell someone that you will not write the note? How are you going to handle a call from the development office asking that you do so?

You would say no because it is inherently unethical on many levels. Then you report it to the appropriate higher authority figures.

Right?

 

[starspells]

Would you actually do that in real life though? What if your boss is pushing you to do it since the request came from a big donor? You can't p*** the donor off because you could lose the hospital a ton of money. If you say no, your boss could find some reason to fire you, make your life miserable, etc. What would you say to the donor/patient? What would you say to your boss? Would you really say to both of them "this is inherently unethical on many levels!" and then report them, risking damage to that relationship? I mean, it's just a note so this girl can cancel a trip - it's hardly consequential, right? What's the big deal?

It's easy to sit in your interview chair and say "well obviously X is the right thing to do" but it's not always that easy in real life. My experience has been that many interviewers will dig a little deeper to get at how your decision would actually look in practice.

Asking someone to lie for you is wrong and extremely unprofessional. It's so embarrassing to even ask someone to lie for you. I would tell the boss I'm not comfortable lying and report it accordingly. What happens if I get caught? It reflects terribly on me that I agreed to engage in a clearly unethical act. I see no benefits to this for myself. It's a difficult decision and it is not easy to report something that may get a lot of people in trouble but it really is the right thing to do.

 

[ImmunoLove]

Has anybody read the articles that have come out over the past year regarding ethical decision making as it pertains to AI, specifically self-driving cars? I read a good one on how the engineers of the cars are actually having to address the issue of "Who deserves to live more". One specific scenario I read about is one where essentially it comes down to you swerving away from a group of kids who ran into the street and driving into a tree, traffic, off a cliff, etc, vs. not swerving and kill all of them.

Yeah it's pretty interesting. And insurance also has its own ethical responsibility too, so the arguments become quite fascinating.


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[ImmunoLove]

You are an attending plastic surgeon and your 18 year old daughter comes into your office saying she wants breast implants. She states that her boyfriend has offered to pay for the procedure. What do you do?

To add to what's already been mentioned: I'd most definitely ask her her motivations for the implants. Does she want them? Is she in a relatively healthy mind frame and this is "for her" or has she developed truly negative body image issues or some other psych condition where she feels implants are a panacea? To what extent is the boyfriend involved in this decision? Is he just supporting her wishes and desires or did he he posit this notion within her? I would ask these questions of any patient wanting implants, but I'd be more careful given the potential red flags (boyfriend pays, she's young).

If she really wanted them and she was in a "healthy" place etc etc I'd also probably refer her to the best surgeon I know and be supportive as a parent and as a physician (she's my daughter and I prefer to be involved in family care but not directly providing it, because it may interfere with my judgement).

Just a few quick thoughts...


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[ImmunoLove]

It's pretty awesome/ scary that in today's world the question of "Who's life is worth more" is actually becoming an increasingly important question to determine the answer to, and not just in a mass casualty or limited resources scenario, but a lose/ lose scenario where no matter what SOMEONE is going to get hurt, and a machine has to figure out where the least amount of impact will lie.

As for insurance companies, I would argue that it is less of an ethical dilemma (at least for preventable conditions) because their primary role is that of a business. You can calculate the estimated lifetime cost for someone based on their voluntary risk factors and adjust premiums/ plan costs accordingly, but yes it does become an ethical issue for genetic conditions or accidental injuries where no control is had over their own outcomes, but insurance companies are able to decline them/ price gouge.

My roommate is a project manager at Google.... We literally have these discussions every night. It gets pretty intense.


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[DokterMom]

Would you actually do that in real life though? What if your boss is pushing you to do it since the request came from a big donor? You can't p*** the donor off because you could lose the hospital a ton of money. If you say no, your boss could find some reason to fire you, make your life miserable, etc. What would you say to the donor/patient? What would you say to your boss? Would you really say to both of them "this is inherently unethical on many levels!" and then report them, risking damage to that relationship? I mean, it's just a note so this girl can cancel a trip - it's hardly consequential, right? What's the big deal?

It's easy to sit in your interview chair and say "well obviously X is the right thing to do" but it's not always that easy in real life. My experience has been that many interviewers will dig a little deeper to get at how your decision would actually look in practice.

Asking someone to lie for you is wrong and extremely unprofessional. It's so embarrassing to even ask someone to lie for you. I would tell the boss I'm not comfortable lying and report it accordingly. What happens if I get caught? It reflects terribly on me that I agreed to engage in a clearly unethical act. I see no benefits to this for myself. It's a difficult decision and it is not easy to report something that may get a lot of people in trouble but it really is the right thing to do.

@starspells - You're right that this is dishonest and unethical. But recognize that your moral high ground comes at a high price. (I'm assuming there's good reason to believe that the wealthy donor would cut off funding to the hospital if his daughter's request were not accommodated.) Essentially, you're prioritizing your 'clear conscience' over the well-being of hundreds who could be helped by the donation.

The flip-side is a sneering "Oh, so your integrity is for sale, provided it's at a good price..." implying that there's not really much in the way of "integrity" for sale.

My rationale for the ethical compromise is that it is not ME who is being helped by the questionable behavior, but many others, who have no culpability in the ethical dilemma. Balance that good with the harm -- which is relatively small. True, the airline is also in no way culpable. But to even the moral score, the hospital could donate the price of an airline ticket (from the benefactor's donation) to the airline or charity of the airline's choice.

 

[Promethean]

No, the elderly patient is at home and doing fine despite being 85 years old. Will Dad's primary care provider go along with the plan?

"Ma'am, I'm so sorry, but I can't write a note describing your father's condition as gravely ill. It may be superstitious of me, but if I were to speak ill of his health, and (Heaven forbid!) something should actually happen to him, I would almost feel that I had wished it on him. You know that I care about him and all your family, and want only the very best for you all, always. Perhaps there is some other alternative that would fulfill your need? You know, our friends in the hospital development office? They have some connections in the legal department. I bet if we asked, we could get one of the lawyers to look over your contract and see if there isn't another way to get your refund. Let me just get their number for you..."

When administration throws you a curve, duck. If possible, let it boomerang back onto them. Keep it sincere, and patient focused, and they can't hurt you.

 

[nwts]

Are these really ethical dilemmas? In my state, they are considered basic rights.

It's actually a little more nuanced than just the idea that people have the right to get abortions if they want. While all states grant people the right to have abortions in general (with various restrictions, depending upon the state), I'm pretty sure there is not a single state that requires individual physicians to perform abortions. So if a person were asked about a 15 year-old wanting an abortion, he would not be describing a violation of the patient's legal rights if he said: "I would tell the patient that I do not perform abortions." It only becomes an issues of interference with the patient's rights if the physician were to try to stop the patient from finding a physician who does perform abortions and going to that physician for an abortion.

There is a lot of nuance in how exactly a person navigates this situation. If you say that you'd certainly do it without asking any questions, some people might ask you why you didn't verify that the patient was not a victim of a crime (since 15 is likely younger than the age of consent in most states) and that the patient had decided that she wanted the abortion without being coerced. If you said that you would try to force her not to get one, there are some obvious issues that come up. Anywhere in between those two extremes, you would need to explain your thinking and how you decided upon the exact approach you would take.

 

[ImmunoLove]

"Ma'am, I'm so sorry, but I can't write a note describing your father's condition as gravely ill. It may be superstitious of me, but if I were to speak ill of his health, and (Heaven forbid!) something should actually happen to him, I would almost feel that I had wished it on him. You know that I care about him and all your family, and want only the very best for you all, always. Perhaps there is some other alternative that would fulfill your need? You know, our friends in the hospital development office? They have some connections in the legal department. I bet if we asked, we could get one of the lawyers to look over your contract and see if there isn't another way to get your refund. Let me just get their number for you..."

When administration throws you a curve, duck. If possible, let it boomerang back onto them. Keep it sincere, and patient focused, and they can't hurt you.

Epic turf. Now THAT is how it's done! Bravo!
(And now that you've contacted legal, they can't really coerce you to do something illegal, as that would jeopardize them even more, and admin is exceptionally risk-averse. You solved so many problems at once...Nice!!)


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[Promethean]

Epic turf. Now THAT is how it's done! Bravo!
(And now that you've contacted legal, they can't really coerce you to do something illegal, as that would jeopardize them even more, and admin is exceptionally risk-averse. You solved so many problems at once...Nice!!)

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Thank you!

I was an OR charge nurse. I had to coordinate the interests of administration, anesthesiologists, surgeons, consultants, pathologists, radiologists, vendors, nursing/surgical techs, environmental services, central supply/sterile services and, oh yeah! patients and families.

My turfing skills were honed through endless misadventures.

 

[maxwell_edison]

There is more than one reasonable answer if the question is "what would you do?" Saying "I wouldn't write the note." is what you would NOT do. How do you tell someone that you will not write the note? How are you going to handle a call from the development office asking that you do so?

I think LizzyM described my thinking on this, and how I answered.

Best I can guess is that they want you to think out the consequences fully, and not just parrot the "goody two shoes" answer. Most things in medicine will not be that simple.

Mine were all along the lines of you friend/etc is doing some everyday thing that people do that is bad, stupid, illegal in a minor/civil way, etc, and what would you do. And I think they are listening for the "I'd turn him in and he'd get fined/punished/his car towed" or similar answer which is the "right" answer, but given without thought to the broader picture.

I talked about graduated steps to pushing my "friend" to be honest, without just tattling on him. That there are other ways to solve the problem, while still being honest yourself, and without risking the relationship with your friend/patient/boss/etc.

 

[CowboyNiceguy]

Believe or not, some people are against abortion, or physician assisted suicide. As an interviewer, I'm not judging their beliefs, just their ability to articulate their position.

Is is considered strange here to oppose assisted suicide? Am I in the minority? I've wanted to work in oncology and while I don't there's anything wrong with someone choosing suicide when their health has become hopeless, I don't see that as being part of my job. I want to do the best I can to improve their health and balance it with their comfort, but the final step would be referral to hospice. I'm interested in other opinions on this, but at this point I'm not comfortable with the idea of assisting in suicide, even if it were legal here.

 

[LizzyM]

Is is considered strange here to oppose assisted suicide? Am I in the minority? I've wanted to work in oncology and while I don't there's anything wrong with someone choosing suicide when their health has become hopeless, I don't see that as being part of my job. I want to do the best I can to improve their health and balance it with their comfort, but the final step would be referral to hospice. I'm interested in other opinions on this, but at this point I'm not comfortable with the idea of assisting in suicide, even if it were legal here.

The tide is turning and there is grown favor toward physician assisted suicide. It well may become the next fight between those who do not wish to become involved in killing and those who will say that the licensed provider is obligated to meet the demands of the patient without regard to the provider's moral opposition. We see this with abortion and it will be even greater with assisted suicide which will eventually become "aid in dying" for those who are unable to express their wishes because of profound disability.

 

[Goro]

Not at all, and one has to stick to one's moral beliefs. Just be able to justify them!

Is is considered strange here to oppose assisted suicide? Am I in the minority? I've wanted to work in oncology and while I don't there's anything wrong with someone choosing suicide when their health has become hopeless, I don't see that as being part of my job. I want to do the best I can to improve their health and balance it with their comfort, but the final step would be referral to hospice. I'm interested in other opinions on this, but at this point I'm not comfortable with the idea of assisting in suicide, even if it were legal here.

 

[CowboyNiceguy]

The tide is turning and there is grown favor toward physician assisted suicide. It well may become the next fight between those who do not wish to become involved in killing and those who will say that the licensed provider is obligated to meet the demands of the patient without regard to the provider's moral opposition. We see this with abortion and it will be even greater with assisted suicide which will eventually become "aid in dying" for those who are unable to express their wishes because of profound disability.

Assisting in suicide of the disabled or anyone that cannot properly give consent is an even scarier thought. I was only considering the terminally ill patients in intense pain - the "ideal" suicide candidate.

 

[Promethean]

Assisting in suicide of the disabled or anyone that cannot properly give consent is an even scarier thought. I was only considering the terminally ill patients in intense pain - the "ideal" suicide candidate.

If it makes you feel any more at ease, what I've witnessed in clinical practice is the opposite, where people with intellectual disabilities or who otherwise may not be able to consent to DNRs are subjected to extraordinary life saving measures because they are a vulnerable population. The principle is that we must err on the side of preserving life at all costs, and I can respect the reasoning... It isn't the care provider's place to determine for them when their quality of life is no longer adequate. That is a slippery slope that leads to atrocities.

And yet... In practice it means that frail elderly Down's syndrome patients (who usually have Alzheimer's as well) without families to speak up for them, who have become wards of the state, are more likely to have to endure greater pain and indignities during their end of life care than people who can set their own limits regarding CPR, intubation, parenteral feeding, etc. Beyond the drama of a code, they also can't say that they *don't* want surgery or aggressive chemo for cancers, for instance. And physicians can find themselves compelled not to withhold such care, even if there is a great likelihood that quantity will not correlate with quality of life.

This kind of disconnect between intentions, ideals, and unintended consequences are why we are expected to be so well versed in ethics. It is easy to talk about how things ought to be or what our values are, but it gets real fast when you are the one who must make hard choices in the face of real human suffering.