Ethical Question Drinking

[StephanieZ]

I dread getting questions like this at interviews. I would not turn him in. Period. I would probably not go to a university that required it's students to be moral watchdogs either. How can this hypothetical university have the right to mandate that it's students get involved in something that is none of their business? My answer would probably be something like this: This university needs a dose of reality. Plenty of people begin drinking before the legal age of 21 (which is a ridiculous age restriction that should never have been set, but that's a topic unto itself). Most of them don't become alcoholics. And in the long run, especially for medical school, personal relationships are more important than adhering to some draconian no tolerance policy that actually impinges on MY right mind my own business. I mean, aren't we all taught in kindergarten that nobody likes a tattle-tale? I dread these questions in interviews because I am more likely to go off on a tirade than say anything logical or sound.

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[studmuffin]

Dude you willlose every friend you have doing things like that. Theres a difference between being ethical and being a tattletale.

 

[studmuffin]

How about this instead: You go to a school like Washington & Lee where the honor code is taken so seriously, students take virtually all exams out of the classroom. On the students' word of honor they supposedly do not cheat on the exams, and the only penalty for cheating is expulsion. You catch a close friend of yours cheating on an exam. Do you report them?

I wouldn't go to that school like that. Who would, seriously, knowing that an ethical issue like this could arise?

 

[sparklingwater]

How about if the interviewer suggests not turning in your friend suggests in the future that you will not follow legal medical protocol you find unfair. I believe in some/all areas, a doctor can not prescribe a drug unless an exam is done or just other small medical infractions. As a doctor, if your friend and colleague, prescribed such a drug or performed a procedure without following the correct protocols/consent/etc., would you report it or would you plead against your friend.

What do you do then if he suggests that you could compromise patient care in the future by looking the other way about things that 'aren't your business'?

 

[gettheleadout]

I wouldn't go to that school like that. Who would, seriously, knowing that an ethical issue like this could arise?

A lot of people, actually. It's a competitive/prestigious LAC.

 

[SBR249]

How about if the interviewer suggests not turning in your friend suggests in the future that you will not follow legal medical protocol you find unfair. I believe in some/all areas, a doctor can not prescribe a drug unless an exam is done or just other small medical infractions. As a doctor, if your friend and colleague, prescribed such a drug or performed a procedure without following the correct protocols/consent/etc., would you report it or would you plead against your friend.

What do you do then if he suggests that you could compromise patient care in the future by looking the other way about things that 'aren't your business'?

It's not about following protocol, it's about blindly following orders. A better analogy would be if a drug is not FDA-approved to treat a disease but has been shown to be efficacious in treating it and your patient just happens to have that disease. Would you recommend or prescribe off-label use in that case? IMHO, I certainly would if it has been shown to benefit my patient. It's both legal and prevalent.

 

[gettheleadout]

It's not about following protocol, it's about blindly following orders. A better analogy would be if a drug is not FDA-approved to treat a disease but has been shown to be efficacious in treating it and your patient just happens to have that disease. Would you recommend or prescribe off-label use in that case? IMHO, I certainly would if it has been shown to benefit my patient. It's both legal and prevalent.

So why isn't it FDA approved?

 

[isoquin]

I don't understand how it would be ethical at all, to turn in your friend for a six pack.

In what world is it preferable to rat your friend out, putting a black eye on his academic record, which he'll have to attempt to explain as often as he's interviewed when he applies to medical school?

I would not turn him in. Period. I would probably not go to a university that required it's students to be moral watchdogs either. How can this hypothetical university have the right to mandate that it's students get involved in something that is none of their business?

Both of the above are missing the point, and are the wrong answer. There are some ethical question in which you can reject the premise, but this isn't one of them, because similar situations will pop up in med school and your career. Forming unchangeable answers and ending them with "Period" is an indicator of a deficiency in critical ethical thinking.

The reason why is demonstrated by this impressive and insightful reason:

As a doctor, if your friend and colleague, prescribed such a drug or performed a procedure without following the correct protocols/consent/etc., would you report it or would you plead against your friend.

What do you do then if he suggests that you could compromise patient care in the future by looking the other way about things that 'aren't your business'?

sparklingwater is absolutely correct. You are entering a profession where people die when you turn a blind eye. It's time to put away blind schoolyard loyalty and demonstrate some ethical standards.

 

[SBR249]

So why isn't it FDA approved?

Because the FDA-approval process is a lengthy and expensive process that usually requires sponsorship by pharmaceutical companies to conduct clinical trials. Generic drugs are usually not profitable enough for the big pharma to investigate off-label efficacy.

 

[gettheleadout]

Because the FDA-approval process is a lengthy and expensive process that usually requires sponsorship by pharmaceutical companies to conduct clinical trials. Generic drugs are usually not profitable enough for the big pharma to investigate off-label efficacy.

And when your superiors cite you for giving your professional opinion to a patient to use unregulated pharmaceuticals?

 

[SBR249]

Both of the above are missing the point, and are the wrong answer. There are some ethical question in which you can reject the premise, but this isn't one of them, because similar situations will pop up in med school and your career. Forming unchangeable answers and ending them with "Period" is an indicator of a deficiency in critical ethical thinking.

The reason why is demonstrated by this impressive and insightful reason:



sparklingwater is absolutely correct. You are entering a profession where people die when you turn a blind eye. It's time to put away blind schoolyard loyalty and demonstrate some ethical standards.

Correct me if I'm wrong, but that's a little contradictory. On the one hand, you are railing against "unchangeable answers", on the other, you are advocating for "demonstrat[ing] some ethical standards" which in this context is a strict and unyielding adherence to protocol. So what you are saying is that the group mentality should be conformed to and all independent thought or questioning of the group mentality is unethical. All of this being backed up by a healthy dose of the good ole "people can die" admonishment.

 

[SBR249]

And when your superiors cite you for giving your professional opinion to a patient to use unregulated pharmaceuticals?

Who said unregulated? I said FDA-approved to treat a specific disease. Any drug to come on the market must be FDA-approved. It's just not indicated for a particular condition. And off-label usage of FDA-approved drugs for non-indicated diseases is perfectly legal in the US as it pertains to the practice of medicine not the drugs themselves. The FDA has the mandate to regulate the latter, not the former.

 

[Kevin Baker]

Both of the above are missing the point, and are the wrong answer. There are some ethical question in which you can reject the premise, but this isn't one of them, because similar situations will pop up in med school and your career. Forming unchangeable answers and ending them with "Period" is an indicator of a deficiency in critical ethical thinking.

The reason why is demonstrated by this impressive and insightful reason:



sparklingwater is absolutely correct. You are entering a profession where people die when you turn a blind eye. It's time to put away blind schoolyard loyalty and demonstrate some ethical standards.

This scenario isn't about blind schoolyard loyalty. It is about an institution oversteppings its bounds.

 

[gettheleadout]

Who said unregulated? I said FDA-approved to treat a specific disease. Any drug to come on the market must be FDA-approved. It's just not indicated for a particular condition. And off-label usage of FDA-approved drugs for non-indicated diseases is perfectly legal in the US as it pertains to the practice of medicine not the drugs themselves. The FDA has the mandate to regulate the latter, not the former.

Sorry, I thought you were saying not FDA-approved for production in the U.S. i.e. a drug that's essentially the equivalent of unregulated "supplements" that litter the market today.

This scenario isn't about blind schoolyard loyalty. It is about an institution oversteppings its bounds.

At the same time though, one agrees to an institution's rules when joining.

 

[isoquin]

Correct me if I'm wrong, but that's a little contradictory. On the one hand, you are railing against "unchangeable answers", on the other, you are advocating for "demonstrat[ing] some ethical standards" which in this context is a strict and unyielding adherence to protocol. So what you are saying is that the group mentality should be conformed to and all independent thought or questioning of the group mentality is unethical. All of this being backed up by a healthy dose of the good ole "people can die" admonishment.

No. Nowhere have I once advocated for "strict and unyielding adherence to protocol." The good ethical answer neither blindly follows the rules nor blindly ignores them. The adherence is to a set of personal ethical standards, which is independent from previously established rules, but must work within them. While the standards remain unchanged, their application to differing scenarios produces differing outcomes.

As I said in my first post here, ethics is the study of right and wrong. If the total extent of one's ability to reason right from wrong is either completely following or completely ignoring a set of rules because they don't like the rules, they lack critical ethical thinking, and it will show on an interview.

This scenario isn't about blind schoolyard loyalty. It is about an institution oversteppings its bounds.

The scenario is asking for ethical reasoning, and you are providing an unsupported knee-jerk reaction that in no way exhibits it. Refuting the scenario because you disagree with the legitimate premise is avoiding the ethical issue altogether. Barring tremendous coercion of a scenario, you should never avoid an ethical dilemma during an interview simply because you don't like the setup. Refuting the premise of a believable situation demonstrates immaturity. In this case, your opinion of the institution overstepping its bounds is meaningless, as you will be faced with similar challenges throughout medicine.

Blatantly ignoring rules simply because you disagree with them is what gets med students in trouble. You will hear stories of students who believed they ought to have more time on exams, to get a shelf exam failure due to broken rules.

Lastly, and more importantly, the correct response to an ethical question has little to do with the end result. As someone else in this thread mentioned, you can wind up in a completely different place from what your interviewer expected. It's how you got there that matters.

 

[SBR249]

No. Nowhere have I once advocated for "strict and unyielding adherence to protocol." The good ethical answer neither blindly follows the rules nor blindly ignores them. The adherence is to a set of personal ethical standards, which is independent from previously established rules, but must work within them. While the standards remain unchanged, their application to differing scenarios produces differing outcomes.

Yet you agree with sparklingwater's response that looking the other way is never justified and that you should always report deviations from regulation and/or protocol. Furthermore, you say that that demonstrates ethical standards. So in this case does proper ethical standards always call for obeying the higher authority?

 

[isoquin]

Neither I nor sparklingwater has stated "you should always report deviations from regulation." I agree with sparklingwater's response because s/he reached a valid conclusion based on an implicitly stated ethical standard which coincidentally agreed with protocols in this scenario. You seem to continue missing this distinction, and the very purpose behind ethical questions. Interviewers aren't looking to see whether you agree or disagree with established rules. They are seeking your personal ethical standards and how they are applied with a system restricted by rules.

 

[Kevin Baker]

The scenario is asking for ethical reasoning, and you are providing an unsupported knee-jerk reaction that in no way exhibits it. Refuting the scenario because you disagree with the legitimate premise is avoiding the ethical issue altogether. Barring tremendous coercion of a scenario, you should never avoid an ethical dilemma during an interview simply because you don't like the setup. Refuting the premise of a believable situation demonstrates immaturity. In this case, your opinion of the institution overstepping its bounds is meaningless, as you will be faced with similar challenges throughout medicine.

Blatantly ignoring rules simply because you disagree with them is what gets med students in trouble. You will hear stories of students who believed they ought to have more time on exams, to get a shelf exam failure due to broken rules.

Lastly, and more importantly, the correct response to an ethical question has little to do with the end result. As someone else in this thread mentioned, you can wind up in a completely different place from what your interviewer expected. It's how you got there that matters.

I'm sorry, but I feel I must have not made my argument clear. I am not trying to skirt the ethical dilemma but I am subscribing to a different ethical theory and am making an a priori argument. This is a classic rule breaking scenario and displays the debate between Kantian deontology versus the consequentialists (or even the pragmatists). Simply because I attempt to frame the action's goodness in a different light does not mean I am skirting the issue. Rather than make a complex Foucault derived biopower argument over the perils of regulating things outside of one's legitimate sphere in the name of rationally justifying the division of power, I use a nazi parable. If one agrees with Kant, one should go right on following the contract. If one subscribes to any different philosophy, and this includes non Kantian deontology, meaning there is even a remote room for moral ambiguity in whether or not one should always follow the rules, then maybe there is some room for reframing the correct moral action. Perhaps this scenario doesn't fall into your own definition of a legitimate time to break the rules, but that doesn't mean those of us who think it does are skirting the central ethical issue.

Regardless of whether you see an a priori argument as skirting the issue, if a student understands this central debate, they show a well roundedness and an ability to ponder multiple viewpoints and reach an ideologically consistent conclusion.

 

[SBR249]

Neither I nor sparklingwater has stated "you should always report deviations from regulation." I agree with sparklingwater's response because s/he reached a valid conclusion based on an implicitly stated ethical standard which coincidentally agreed with protocols in this scenario. You seem to continue missing this distinction, and the very purpose behind ethical questions. Interviewers aren't looking to see whether you agree or disagree with established rules. They are seeking your personal ethical standards and how they are applied with a system restricted by rules.

Then I would say that it is not I who missed any distinctions but that your response was vague.

Here's what I understand of sparklingwater's thought process:

1) Should you turn your friend in? ---> Yes
2) Why? Because not turning him in indicates a lack of ethical standards that would or might later lead you to not turn in unethical doctors which would lead to patient harm or death

My conclusion was that he is then advocating for a uniform implementation of an ethical standard to all similar situations where a higher authority's directives may or may not conflict with your own inclinations. The justification for this being somewhat akin to the "broken windows" policy advocated by Rudy Giuliani that unattended broken windows naturally lead to more serious crime.

Your response then, as I understood it, was that this thought process demonstrated "ethical standards". While I have no problems with fixed ethical standards but different application based on circumstances, your response seems to indicate that you support fixed ethical standards with uniform application across the board. I'd say this may be a case of misunderstood intentions.

 

[isoquin]

I'm sorry, but I feel I must have not made my argument clear. I am not trying to skirt the ethical dilemma but I am subscribing to a different ethical theory and am making an a priori argument. This is a classic rule breaking scenario and displays the debate between Kantian deontology versus the consequentialists (or even the pragmatists). Simply because I attempt to frame the action's goodness in a different light does not mean I am skirting the issue. Rather than make a complex Foucault derived biopower argument over the perils of regulating things outside of one's legitimate sphere in the name of rationally justifying the division of power, I use a nazi parable. If one agrees with Kant, one should go right on following the contract. If one subscribes to any different philosophy, and this includes non Kantian deontology, meaning there is even a remote room for moral ambiguity in whether or not one should always follow the rules, then maybe there is some room for reframing the correct moral action. Perhaps this scenario doesn't fall into your own definition of a legitimate time to break the rules, but that doesn't mean those of us who think it does are skirting the central ethical issue.

Regardless of whether you see an a priori argument as skirting the issue, if a student understands this central debate, they show a well roundedness and an ability to ponder multiple viewpoints and reach an ideologically consistent conclusion.

I still disagree with your final conclusion. Almost any student posed this scenario will be able to quickly identify the central issue. You've only identified the obvious aspects of the scenario if you believe the only point is "to ponder multiple viewpoints." It's equivalent to getting a lot of great physical exam findings, yet having no clue how to use them to reason through a differential diagnosis.

What you stated was "It is about an institution oversteppings its bounds," which does not show a priori ethical reasoning, but rather blatant rejection of the scenario. The push-back would simply be pointing out that the students agreed to the institution's policies, overstepping or otherwise, upon accepting a matriculating position. You similarly don't get to say "I'm sorry officer, I was going 90mph because I thought the local government was overstepping its bounds." The entire point of the ethical scenario is to observe the applicant's ethical standards under pressure. Rejecting the pressure is still missing the point, regardless of how much philosophical misdirection is used.

 

[isoquin]

Here's what I understand of sparklingwater's thought process:

1) Should you turn your friend in? ---> Yes
2) Why? Because not turning him in indicates a lack of ethical standards that would or might later lead you to not turn in unethical doctors which would lead to patient harm or death

This again shows your concrete reasoning. You read the "output" as static, when it is the standards that ought to be. Here's what *I* read of sparklingwater's response:
1) Should you turn your friend in? ---> depends on the situation
2) Why? Because the next logical progression of the ethical discussion is going to jump to a situation that is clearly not as gray.

S/he produced insight into how these types of ethical conversations progress by presenting the next ethical question. You are misinterpreting that insight as 1) answering a question, and 2) extending it to all areas involving similar "rule vs friend" setups.

While I have no problems with fixed ethical standards but different application based on circumstances, your response seems to indicate that you support fixed ethical standards with uniform application across the board.

Yes, ethical standards should be fixed with uniform application across all scenarios. That doesn't mean the answer is always the same just because situations are similar. You still appear to conclude that the ethical standard in question here is whether the rules should be followed "across the board", or if they can be broken. It's not.

 

[SBR249]

This again shows your concrete reasoning. You read the "output" as static, when it is the standards that ought to be. Here's what *I* read of sparklingwater's response:
1) Should you turn your friend in? ---> depends on the situation
2) Why? Because the next logical progression of the ethical discussion is going to jump to a situation that is clearly not as gray.

S/he produced insight into how these types of ethical conversations progress by presenting the next ethical question. You are misinterpreting that insight as 1) answering a question, and 2) extending it to all areas involving similar "rule vs friend" setups.


Yes, ethical standards should be fixed with uniform application across all scenarios. That doesn't mean the answer is always the same just because situations are similar. You still appear to conclude that the ethical standard in question here is whether the rules should be followed "across the board", or if they can be broken. It's not.

So according to your thought process, you would refuse to respond with a clear cut position until a situation arises that compels a clear cut answer? Because if that's the case, then I would read the OP's response as,

1) Would you turn your friend in? Situation too nebulous, ethical standards must be established in a more unambiguous situation so that it can be retroactively applied to these ambiguous questions, therefore onto #2
2) Why? Because in another example, such as with patients, ethical standards demand that you turn the doctor in.
3) So how will you answer #1 in light of what is established in #2? Answer --> Turn your friend in.

Therefore, my interpretation of all that is that a framework of rigid ethical standards and its implementation is first constructed on a clear cut test case (an anchor point if you will) and then applied to all other ambiguous cases (such as ones which will come up in interviews). In this way, should one question the actions advocated for, the responder can then refer back to the anchor point case as proof that the implementation is valid.

Uniform ethical standards with uniform resulting actions.

Also, I want to point out that these ethical conversation progressions are well-documented and by no means unknown. You will be asked an ambiguous ethical question whereby you are tacitly asked to take a position, then based on that position, a more concrete extrapolation or analogous extension/example will be presented that will almost inevitably contradict your original position. If your thought process is to try to guess what the questioner is going to come up with as the devil's advocate and preempt that by taking a position that addresses his next point, he'll simply come up with another more appropriate one. So I don't think that's a way to approach these questions.

For example:

Situation 1:

1) You say you would turn friend in because ethical lapses in small things can lead to later lapses that cause patient harm
2) The interviewer will then ask how you would respond to off-label drug usage by physicians as it's technically deviations from protocol

Situation 2:

1) You refuse to turn friend in because you do not agree with punishment
2) Interviewer questions whether your possess ethical standards to expose questionable behavior in medicine

There's no right or wrong answer here and it all depends on how you go about defending your position.

Finally, I'm not drawing any conclusions on what ethical standards are, I'm interpreting the context in which you commended that "demonstration of ethical standards"

It's time to put away blind schoolyard loyalty and demonstrate some ethical standards.

With such a juxtaposition, I'm inclined to interpret "blind schoolyard loyalty" (meaning to not turn your friend in) as the opposite of "ethical standards" (meaning to turn your friend in).

 

[Morsetlis]

Your friend is not a doctor, and patients are not going to die.

Bioethics isn't Drinkingethics.

That said, I wouldn't mention the incident to an adcom unless you are an incredibly good tales-spinner.

 

[Kevin Baker]

I still disagree with your final conclusion. Almost any student posed this scenario will be able to quickly identify the central issue. You've only identified the obvious aspects of the scenario if you believe the only point is "to ponder multiple viewpoints." It's equivalent to getting a lot of great physical exam findings, yet having no clue how to use them to reason through a differential diagnosis.

What you stated was "It is about an institution oversteppings its bounds," which does not show a priori ethical reasoning, but rather blatant rejection of the scenario. The push-back would simply be pointing out that the students agreed to the institution's policies, overstepping or otherwise, upon accepting a matriculating position. You similarly don't get to say "I'm sorry officer, I was going 90mph because I thought the local government was overstepping its bounds." The entire point of the ethical scenario is to observe the applicant's ethical standards under pressure. Rejecting the pressure is still missing the point, regardless of how much philosophical misdirection is used.

You can disagree with the conclusion. But if you believe my logic is inconsistent or is rejecting the particular scenario, then either I failed in explaining the ethics or you seriously misread it.

My central argument was Professor Hitler told you to kill six million jews and you promised to complete all homework assignments. This statement crudely makes the a priori argument that some rules not only can be broken without causing an evil action but should be broken. You are correct in stating the push back comes down to whether or not one should always follow a contract and if there is some ambiguity there, whether this situation dictates breaking that contract.

There is no rejection of ethical pressure. My argument simply looks at the bigger picture and reframes a simple scenario while addressing the actual ethical issue (is it okay to knowingly break a contract). I'd be happy to debate more but I'm not seeing any clash and if we are unable to agree on whether or not this a priori argument addresses the central issue, there is no need for more debate on the subject.

 

[isoquin]

So according to your thought process, you would refuse to respond with a clear cut position until a situation arises that compels a clear cut answer?

Incorrect.

Therefore, my interpretation of all that is that a framework of rigid ethical standards and its implementation is first constructed on a clear cut test case (an anchor point if you will) and then applied to all other ambiguous cases (such as ones which will come up in interviews).

Incorrect, as I've mentioned several times now. Application of the answer is not what is statically applied to all other similar cases. Similarly, finding an answer from a "test case" and then retroactively forming ethical standards form it does not show insight into the exercise. As I mentioned in my first post here, the correct order is establishing ethical standards based on right and wrong, applying those standards in a pressured rule system to minimize wrong, forming a solution based on those established standards and the situation, and then dynamically forming new solutions based on the same standards as the scenario changes. You continue to incorrectly read this as 1) form a solution, 2) apply it to everything that's similar, as demonstrated in this quote:

Uniform ethical standards with uniform resulting actions.

With such a juxtaposition, I'm inclined to interpret "blind schoolyard loyalty" (meaning to not turn your friend in) as the opposite of "ethical standards" (meaning to turn your friend in).

Incorrect. Please return my quote to its context.

 

[isoquin]

You can disagree with the conclusion. But if you believe my logic is inconsistent or is rejecting the particular scenario, then either I failed in explaining the ethics or you seriously misread it.

My central argument was Professor Hitler told you to kill six million jews and you promised to complete all homework assignments. This statement crudely makes the a priori argument that some rules not only can be broken without causing an evil action but should be broken.

This is a poor comparison to make. I hate to get sucked into a conversation devolved into nazis, but let's compare apples to apples here. The student joined a college that had pre-existing policies that were accepted upon matriculating. After that point, a negative policy (i.e. things NOT to do) was disregarded. Are you trying to compare this to a soldier ordered (things TO do) to do something after he joined up, completely unaware such acts would be undertaken? Or are you comparing it to a soldier who knowingly joined such a military knowing such things would be done? In the former case, your a priori argument holds. In the latter, it makes no sense. And in both, it is a poor apples-to-oranges comparison to the student in question.

Yes, I believe your logic is inconsistent, and that it has nothing to do with your clarity or the accuracy of my interpretation.

There is no rejection of ethical pressure. My argument simply looks at the bigger picture and reframes a simple scenario while addressing the actual ethical issue (is it okay to knowingly break a contract). I'd be happy to debate more but I'm not seeing any clash and if we are unable to agree on whether or not this a priori argument addresses the central issue, there is no need for more debate on the subject.

Yes I believe you are correct in identifying that there are circumstances where is it okay to knowingly break a contract. However the original ethical issue is not asking "is it okay?" but rather "WHEN is it okay, and why?" These questions are designed to force applicants to hold their own in ethical gray, not retort with black and white (regardless if they are correct in abstraction). Looking to a bigger picture and reframing the scenario is sidestepping that scenario (despite its accuracy), and not recommended for interviewers during an ethical question.

This discussion has been enjoyable.