ethical question... hm..

[johndoe3344]

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Hey,

So I found this on one of the past interview questions. I think it's an ethical dilemma:

A man is HIV positive, he wants surgery so he can ride his Harley, you are the orthopedic surgeon, what do you do?

I don't even understand why a dilemma exists? Is there some rule I don't know of that says that HIV+ people can't have surgery? I think the answer would be to just... give the guy his surgery..?

 

[jvesco22]

johndoe pls go

 

[metalgearHMN]

Yea, but you might cut yourself, and since he's already cut open it would put you at risk for contracting AIDS.

 

[JoshUNCW]

Do your job, do the surgery, don't cut yourself.

 

[Danae00]

.

 

[Depakote]

I don't really see how it's an ethical question, either.

It's more of a management question, do the patient's co-morbidities make him an excessive surgical risk or not. Someone with a CD-4 T-cell count of less than 200 and full blown AIDS probably shouldn't be getting an elective procedure while someone with a high CD-4 T-Cell count and an undetectable viral load might benefit from a orthopedic procedure that gives them significant quality of life improvements.

The other issue that they're probably looking for you to address is whether you'd work on a patient with HIV. Given that you will run into these patients, many of whom will be undiagnosed at the time you see them, it would be unrealistic to say you wouldn't.

 

[jckut10]

.

 

[jvesco22]

http://hivinsite.ucsf.edu/InSite?page=kb-03-03-02#S4X

 

[loveoforganic]

Pretty much agree with the above. If I was the surgeon, there's a good chance I'd turn the patient down since it's obviously an elective surgery, and I don't feel the benefit to the patient outweighs the risk to myself. But then again, maybe accidental nicks hardly ever happen in the OR. Don't really know!

 

[Depakote]

Pretty much agree with the above. If I was the surgeon, there's a good chance I'd turn the patient down since it's obviously an elective surgery, and I don't feel the benefit to the patient outweighs the risk to myself. But then again, maybe accidental nicks hardly ever happen in the OR. Don't really know!

The problem with that is you can easily paint yourself into a corner. There will be plenty of people with scary co-morbidities that need to go to the OR. You're not going to have the luxury of operating on only healthy patients, even in ortho.

 

[willen101383]

The problem with that is you can easily paint yourself into a corner. There will be plenty of people with scary co-morbidities that need to go to the OR. You're not going to have the luxury of operating on only healthy patients, even in ortho.

Agreed. I would personally rather risk occ exposure with a HIV patient than something like Hep C...but either way dont be a physician if you cant accept the risk. The needlestick risk is shockingly low anyway. For example, my old man is a hem/onc. He stuck himself with a hollow bore needle from an HIV/Hep B pos patient and did not seroconvert for either.

 

[kami333]

Just use the conscience clause, aka my religion believes AIDS is a result of God(s)' wrath and the righteous should not touch them.

 

[LizzyM]

Change up the question. There is a new condition in America. There is no know treatment, certainly no cure, no vaccine or similar way to prevent the condition. What we know about how it is spread is spotty. Half of those we see die within a few months. You are a physician. You have been asked to see (as a consultant or as a primary care provider) a patient, or a group of patients, with this condition. What do you do?

Twenty years ago I was stunned when we were in a situation similar to this and some first year medical students told me that they would refuse to care for such patients because their own health was more important than the patient's need for health care.

 

[vin5cent0]

Change up the question. There is a new condition in America. There is no know treatment, certainly no cure, no vaccine or similar way to prevent the condition. What we know about how it is spread is spotty. Half of those we see die within a few months. You are a physician. You have been asked to see (as a consultant or as a primary care provider) a patient, or a group of patients, with this condition. What do you do?

Twenty years ago I was stunned when we were in a situation similar to this and some first year medical students told me that they would refuse to care for such patients because their own health was more important than the patient's need for health care.

Why would you be stunned? Obviously most people think their own well-being is more important than someone they have no relation to, regardless of them saying it out loud.

 

[loveoforganic]

The problem with that is you can easily paint yourself into a corner. There will be plenty of people with scary co-morbidities that need to go to the OR. You're not going to have the luxury of operating on only healthy patients, even in ortho.

But does this patient need to go to the or?

 

[RevMD]

Why would you be stunned? Obviously most people think their own well-being is more important than someone they have no relation to, regardless of them saying it out loud.

Exactly. Of course, I would not say directly my own health is more important than the patient's, because the doctor is expected to risk his own for the well-being of another. But the given situation calls for potential risk of transmitting HIV during the surgery to those in the OR, which seems to outweigh the benefit of the patient's love of riding his Harley. The HIV patient's life already has a ticking timer since there is no cure for the disease. So, I don't see how I would actually be improving the well-being or the prolonging the life of the patient by refusing to do the surgery.

 

[jckut10]

.

 

[DirtyJustice]

Change up the question. There is a new condition in America. There is no know treatment, certainly no cure, no vaccine or similar way to prevent the condition. What we know about how it is spread is spotty. Half of those we see die within a few months. You are a physician. You have been asked to see (as a consultant or as a primary care provider) a patient, or a group of patients, with this condition. What do you do?

Twenty years ago I was stunned when we were in a situation similar to this and some first year medical students told me that they would refuse to care for such patients because their own health was more important than the patient's need for health care.

A dead doctor can help 0 patients. To me it is not that odd. I would help them personally, b ut I can see both sides.

 

[FIREitUP]

Change up the question. There is a new condition in America. There is no know treatment, certainly no cure, no vaccine or similar way to prevent the condition. What we know about how it is spread is spotty. Half of those we see die within a few months. You are a physician. You have been asked to see (as a consultant or as a primary care provider) a patient, or a group of patients, with this condition. What do you do?

Twenty years ago I was stunned when we were in a situation similar to this and some first year medical students told me that they would refuse to care for such patients because their own health was more important than the patient's need for health care.

all physicians should unconditionally risk their lives for their patients no matter what (end sarcasm).

no matter how careful you are in surgery, theres always a chance you will get stuck by a resident or something. not worth it IMO.

 

[jckut10]

Again: your odds of contracting HIV from a needle stick are extremely low. The only way you're going to get it from a patient is if you have sex with him or her in the OR.

 

[loveoforganic]

Not sure if there's a functional difference, but we're not necessarily referring to needle sticks.

 

[nickmx50]

Here's some Karma. The 1st year that refuses to treat the patient bumps into someone on the street with the disease and ends up dying anyway. I don't see how we can make a commitment to treat patients, regardless of ailment, and then put a caveat on who to care for. I welcome the opportunity to be a hero in a situation like this. Of course, I'd take every possible precaution I could, and them some. I think when we start picking and choosing who gets care, especially because of ailment, we've crossed a moral and ethical line. It takes a lot of courage, but someone has to have courage for them and their families.

 

[CapnCrunch]

Change up the question. There is a new condition in America. There is no know treatment, certainly no cure, no vaccine or similar way to prevent the condition. What we know about how it is spread is spotty. Half of those we see die within a few months. You are a physician. You have been asked to see (as a consultant or as a primary care provider) a patient, or a group of patients, with this condition. What do you do?

In my opinion, your own health is only a priority to a certain extent until it becomes selfish. Who else is going to see the patient if not a physician? It would probably haunt me later if I refused someone my services when I could have done something.

 

[CapnCrunch]

Here's some Karma. The 1st year that refuses to treat the patient bumps into someone on the street with the disease and ends up dying anyway. I don't see how we can make a commitment to treat patients, regardless of ailment, and then put a caveat on who to care for. I welcome the opportunity to be a hero in a situation like this. Of course, I'd take every possible precaution I could, and them some. I think when we start picking and choosing who gets care, especially because of ailment, we've crossed a moral and ethical line. It takes a lot of courage, but someone has to have courage for them and their families.

Well said. Beat me to it. 😀

 

[KeyzerSoze]

Here's some Karma. The 1st year that refuses to treat the patient bumps into someone on the street with the disease and ends up dying anyway. I don't see how we can make a commitment to treat patients, regardless of ailment, and then put a caveat on who to care for. I welcome the opportunity to be a hero in a situation like this. Of course, I'd take every possible precaution I could, and them some. I think when we start picking and choosing who gets care, especially because of ailment, we've crossed a moral and ethical line. It takes a lot of courage, but someone has to have courage for them and their families.

Sorry, I don't believe you. Would you treat a patient if it would certainly lead to your own death within several months? Assuming you wouldn't, how low would the risk have to be?

 

[ipostman]

.

 

[nickmx50]

Sorry, I don't believe you. Would you treat a patient if it would certainly lead to your own death within several months? Assuming you wouldn't, how low would the risk have to be?

It's a good thing I don't need you to believe me in order for me to do the right thing. It's no different than someone signing up for the military and agreeing to fight on the front lines or being a firefighter and running into a burning building to save a child. Those scenarios carry an immediate risk of death and people do it everyday. Simply put, would you put your life in danger for a chance of saving someone else? Not everyone can do it, I understand. Doesn't mean that I wouldn't.

 

[dr zaius]

Here's some Karma. The 1st year that refuses to treat the patient bumps into someone on the street with the disease and ends up dying anyway. I don't see how we can make a commitment to treat patients, regardless of ailment, and then put a caveat on who to care for. I welcome the opportunity to be a hero in a situation like this. Of course, I'd take every possible precaution I could, and them some. I think when we start picking and choosing who gets care, especially because of ailment, we've crossed a moral and ethical line. It takes a lot of courage, but someone has to have courage for them and their families.

Exactly. I could see denying someone in this situation an elective surgery, but not as a consult or primary care physician. To me it seems unethical to do so.

It would also be interesting to see this new disease up close and try to figure out the mechanisms behind the spread of it as well as how it ultimately kills the patient. I would jump on the situation in an air tight hazmat suit in a heartbeat.

 

[Dannyw]

Just use the conscience clause, aka my religion believes AIDS is a result of God(s)' wrath and the righteous should not touch them.

To me that is a pathetic excuse and it's terrifying that people believe that.

 

[RevMD]

It's a good thing I don't need you to believe me in order for me to do the right thing. It's no different than someone signing up for the military and agreeing to fight on the front lines or being a firefighter and running into a burning building to save a child. Those scenarios carry an immediate risk of death and people do it everyday. Simply put, would you put your life in danger for a chance of saving someone else? Not everyone can do it, I understand. Doesn't mean that I wouldn't.

Given the scenario in the OP, you are not saving someone's life by refusing to do surgery. The patient has HIV and simply wants what seems to be an elective surgery so that he can ride his Harley. I cannot see how putting myself and the surgical staff at risk of transmission is outweighed by the benefits on helping this patient ride his bike again. Besides, the patient is much safer driving a car.

Now if the scenario was further detailed to say that without surgery, the HIV patient can only walk supported by crutches. Then I would be more obligated to take the risk to improve the well-being of the patient. Refusing to do the surgery would haunt my conscience.

 

[tremulousNeedle]

Hello, I am currently a 4th year medical student and I interview for the admission committee at my school. I have also taken medical ethics. A lot of the pre-med responders have replied with thoughtful replies, but lack understanding of the complexities of clinical medical ethics.

First off, asking ethical questions do have some value, but it shows a lack of interviewer experience or forethought to ask about healthcare ethical dilemmas. Applicants usually have a superficial understanding of medical ethics, which is more complicated than your every-day ethical issues.

Regardless, the best way to handle these questions is to always respond with whatever has the patient's best interest at heart. For your specific example: It is wrong for the surgeon to refuse the procedure simply because the patient is HIV+ (it's actually illegal in many states to refuse care simply because a patient has an infectious disease). However, if the surgeon is concerned that the risk to the patient is too great with the procedure, then he can refuse to perform the operation (i.e propensity for blood clots, great risk for post op infection, severe anesthesia reaction, etc. and by the way patients with well controlled HIV are not at increased risk for post-op infections.). Its all a matter of weighing benefits (improved mobility or quality of life) against the risks.

Also, using the "its against your religion point of view can actually backfire". Example, in most states if your patient comes to you and asks for something that goes against your religious beliefs (morning after pill has recently been a hot topic), you are allowed to refuse this service, but you are REQUIRED BY LAW to refer them to someone who is able to provide the service.

Again, the take home point is to DO WHATEVER IS IN THE BEST INTEREST OF THE PATIENT, not what is in the best interest of the doctor.
I hope this helps.