Ethical responsibilities towards treating a patient

[NadineO2]

Hello,
I know this might be quite an unconventional question, but it has been playing on my mind since the terror attack in London yesterday. They tried to keep the killer alive but he died in hospital.
Now my question would be, if you would be ethically against treating a "murderer" or even help performing an abortion, would you still HAVE to do that?
In other words, are your own feelings and/or emotions coming before the Hyppocratic oath?
I'm sorry if I posted this in the wrong forum, I'm only at the start of maybe one day becoming a doctor, after I get rid of an illness. So until then I'm trying to get as much information as possible.
Thank you in advance for your answers.

Sent from my HTC Desire 530 using SDN mobile

---

Members don't see this ad.

 

[RustedFox]

 

[CliveStaples]

"Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgment."

I chose not to go into the business of judging crimes. Treat the human that comes through the door. The state/God/nature will do the rest.

 

[bravotwozero]

Rofl copter, nice!


Sent from my iPhone using Tapatalk

 

[Spectre of Ockham]

No , you treat everyone the same, otherwise I wouldn't touch quite a few of the aggressive train wrecks that hit the ER.

They are patients , they deserve to live and receive the best care. End of the discussion - forever.

 

[Status Sciaticus]

"Many that live deserve death. And some that die deserve life. Can you give it to them, Frodo? Then do not be too eager to deal out death in judgment." - Gandalf The Grey

I chose not to go into the business of judging crimes. Treat the human that comes through the door. The state/God/nature will do the rest.

 

[GeneralVeers]

I only refuse to treat if it puts my personal health/safety at harm. Otherwise have to treat anyone.

I don't go near aggressive, violent patients.

 

[Apollyon]

Yes. Unlike the responses of some of my erstwhile colleagues, it stops when I get to the patient. We often get prisoners where I work, and I repetitively state that I do NOT want to know why they are "in stir", because that might make my own personal biases affect what I do. There's a patient, I treat them. Done.

 

[Siggy]

Hello,
I know this might be quite an unconventional question, but it has been playing on my mind since the terror attack in London yesterday. They tried to keep the killer alive but he died in hospital.
Now my question would be, if you would be ethically against treating a "murderer" or even help performing an abortion, would you still HAVE to do that?
In other words, are your own feelings and/or emotions coming before the Hyppocratic oath?
I'm sorry if I posted this in the wrong forum, I'm only at the start of maybe one day becoming a doctor, after I get rid of an illness. So until then I'm trying to get as much information as possible.
Thank you in advance for your answers.

Sent from my HTC Desire 530 using SDN mobile

Well, I've treated murders. I've treated felons. I've treated inmates who were awaiting trial. Why do you think that it's your place to determine that they do or don't get medical care in an ethical sense? They're either not convicted, or they're paying their debt to society. That debt doesn't include no medical care.

 

[deleted109597]

When we have one patient, we don't choose. However, the reality is that there is only one of me, and if two patients come in at the same time, I have to choose. If one is a cop, and the other is a criminal, and they shot each other, you still have to choose one. Most of us would feel better the next morning if we treated the cop and the criminal died than if they treated the criminal and the cop died.
It's like choosing to shoot someone. Most of us wouldn't. But if you had the chance to shoot Hitler, you probably would.

However, all of us would treat everyone to the extent of our abilities (I hope). It just so happens our abilities are not infinite. And no, none of us do abortions, because we are emergency doctors.

 

[Raryn]

"Many that live deserve death. And some that die deserve life. Can you give it to them, Frodo? Then do not be too eager to deal out death in judgment." - Gandalf The Grey

I chose not to go into the business of judging crimes. Treat the human that comes through the door. The state/God/nature will do the rest.

Username checks out.

 

[n2b8me]

I am ethically against treating a lot of things. I also know that I am legally obligated to treat pretty much anything and everything.... "your honor, I intended to treat this patient, but during CPR I noticed the swastika tattoo on his chest and because of my moral objection to nazism I pronounced him instead"

 

[GeneralVeers]

I am ethically against treating a lot of things. I also know that I am legally obligated to treat pretty much anything and everything.... "your honor, I intended to treat this patient, but during CPR I noticed the swastika tattoo on his chest and because of my moral objection to nazism I pronounced him instead"

In some cases it is morally the right thing NOT to treat. When EMS brings in the 95 yo demented, bed-bound nursing home patient, I usually cease all efforts to do anything and declare the patient dead.

 

[BoardingDoc]

In some cases it is morally the right thing NOT to treat. When EMS brings in the 95 yo demented, bed-bound nursing home patient, I usually cease all efforts to do anything and declare the patient dead.

Taken out of context with the fact that you don't say that the patient is coding in this scenario, your comment is hilarious.

I'm picturing you getting your frequent flyer nursing home patient coming in with a UTI and AMS and going "nope, not treating this one. Time of death, 0807."

 

[Birdstrike]

Hello,
I know this might be quite an unconventional question, but it has been playing on my mind since the terror attack in London yesterday. They tried to keep the killer alive but he died in hospital.
Now my question would be, if you would be ethically against treating a "murderer" or even help performing an abortion, would you still HAVE to do that?
In other words, are your own feelings and/or emotions coming before the Hyppocratic oath?
I'm sorry if I posted this in the wrong forum, I'm only at the start of maybe one day becoming a doctor, after I get rid of an illness. So until then I'm trying to get as much information as possible.
Thank you in advance for your answers.

Sent from my HTC Desire 530 using SDN mobile

Simple answer. You are not a judge, jury or executioner. You're a healthcare professional. You treat people, their injuries and diseases. Period.

Just imagine a hypothetical scenario where a physician lets a suspected mass murderer die and it later turns out to be a case of mistaken identity, or it was one of the victims who looked like the killer. Or imagine a hypothetical scenario where a healthcare provider denies treatment based on determining their patient is guilty of a heinous crime, another provider steps in to do so, saves the suspect's life, then ultimately at trial, they're found not guilty. You don't want to put yourself in that scenario.

Therefore, the most ethical path is for all of us to stay in our own lane. Doctors, stick to doctoring. Judges stick to judging. Jurors stick to jury duty. When you start to mix and match those rolls is when you have problems, no the other way around.

It's actually fairly routine in the ED that police bring in people under arrest for crimes. Many likely are found guilty. Some certainly aren't.

You just stay focused, treat as you'd treat any other patient, and let the justice system do its job. No, our Justin system is not refectory and checks and balances are sometimes needed. But the ED is not the place for that.


Sent from my iPhone using SDN mobile

 

[ysm13n]

It is important to note that you conflated performing an abortion with treating a murderer. While we do not refuse to treat patients, there is certainly a concept of consciousness objection to performing specific procedures which you are not comfortable with. Physicians have rights too and some choose to not perform abortions, extubate terminal patients, or perform certain cosmetic procedures on minors. As a general rule, you should still be available in referring the patient to a provider that would consider the desired procedure.

 

[Birdstrike]

It is important to note that you conflated performing an abortion with treating a murderer. While we do not refuse to treat patients, there is certainly a concept of consciousness objection to performing specific procedures which you are not comfortable with. Physicians have rights too and some choose to not perform abortions, extubate terminal patients, or perform certain cosmetic procedures on minors. As a general rule, you should still be available in referring the patient to a provider that would consider the desired procedure.

I'm not sure if you're responding to my post or not, but I made no comment whatsoever on abortion. Actually, when I read the OP I missed the abortion part and wasn't commenting on that. It's an important discussion, but not the one I was responding to.


Sent from my iPhone using SDN mobile

 

[ysm13n]

I'm not sure if you're responding to my post or not, but I made no comment whatsoever on abortion. Actually, when I read the OP I missed the abortion part and wasn't commenting on that. It's an important discussion, but not the one I was responding to.


Sent from my iPhone using SDN mobile

I was responding to OP. Should have quoted him him. my bad

 

[Mad Jack]

When we have one patient, we don't choose. However, the reality is that there is only one of me, and if two patients come in at the same time, I have to choose. If one is a cop, and the other is a criminal, and they shot each other, you still have to choose one. Most of us would feel better the next morning if we treated the cop and the criminal died than if they treated the criminal and the cop died.
It's like choosing to shoot someone. Most of us wouldn't. But if you had the chance to shoot Hitler, you probably would.

However, all of us would treat everyone to the extent of our abilities (I hope). It just so happens our abilities are not infinite. And no, none of us do abortions, because we are emergency doctors.

The Soldier, the Terrorist, and the Blood Drive | BrainLine.org

An article that covers the sort of situation being discussed.

 

[gman33]

If you object to certain procedures, don't practice the kind of medicine that performs them.

Otherwise, do your job and treat the patients that show up.

If you have problems with this, stay very far away from emergency medicine.

 

[ysm13n]

If you object to certain procedures, don't practice the kind of medicine that performs them.

Otherwise, do your job and treat the patients that show up.

If you have problems with this, stay very far away from emergency medicine.

There are many OB/gyn's who do not perform abortions. they simply refer them to someone who will. Similarly, I personally know of a cardiac anesthesia doctor who does not participate in harvesting of organs from brain dead patients. Also (very few) Critical care doctors who do not extubate brain dead patients. It is not an absolute contradiction to be involved in such a specialty.

More Commonly, many doctors will refuse to participate in assisted suicide in the states that allow them...Do you believe they should no longer practice medicine?

I see this as pretty much a non-issue in emergency medicine (at least for me personally)...nothign to contraversial about helping people in need....I did however see this article recently News: Palliative Extubation in the ED (Yes, the ED) : Emergency Medicine News

 

[gro2001]

Taken out of context with the fact that you don't say that the patient is coding in this scenario, your comment is hilarious.

I'm picturing you getting your frequent flyer nursing home patient coming in with a UTI and AMS and going "nope, not treating this one. Time of death, 0807."

Now, hypothetically... what would happen if you did that? Can, like, another doctor undeclare somebody dead? What if you've signed the death certificate and everything?

 

[Janders]

I've treated the true scum of the Earth. No big deal. They get the same treatment as a beautiful celebrity. Very simple. Very easy to just treat the patient in front of you. Rely on the justice system, or your favorite deity, to deal justice upon them... once you've returned their physiology to a baseline homeostasis.

I mean, I'm sure you can come up with a scenario where half my nursing staff, my entire family, most of my closest friends, and the reincarnations of Ghadi, Mother Theresa, and Steve McQueen are lined up in gurneys each dying of a tension pneumothorax, but there is also Hitler, bleeding to death from a femoral wound. And if I try to save those I love, he will die, and vis-a-versa. And yeah, screw Hitler, he can bleed out.

But pragmatically speaking it is very easy to take care of any thing that rolls in. And heaven forbid you are truly single coverage, and two people roll in at the same instant and are both stabbed in the left chest... You WILL do your best. And you WILL choose. And that is that.

 

[The White Coat Investor]

Isn't this what the "slow code" was invented for?

Kidding...kidding

 

[Siggy]

Most of us would feel better the next morning if we treated the cop and the criminal died than if they treated the criminal and the cop died.

How do you know that the officer isn't the person who decided to shoot an innocent person while doing a no-knock warrant on the wrong house?

Man Dies in Police Raid on Wrong House


Congrats... you just saved the real criminals and let the hero die... because you made assumptions. Do you always assume that people shot by the police deserve it? I can post the video of the police gunning down the guy getting his wallet... after being asked by the police for his ID. I can post the story of the Florida officer gunning down a retired librarian because he wanted to play with a loaded gun during a civilian police academy.

 

[deleted109597]

How do you know that the officer isn't the person who decided to shoot an innocent person while doing a no-knock warrant on the wrong house?

Man Dies in Police Raid on Wrong House


Congrats... you just saved the real criminals and let the hero die... because you made assumptions. Do you always assume that people shot by the police deserve it? I can post the video of the police gunning down the guy getting his wallet... after being asked by the police for his ID. I can post the story of the Florida officer gunning down a retired librarian because he wanted to play with a loaded gun during a civilian police academy.

We all live with preassumptions. Who would you treat in the same situation? Because you.can't.treat.both.at.the.same.time.

And I agree that no-knock warrants and the police state are bad things. But that's not what we are talking about.

 

[Venko]

Hello,
I know this might be quite an unconventional question, but it has been playing on my mind since the terror attack in London yesterday. They tried to keep the killer alive but he died in hospital.
Now my question would be, if you would be ethically against treating a "murderer" or even help performing an abortion, would you still HAVE to do that?
In other words, are your own feelings and/or emotions coming before the Hyppocratic oath?
I'm sorry if I posted this in the wrong forum, I'm only at the start of maybe one day becoming a doctor, after I get rid of an illness. So until then I'm trying to get as much information as possible.
Thank you in advance for your answers.

Sent from my HTC Desire 530 using SDN mobile

My decision tree doesn't really involve my personal ethics as it would be applied to their history of behavior (I.e. Murderer, etc).

My ethics apply to my performance of a medical procedure (if I don't feel the procedure is indicated I will not do it). If I were an obstetrician, this may apply to late term abortions etc. thankfully abortion is not within the scope of my practice at all.


Sent from my iPhone using SDN mobile

 

[Siggy]

We all live with preassumptions. Who would you treat in the same situation? Because you.can't.treat.both.at.the.same.time.

And I agree that no-knock warrants and the police state are bad things. But that's not what we are talking about.

Which ever one is the most critical, yet salvageable if I have to choose between one or the other.

...and yes, when we're talking about, "I'm treating the officer over the person he shot just because he's an officer" then we have to consider why we're doing that instead of standard triage. That definitely brings things like abuse of qualified immunity and the blue line of silence to being issues that matter in this discussion. When an officer can kill a member of the public because he was playing with his gun and ignoring all basic firearm safety rules and all basic rules for red gun scenarios... and it takes 6 months just to bring criminal charges... then that's a problem. How about you shoot some random person while playing with a fire arm and see how long it takes you to be charged... I'm thinking it'll take hours, not months. That doesn't get into the abuses when the police simply arrest people because they don't like the lawful action being taken (see public photography and open carry... regardless of how stupid open carry is).

 

[deleted109597]

Which ever one is the most critical, yet salvageable if I have to choose between one or the other.

...and yes, when we're talking about, "I'm treating the officer over the person he shot just because he's an officer" then we have to consider why we're doing that instead of standard triage. That definitely brings things like abuse of qualified immunity and the blue line of silence to being issues that matter in this discussion. When an officer can kill a member of the public because he was playing with his gun and ignoring all basic firearm safety rules and all basic rules for red gun scenarios... and it takes 6 months just to bring criminal charges... then that's a problem. How about you shoot some random person while playing with a fire arm and see how long it takes you to be charged... I'm thinking it'll take hours, not months. That doesn't get into the abuses when the police simply arrest people because they don't like the lawful action being taken (see public photography and open carry... regardless of how stupid open carry is).

Because the scenario, as presented, was all things being equal, and with only one of you, which do you treat first. It's really not hard to answer the question. I did, and you basically called me a monster for it. So I ask you, with all things being equal, and you're by yourself, and both patients roll in, who do you treat?

 

[Rendar5]

Whichever patient comes through the door first