Ethics Discussion

[SFAJess]

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Well I don't know if this is a stupid idea or if this is already a thread...(I'm a little too lazy to look), but I thought we could post ethics questions and discuss them. We are all likely to face these types of questions in interviews, in med school and our careers. We should be able to discuss them and consider both sides. So here are a few that you may have seen before:

1) You are a pediatrician, seeing a patient you have never seen before. The patient is a very ill 6 year old without health insurance. Do you treat her, knowing that you will hear about it later? Or, do you send her to the Free Clinic across town even thoughit will entail a long bus ride for the sick girl?

2) Your patient is 80 years old and suffers from terminal lung cancer, which has spread to his brain. There are no cures for this man at this stage, so your care has been focused on keeping him comfortable. He can't breath on his own , is incoherent, and has been more or less motionless in the hospital for one week. His daughter does not want you to remove life support. What do you do?

3) You have been treating a young man in the hospital for a lung infection. During his hospital stay, he was tested for HIV and the test results were positive. He is unwilling to discuss the matter, does not want medications that will help his HIV symptoms, and appears to be in denial. Do you have a responsibility to alert the man's wife?

4) A 15 year old girl comes in and is pregnant. She wants an abortion, but refuses to tell her mother. What do you do?

5) You have an elderly patient in a private practice setting. He sees you regularly for checkups on his hypertension and high cholesterol levels. You know that he no longer has his driver's license b/c of his eyesight and he has no one to drive him to the appointments. Do you continue to treat him and schedule future appts knowing he will be driving himself to your office? If not, what do you do?


Here's just a few....answer them or post your questions that you have found.

 

[dave613]

Both passive and active euthanasia are immorally wrong, i don't care what the AMA says. I don't believe people should give up their lives unless they are in so much pain, that they can't physically or mentally do anything.

 

[deuist]

1) What do you mean by "hear about it later?" If you are in private practice as the sole physician, you will have to cover the cost of the procedure yourself --- but you won't hear about it later. If you are in a group practice, again, you could pay for it yourself. Also, this question could not be answered until we dicuss how sick the girl is.
Should she go to ER? If so, she doesn't need health insurance. If she's not that sick, she can get on bus.

2) If the daughter is the only next-of-kin, keep him on life support. Continually feed him morphine until he dies.

3) Some court cases have dictated that knowingly spreading HIV is attempted/committing murder. If you accept this interpretation, then you are required by law to tell the wife.

4) The law in most states requires that a parent sign off on an abortion. I wouldn't give the abortion unless the mother consented.

5) If he is driving to my office, I would imagine that he's driving elsewhere. You could dodge this question by saying that the man's suspension is the DMV's problem. If you refuse to schedule his appointment, he could just as easily go elsewhere. You could also alert the authorities.



If you ever get an ethics question during an interview, ask your interviewer a series of questions to figure out exactly what is going on with the particular situation. As you read in my first response, there are lots of points to take into consideration. You can't give a blanket statement such as, "Perform the abortion," unless you know all the details.

 

[neoncandle]

1) Usually this is why you have front-office people. They have the fun job of sending most people to the free clinic. If you really care you can see the patient and not charge for the phyisician's part of the visit. I have seen doctors do that from time to time in the ER. Let billing handle it. If someone has a life-threatening issue, it is your responsibility to see that patient. So, don't send anyone really sick across the city in a bus unless you want to get sued. In the end, some doctors will see this patient and some won't.. they have to live with that decision and someday that will be us.
2) Keep the patient on life-support. Most people can't live for long on a respiratory.. pneumonia usually sets in in about two weeks anyway, even with preventative measures.
3) I would go talk to the ethics committee at the hospital about this one. I wouldn't just tell the wife without knowing what the laws are in the state I am in. Your responsibility is firstly to the patient and you just can't share that information with anyone. Still, I hope that there are laws that allow you to alert authorities or something.
4) In Texas they do not allow abortions without parental consent.
5) I would probably talk to the patient about it and tell him to take a cab or find a new doctor.

 

[ivfmd]

In general, it's is wise not to respond to these ethical questions with just an answer. It is best to respond with a thought process.

If the question is "In this particular scenario, Would you do A or B?", do not answer "I would do A, because..." or "I would do B, because...".

The most thoughful answer is "Well, it depends. Some people would support A because bla bla bla. Others would argue for B because bla bla bla. Some factors that would shift one towards A or B include bla bla bla. As for me, I would lean towards A. However, if C, D, E, or F, then I might lean towards B"

I'm sure you get my point. The interviewer is clearly not looking for your opinion on a certain controversial issue. Rather, the interviewer is looking for your grasp of the details on a particular topic. If you are not well-versed on this topic, then at least your ability to be open minded and to think logically. It is crucial for physicians to be able to think of issues from both sides. In my past experience as an interviewer, some of the best responses came from candidates who never really gave an answer.

For example, in response to your question:

1) You are a pediatrician, seeing a patient you have never seen before. The patient is a very ill 6 year old without health insurance. Do you treat her, knowing that you will hear about it later? Or, do you send her to the Free Clinic across town even thoughit will entail a long bus ride for the sick girl?

This is a tough question. I realize that one of the big problems facing healthcare is the allocation of resources and who should care for which patients. Ideally, I would love to be able to help every single patient who comes through the door. However, it would be irresponsibly idealistic to think that any physician could survive for long and maintain a good nursing staff and a clean, well-stocked office without some means in place of generating enough funds to support all this.<all this time, observe your interviewer for verbal cues. is he/she smiling and nodding, If so, continue along this line of reasoning. If he/she acts impatient and gives you that "quit beating around the bush" look. Then you should change your tactic. Assuming, he/she is liking your direction so far...> In a perfect world, this 6yo girl would have had adequate access to preventative care to minimize the chance of her illness progressing to this stage. However, that is not your question, I realize that <smile>. Since this girl is "very ill", regardless of any consideration of payment, I would quickly assess her. Now if I judge her to require immediate hospitalization, then I do what is needed to stabilize her and call 911 for an ambulance to take her to the nearest hospital. So is she really THAT sick? <the interviewer smiles and replies ' no, she is sick but you judge that she can be adequately treated in an office setting'> Well, in that case, after assessing her medically, I would have a discussion with the parents who brought her in. I'd try to let them understand that while I am truly concerned for the well-being of their daughter, that it would be more economical for them to go to the clinic across town rather than see us as a cash patient. <Ask the interviewer, Dr. X, would her care be compromised at all by going by bus across town? Interviewer replies 'no'> Well, then I'd make sure the parents have adequate directions to get to the clinic. I would also ask them to call us back if they have any problems getting seen at the clinic. Of course, if any of the actions I've just described are not legally appropriate, bear in mind, I haven't actually finished medical school yet. I am looking forward to the four years that I'll be learning at your school, so that I will be able to learn the right away to approach this. But this is just what comes to mind offhand to me right now.

Bottom line. The interview is an interactive process. Some interviewers like one type of approach more than others. Always use nonverbal cues to see how you're doing. Always ask intellgent questions back to the interviewer for clarification. In no time, you'll notice that the time allotted for the interview has passed and you have left the interviewer with nothing but good impressions about your thought processing ability and you have limited the time for there to be further questions that might trip you up. This is the same strategy that you'll employ in the future on oral exams.

 

[Caribou]

Both passive and active euthanasia are immorally wrong, i don't care what the AMA says. I don't believe people should give up their lives unless they are in so much pain, that they can't physically or mentally do anything.

Can you clarify what you classify as passive and active euthanasia, because I feel that the level of pain a person is feeling shouldn't change whether or not the act is considered euthanasia. Also, are you talking about voluntary, unvoluntary, or involuntary euthanasia? Because they are all very different acts and carry very different moral implications. I agree that when a person is feeling so much pain that "they can't physically or mentally do anything," voluntary passive euthanasia is morally acceptable, but how is it different (in the moral sense) from voluntary active euthanasia? Aren't the ends and the intentions the same? Is not then the act the same in a sense? You are killing the person in both cases. Whether you kill the person by taking away what keeps them alive or by adding something that kills them quickly, you are still taking away their life. Anybody have thoughts on the issue? (Keep in mind I argue for morality, not legality)

 

[SFAJess]

If you ever get an ethics question during an interview, ask your interviewer a series of questions to figure out exactly what is going on with the particular situation. As you read in my first response, there are lots of points to take into consideration. You can't give a blanket statement such as, "Perform the abortion," unless you know all the details.

Very good point...I was expecting for people to bring up the fact that we don't know what kind of setting it is and we don't know how sick the little girl is.

 

[SFAJess]

Can you clarify what you classify as passive and active euthanasia, because I feel that the level of pain a person is feeling shouldn't change whether or not the act is considered euthanasia. Also, are you talking about voluntary, unvoluntary, or involuntary euthanasia? Because they are all very different acts and carry very different moral implications. I agree that when a person is feeling so much pain that "they can't physically or mentally do anything," voluntary passive euthanasia is morally acceptable, but how is it different (in the moral sense) from voluntary active euthanasia? Aren't the ends and the intentions the same? Is not then the act the same in a sense? You are killing the person in both cases. Whether you kill the person by taking away what keeps them alive or by adding something that kills them quickly, you are still taking away their life. Anybody have thoughts on the issue? (Keep in mind I argue for morality, not legality)

I don't think I would be able to do it in any case....I have read though about Advance Care Planning where someone can make a legal document while they are sound of mind that if they are ever in such a situation that they would want or they would not want for the physician to "pull the plug". In any case, I wouldn't feel right as a physician to do it.



Quote:
Originally Posted by deuist
If you ever get an ethics question during an interview, ask your interviewer a series of questions to figure out exactly what is going on with the particular situation. As you read in my first response, there are lots of points to take into consideration. You can't give a blanket statement such as, "Perform the abortion," unless you know all the details.


Very good point...I was expecting for people to bring up the fact that we don't know what kind of setting it is and we don't know how sick the little girl is.

 

[indo]

Both passive and active euthanasia are immorally wrong, i don't care what the AMA says. I don't believe people should give up their lives unless they are in so much pain, that they can't physically or mentally do anything.

Immorally wrong? haha...i know what you meant.

If I am in a vegetative state I have no life to be taken from me.

 

[PostalWookie]

Here's a point to debate - the Catholic church is stupid.

The proof:
- the Pope says condoms can't prevent AIDs
- church won't let a girl have communion wafer without gluten even though she has a disease the doesn't allow her to have any
- the Catholic church did not officially admit that Galileo was correct until like a decade ago

 

[adamj61]

#4 is easy, insurance companies can't tell the parents, and if the parents have it...would pay for the abortion.

 

[adamj61]

Here's a point to debate - the Catholic church is stupid.

The proof:
- the Pope says condoms can't prevent AIDs
- church won't let a girl have communion wafer without gluten even though she has a disease the doesn't allow her to have any
- the Catholic church did not officially admit that Galileo was correct until like a decade ago

It took until 1990 for the church to admit the earth wasn't flat.

Not to mention the idea behind denying priests sex, then placing alter boys all around them has to be the most idiotic idea ever. All they want to do is control everyone, especially women