Interesting Ethical Question

[muonwhiz]

I saw an interesting ethical question on the net recently. Situation: A first year medical student has just finished her first semester or quarter and is flying home to visit relatives over the Christmas break. While in flight, one of the crew comes on the microphone and asks if anyone on board is a doctor or has medical training. Apparently, a passenger has taken ill and needs assistance. The flight isn't scheduled to land for at least an hour. No one appears to come forward in answer to the call. What should the medical student do?
One of the professors moderating the discussion stated that the medical student should come forward regardless of whether or not anyone else did. The student should explain the limitations of her training and offer to help. The given rationale was that the medical student had already entered the profession, even if training was not completed. Therefore, she had the obligation not to turn aside. Another participant stated that since the student had little training completed, that she would not be in a position to help, so would not be obligated to come forward. What do you think?

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[Mango]

I would say that you would be obligated NOT to come forward. There is absolutely nothing taught in the first semester, or even in the first year of medical school that would allow you to help that patient. You may be able to take a history from them, but you won't know what to do with the info!

As to the crap about "being part of the profession makes you obligated to help." That's rediculous. If you are not qualified in any way to give medical help, then you are not obligated to "help."

Incidentally, I was on a flight when this happened, and the flight attendant specifically asked for a physician, RN, or Paramedic. She said nothing about first year med students!! The patient was a 20 year old who decided it was a good idea to not eat for 3 days so that she would fit into her New Year's Eve dress. She passed out, and the flight attendant couldn't find a pulse!There were two docs and a nurse on the plane, and they pumped her full of OJ and food, and she was fine. I was in the seat behind her, which is why I know the details. It was an interesting flight!

 

[Hskermdic]

I would be concerned that if the first year medical student with no medical experience came forward and helped their may be others on the plane doctor is helping the patient so they wouldn't who are more qualified and think that a step up.

 

[Starflyr]

I think it depends. A lot of 1st year medical students have been through (non-medical school) first aid/CPR/lifeguarding/EMT/whatever else training. I think if that's the case, they should see if they can help. If its NOT the case, no, they shouldnt - knowing all 86 bagillion parts of the body probably isnt going to help someone in a medical emergency.

smiles,
Star

 

[UHS03]

at UHS we had to sign an agreement promising to not practice medicine in any form, regardless of prior training, before graduation. Obviously, the exception to this is practicing under the direct supervision of a licensed physician.

 

[muonwhiz]

Don't you guys think that the medical student has an obligation to come forward? I think the student should fully disclose the extent of her training (or lack thereof) to the patient or his/her family if there or the flight crew. Also, the student shouldn't take on some treatment unless she has some experience. But it doesn't seem right for the student to just sit tight if no one else is helping. At the least, she could hold the patient's hand and try to be of some comfort. Also, it's my impression that alot of med schools have their first year classes take some varient of the Hipocratic oath at White Coat ceremonies by which they agree to abide by the prevailing ethical code. Anyone know differently?

 

[melancholy]

Interesting question.. I've pondered something similar before because of another situation my friend mentioned. I hope you don't mind if I mention a few situations I think might be relevant.

This other situation dealt with a worker at a med school who had a heart attack in the middle of the gym. Help was sought out and two upperclass med school students were asked to perform CPR but both declined for various reasons.

I also recall watching a special report on TV regarding a terrible car accident in Montana (out in the middle of nowhere) where the only passerby with medical experience was a podiatrist.. who stopped to help and was later sued even though he tried his best to help save the victims.

One more episode that is not as related but I thought I'd mention is that of a father who has a heart attack about a block or two from a hospital. The daughter ran into the ER begging them to help resuscitate the father, but for whatever reasons, the ER did not have available emergency equipment to spare and consequently did not help the victim. The father did not survive and the daughter ended up suing the hospital.

I haven't entered med school yet, but I realize there are legal issues as well as Good Samaritan laws to take into account.. I have a feeling a lot of schools integrate these issues into some sort of class. I know that laws differ state-to-state, so it helps to be aware of the implications of stepping forward to help. If I were a first-year med school student, I would WANT to help someone in need if I could.. but aside from the basic first aid and CPR (IF you are CURRENTLY certified.. an expired license will not help), there's not much a medical student could or should do I think. It's kind of depressing how the U.S. has grown in terms of all the litigation and malpractice suits that occur these days.. whatever happened to helping someone in good faith?

At any rate, if no one else with significant training offered to help on that plane, I would try to at least survey the situation. I guess the main lesson from this is we have to all be aware of our environment/situation and the consequences of any actions.

-Hey.. we are all in this to help save lives and improve the quality of life for others. However, if something terrible happens and legal issues come into play.. a promising medical career could be cut short, possibly denying the community of another doctor to save lives in the future.

(Note: Try to stick to positive criticism please.. no flaming. Any constructive input to this ethical question would be greatly appreciated!)

 

[drjay]

To Mango's Response:

Hey Mango, you may be right about the fact that some schools do not teach much in the first year, but in my first year we learned BCLS and that in itself is a reason to come forward and offer help. If at that time, you are unable to help to your capacity, then you can easily do what you can and then proceed back to your seat to enjoy the rest of your flight. Many first years have learned enough to at least have an idea for general medical problems.

 

[Bigk9s]

I agree with drjay. You have to at least offer to help. Chances are you'll do more good, despite your limited skills, than just sitting and watching like the rest of the non-medical personnel.

 

[skelly99]

This is an interesting question, and there is definitely a distinction between legal and ethical responsibility to help. Here is my take on the question based on limited experience as an EMT (but not a lawyer).

There is no legal responsibility to help the sick person. However, if you choose to do so, Good Samaritan laws will most likely kick in. Does this mean that the person can't sue you? No. Anyone can sue, but I am hard pressed to think of a single case where they were successful. That is, assuming that--
1. The person rendering aid had no legal duty to respond. If they did, and did not help the patient, then they could be held accountable;
2. The person rendering aid performed to his or her level of training--and not beyond. A medical student could stop and help, take a history, vitals, etc., to his or her level of training, but could not administer meds, etc.;
3. The person rendering aid did no further harm than would have been done if no aid were given.
4. The person rendering aid obtained consent (unless implied due to unconciousness, etc.) before helping out.

On an ethical level, I would hope that a person in this situation would help. There was an interesting show on the Discovery Channel (?) called the Human Zoo where they showed an actor lying on a sidewalk pretending to be unconcious on a very busy street. It took something like 10 minutes for anyone to walk over and check on the person. However, once ONE person did that, several others came over to help. Even though you are a med student, just offering to help may cause others (including physicians, etc.) to come help as well.

Just some thoughts. Cheers.

 

[dcpayne]

Another situation to consider...

When my girlfriend was a first year med student, she came across an accident that had just happened along a busy stretch of interstate during a heavy rain storm. Since it was apparent that the accident had just happened, she drove to the next exit and called 911, she then went back to the site and 10 - 15 minutes later no one had stopped so she pulled off the highway, pulled the victim out of the car and dragged her across the highway to the shoulder on the other side (where there was a much wider shoulder). She then performed CPR alone until helped arrived in the form of a local doctor who stopped and assisted in reviving the victim. Eventually the ambulance arrived and the victim taken to the hospital. Just some food for thought on subject. Afterall, a first year Medical student is going to be more of a help on that plane than a flight attendant with no medical training at all.

 

[dieselkid]

This is a good thread. Curious if any military people out there have any thoughts on the following. In military training/combat what is the official stance on assisting fellow soldiers? Is that left to the corpsman, or is there a responsibility to respond?

 

[ewagner]

If you have a pulse...you have an obligation to respond...offering your limitations as a 1st year student.


Re: UHS03, that so-called agreement, I think was more aimed at those of us with previous allied health or related degrees.

 

[UHS03]

yeah, I figured that was who it was mainly aimed at..and that agreement wouldn't stop me from trying to help someone in trouble (obviously within my scope of knowledge.) I only mentioned it because it seemed relevent to the discussion.

 

[pyoj]

Originally posted by dieselkid:
•In military training/combat what is the official stance on assisting fellow soldiers? Is that left to the corpsman, or is there a responsibility to respond?•

i'm not in the military (yet), but i have been taught breifly about "high casualty" situations in my EMT class. "Triage" is the key word and EMS got it from the military. tend to the seriously wounded first, then the dying and those with minor injuries.

i know in NY, one is protected with the "good samaritan law" if one decides to help someone who is injured if you have have the proper certification/license (CPR, FirstAid, EMT, etc.) or higher. but, even then, you are under no obligation to intervene if you do not have the proper equipment or personnel, or if you don't feel confident in your life saving skills. but once you do committ, you MUST stay with the patient until more help arives (abandoning the patient would be BAD). it is my understanding that a MSI is not legaly "permitted" (is that the right word here?) to aid in emergency medical matters unless he/she has some sort of EMS certification. then again, if it is a matter of life or death, your knowledge may be able to help in some way.
~j
COMP '05

 

[ADRIANSHOE]

there is only one reason for a med student to come forward and help: the learning experience therein gained. there is no moral ethical or legal obligation for ANY unlicensed person to involve themselves in a medical situation regardless if they are stupid enough to think first year medical school makes them better qualified than a professionally trained aircrew that sees such things regularly and are often bls trained. However it would be a fine learning experience and probably a chance to pick up chicks.

 

[ewagner]

Perhaps the situation should be better described. There are certain situations in which we should respond, regardless of occupation. But if this is a situation where someone is having a seizure or has explosive diarrhea...a first year student would be helpless (and probably so would I).

 

[muonwhiz]

I've done CPR many times as a lifeguard, even with no certificates, licenses, etc. Once I was in a meeting situation with several other people, and one began having a grand mal seizure. I told one of the others to call 911. Then I got another gentleman to help me gently lower the person to the ground (she was in a chair and could have fallen out, creating injury). I then propped up her head and pushed her jaw forward as if going to start CPR. This would keep her from being able to block her airway even if trying to swallow tongue. Another person suggested that I stick a pencil in her mouth, but of course I declined. I held her jaw forward as described until the paramedics arrived. Just as they arrived, she came out of the seizure and was okay. She had just forgotten to take her meds. I think people can be of help even if they have just a few skills. As a med student I wouldn't hesitiate to try to be of assistance to the limited extent of my skills. Other comments?

 

[bustinbooty]

Here is the legal side as I understand it.
You must have consent from the other party to provide first aid of any kind. You must have verbal consent from the person in need. When verbal consent is given, good samaritan laws kick in. If the person in need is unconcsious, consent is legally assumed. These laws apply to anyone, trained or not. Of course, a person with no training whatsoever should not come forward to help. But most(if not all) 1st years have had BLS of some form and could help.
First year students should have the skills to distinguish between what care he/she should provide and what they shouldn't provide, unlike the ***** who will try to be a hero trying to do something they saw on an E.R. rerun. 1st years should at least have the common sense and obligation to "do no harm".