Let's throw around some ethical delimmas!

none · May 30, 2002

To be honest with you...on the 11 interviews I went on, only 2 involved ethical issues. I think they are less common topics than usually thought.

ellerose · May 30, 2002

Actual question:
Describe an ethical dilemma that you have personally faced and what you did in this situation. (UWash.--panel interview)

Premed2003 · May 30, 2002

What would you do if you had to give CPR to a known AIDS patient without any protective equipment?

I have no idea how to answer this...any thoughts? I'm not sure what I'd do.

The Philosopher · May 30, 2002

Hmmmm..that's a good one.

I don't think HIV/AIDS is an air-borne virus, and it's all about bodily fluids. But if the guy had somethin like..I dunno..pneumonia..or some other air-borne pathogen, then you're in trouble.

But I think it's pretty safe for AIDS/HIV.

I've heard studies being done about the virus being present in saliva, although in very very trace, small amounts...but it's a chance, I guess.

I'd go ahead and administer CPR. I'd figure that the chances of me getting it through his saliva (especially the saliva on his lips) are almost nill, even if I were to wipe his lips, get some sort of napkin or somethin, tear it, cover the guy's lips with it, and administer CPR.

TommyGunn04 · May 30, 2002

I was asked a LOT of ethical questions at Duke. I got one about whether or not I should tell my wealthy patient to go overseas to essentially buy a new liver.

And at another school my interviewer started telling me about how the government is legally required to pay for necessary medical procedures in certain states, so if you need a heart transplant or some other expensive, life-saving treatment that your insurance won't pay for, becoming a convict can pay off! Isn't that crazy? 40+ million Americans are UNINSURED, and we've got cons using millions in tax dollars for transplants and the like! Even without getting into "slippery slope" type arguments about the value of normal citizens vs that of convicts, this somehow just doesn't seem right.

Jadeite · May 30, 2002

I'd definitely give them CPR, it doesn't involve blood-contact, and the saliva I believe has either no chance of transmitting the AIDs virus or a very very small one.

Jade~

Jadeite · May 30, 2002

<blockquote>quote:<hr />Originally posted by TommyGunn04:
I was asked a LOT of ethical questions at Duke. I got one about whether or not I should tell my wealthy patient to go overseas to essentially buy a new liver.

And at another school my interviewer started telling me about how the government is legally required to pay for necessary medical procedures in certain states, so if you need a heart transplant or some other expensive, life-saving treatment that your insurance won't pay for, becoming a convict can pay off! Isn't that crazy? 40+ million Americans are UNINSURED, and we've got cons using millions in tax dollars for transplants and the like! Even without getting into "slippery slope" type arguments about the value of normal citizens vs that of convicts, this somehow just doesn't seem right.<hr /></blockquote>It doesn't seem right, I'll agree, but that's a problem for legislature, not doctors. We go in to medicine to be able to do the transplant and have it succeed. I couldn't choose who's life to save, I don't think any man (or woman) has the ability to really judge the worth of a life, and therefore I think if they get away with it, I'll do the surgery (assuming, of course, that I ever get into medical school.) It's not fair that people with money can get the organs they need to survive when poorer individuals can't, but it's also not fair that anyone needs a new liver or heart or kidney either.

Jade~

Street Philosopher · May 30, 2002

CPR: I don't think there is a chance to get AIDS, but if there was one, even if very small, I wouldn't do it. But that's just me talking right now, and I am ignorant. Then again if you're a surgeon you face those risks on a daily basis. Well, I would say me, the 22 year old college student, would not. But me 4 years later as a doctor might do differently.

As for the foreign liver, I'd give the patient information, but I would stop short of advising one way or the other. What the patient does with my information is up to him/her.

The Philosopher · May 30, 2002

Jade,

So by the same token, if abortions were made legal, and a pregnant females wished to have an abortion, you'd do it?

It's a tough decision with your viewpoint if you are pro-life...

Bikini Princess · May 30, 2002

<blockquote>quote:<hr />Originally posted by Premed2003:
What would you do if you had to give CPR to a known AIDS patient without any protective equipment?

I have no idea how to answer this...any thoughts? I'm not sure what I'd do.<hr /></blockquote>You guys don't know much about emergency medicine. Chest compressions alone have been shown to be more effective than when coupled to supplied respiration in amateur responders, because they usually blow air into the stomach.

Just do chest compressions, there's no need to have facial contact.

For premeds you guys should know this stuff..!!

Bikini Princess · May 30, 2002

Oh, and yes, there's a huge pathogen risk with CPR.

When you do compressions, you crush ribs. This often causes vomiting, which will be all over their face. Vomit often has a large pathogen concentration, especially with viruses. (Ever read "The Hot Zone"?)

SolidGold · May 30, 2002

Aren't the chances of contracting AIDS extremely small anyways when there is mouth to mouth contact (example: you really can't get AIDS by kissing someone, so mouth to mouth should be no different). This is all assuming that the victim has no bloody lesions or anything in the mucosal lining of his mouth.

Bikini Princess · May 30, 2002

<blockquote>quote:<hr />Originally posted by TommyGunn04:
I was asked a LOT of ethical questions at Duke. I got one about whether or not I should tell my wealthy patient to go overseas to essentially buy a new liver.
<hr /></blockquote>Tell them make a deal to spend all their money helping the government promote organ donor awareness, in exchange for a liver, or at least a good spot on the waiting list.

See? Ethicial questions are often simpler to answer than you think. Just go with a compromise that helps everybody slightly.

SolidGold · May 30, 2002

I guess the vomit thing answered my question.

Premed2003 · May 31, 2002

Yeah, regarding AIDS, I meant to add that the person has cuts all over his lips. So you can definitely contract AIDS if you give him CPR....what would you do?

I read this question here on this board months ago because it was an actual question someone was asked. I don't know what I'd answer. Yikes!

Doc AdamK in 2006 · May 31, 2002

Here is one that I was given.

A child needs a blood transplant to stay alive, however the mother says they belong to a religious sect that doesn't allow any medical procedures.

YOu as the physician have the choice. Obey the mother's wishes because she is the legal guardian. Or, call security to detain the mother so she doesn't take her child from the hospital, then given the blood transfusion.

AK

boo_yah · May 31, 2002

I am an EMT. So CPR/AIDS thing is not an issue for me. It is a breach of protocol to administer any kind of aid without body substance isolation (regardless of whether or not the person has AIDS). You MUST have body substance isolation in order to give any kind of care.

Premed2003 · May 31, 2002

I think the AIDS question is set in the context that you can't have any type of protection--what would you do? would you protect yourself or save the person? How should this question be answered?

Any clue? I hope I don't get this one in an interview, but I want to prepare just in case

boo_yah · May 31, 2002

And as for the transfusion, I would definitely give the kid blood. The mom could condemn the doctor for the decision, and still keep her faith.

brickmanli · May 31, 2002

Be careful when they ask you a hard ethics question. It's okay to say you don't know enough about the subject to give an adequate answer.

boo_yah · May 31, 2002

<blockquote>quote:<hr />Originally posted by Premed2003:
I think the AIDS question is set in the context that you can't have any type of protection--what would you do? would you protect yourself or save the person? How should this question be answered?

Any clue? I hope I don't get this one in an interview, but I want to prepare just in case

<hr /></blockquote>No body substance isolation = can't give care

Street Philosopher · May 31, 2002

<blockquote>quote:<hr />Originally posted by Premed2003:
Yeah, regarding AIDS, I meant to add that the person has cuts all over his lips. So you can definitely contract AIDS if you give him CPR....what would you do?

I read this question here on this board months ago because it was an actual question someone was asked. I don't know what I'd answer. Yikes!<hr /></blockquote>Ummm in that case, "Sorry, can't help ya. Better luck next time."

lola · May 31, 2002

about the kid and the blood... what are the legal considerations here? i mean, if legally the doctor has to respect the mother's wishes, then i would do that. if the doctor is free to do whatever he/she wants, then it is a tough call.

u2ecila · May 31, 2002

Wow - this a very interesting thread.

Ok what would I do?

AIDs patient needing CPR:
If I absolutely could not create a safety barrier between myself and the patient, then I would not perform CPR. I am just thinking of the big picture - prolonging the life a dying person and possibly infect myself with AIDS/HIV versus keeping my health and being able to help many more people.

Physician Assisted Suicide vs. Death Penalty:
I believe a person's own life or death is their own choice, especially when a patient is facing a terminal illness. However, I also not opposed to the death penalty. In the end, the difference in the two is who make the choice: the individual or someone else. Let the terminally ill patient die to escape suffering and make the convict live or die for punishment.

Buy Liver Overseas:
Yes, I would tell the patient and let them make their own decision.

Blood Transfusion vs Religious Beliefs:
I would give the child a blood transfusion.

Well, I think I just failed ethics 101, but that is just me.

u2ecila

Jadeite · May 31, 2002

<blockquote>quote:<hr />Originally posted by The Philosopher:
Jade,

So by the same token, if abortions were made legal, and a pregnant females wished to have an abortion, you'd do it?

It's a tough decision with your viewpoint if you are pro-life...<hr /></blockquote>It's not a tough decision, and I am pro-life. I would do the surgery because if I didn't do it, someone else would, and if someone else wouldn't do it, then they would put themselves at great risk either trying to do it in a non-sterile environment and with a non-sterile device coat-hanger with a non-professional, these things do happen. I would offer alternatives such as adoption, but if they were determined, I would do the procedure.

Jade~

TommyGunn04 · May 31, 2002

<blockquote>quote:<hr />Originally posted by Doc AdamK in 2006:
Here is one that I was given.

A child needs a blood transplant to stay alive, however the mother says they belong to a religious sect that doesn't allow any medical procedures.

YOu as the physician have the choice. Obey the mother's wishes because she is the legal guardian. Or, call security to detain the mother so she doesn't take her child from the hospital, then given the blood transfusion.

AK<hr /></blockquote>I recently took a pediatric ethics seminar where we discussed this very topic in detail. If I remember correctly, we learned that the state has a vested interest in the well being of a child, thus regardless of the religious beliefs of the legal guardians, a child cannot be deprived of life-saving treatment. The state has a responsibility to promote the child's "best interests." Thus parents are not legally allowed to "make a martyr" of their children, though once of age a person can legally refuse such treatment.

Jadeite · May 31, 2002

<blockquote>quote:<hr />Originally posted by Doc AdamK in 2006:
Here is one that I was given.

A child needs a blood transplant to stay alive, however the mother says they belong to a religious sect that doesn't allow any medical procedures.

YOu as the physician have the choice. Obey the mother's wishes because she is the legal guardian. Or, call security to detain the mother so she doesn't take her child from the hospital, then given the blood transfusion.

AK<hr /></blockquote>This actually came up in my mother's practice - she had a Jehovah's Witness who had just given birth (she's an OB/GYN) and would die if she didn't receive a transfusion. Mother was able to explain to the woman in no uncertain terms that she had to take it to give that child a mother, and she convinced her to do it.

Along the same lines I would definitely try to convince the mother exactly what was going on, until she agreed.

Jade~

The Philosopher · May 31, 2002

Jade,

So you would go against your personal beliefs and assist another person in doing something which you personally feel is immoral and wrong, especially when other physicians in the same hospital can perform the same procedure while supporting abortion?

TommyGunn04 · May 31, 2002

<blockquote>quote:<hr />Originally posted by Jadeite:

Originally posted by The Philosopher:

It's not a tough decision, and I am pro-life. I would do the surgery because if I didn't do it, someone else would, and if someone else wouldn't do it, then they would put themselves at great risk either trying to do it in a non-sterile environment and with a non-sterile device coat-hanger with a non-professional, these things do happen. I would offer alternatives such as adoption, but if they were determined, I would do the procedure.

Jade~<hr /></blockquote>Just because people are going to do something doesn't make it right, nor does it obligate us to do it ourselves, or even make it safer to do. You don't see us giving high school kids pot, do you? We don't teach killers and theives to murder and steal more effectively, do we? Why then should it be any different concerning abortion? If you think abortion is wrong, the fact that it's "going to happen" doesn't make YOU obligated to perform one, just like "of age" Jehovah's Witnesses aren't obligated to receive transfusions, even if the majority of us think that one would be prudent.

The Philosopher · May 31, 2002

TommyGunn,

That is exactly my point <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />

NUgirl · May 31, 2002

<blockquote>quote:<hr />Originally posted by lola:
about the kid and the blood... what are the legal considerations here? i mean, if legally the doctor has to respect the mother's wishes, then i would do that. if the doctor is free to do whatever he/she wants, then it is a tough call.<hr /></blockquote>I read somewhere that it's a law that minors DO NOT need parental consent for emergency treatment.

DrBlueDevil · May 31, 2002

<blockquote>quote:<hr />Originally posted by The Philosopher:
Jade,

So by the same token, if abortions were made legal, and a pregnant females wished to have an abortion, you'd do it?

It's a tough decision with your viewpoint if you are pro-life...<hr /></blockquote>What the hell? I thought abortions WERE legal. Are you referring to 3rd trimester abortions in states where it's currently illegal, but were made legal? I was under the impression that it's no problem to get an abortion...

Doc AdamK in 2006 · May 31, 2002

LOLA:

Actually my interviewer told me that this was battled out in the courst system. He told me the doctor that gave a blood transfusion won. He argued child endangerment.

The parent can't be the legal guardian in a case when there is abuse.

AK

Doc AdamK in 2006 · May 31, 2002

Jadeite:

Sometimes when your dealing with really religous people, you can't convice them otherwise.

So if you have to call security, that is what you should do. Of Course it's your own call

AK

The Philosopher · May 31, 2002

Dr. BlueDevil,

Sorry for the misinfo...I wasn't meaning to say whether abortions were legal or illegal. It was just a hypothetical situation, and I am not sure of the laws in different states, or in different periods of time of the fetus.

Anyway, that's besides the point. The question was aimed at whether or not one would sacrifice personal beliefs to aide in helping another person doing something immoral (even if that immorality is legal). And in this case, "immoral" is defined as what you personally believe is wrong.

DrBlueDevil · May 31, 2002

<blockquote>quote:<hr />Originally posted by The Philosopher:
Dr. BlueDevil,

Sorry for the misinfo...I wasn't meaning to say whether abortions were legal or illegal. It was just a hypothetical situation, and I am not sure of the laws in different states, or in different periods of time of the fetus.

Anyway, that's besides the point. The question was aimed at whether or not one would sacrifice personal beliefs to aide in helping another person doing something immoral (even if that immorality is legal). And in this case, "immoral" is defined as what you personally believe is wrong.<hr /></blockquote>ahh...gotcha.....and MAN! The Halloween thing! hahahahahah

Jersey Girl · May 31, 2002

If I was presented with a parent who would not let their child recieve a blood transfusion and the child would die, I would definately ignore her wishes. A parent cannot physically beat their child or abuse their child in our legal system. So I am sure that a parent does not have the right to make the decision to take their childs life. We have many civil rights, however in our society, if one persons civil rights interferes with the civil rights of another persons, they lose that right. In this instance, the mothers civil right for freedom of religous belief is interfering with her childs civil right to "life" liberty and happiness.

SicVic · May 31, 2002

I love this post - hey if you are preparing for interviews try to be very versed in such matters. This helps to identify where you stand in various ethical matters.
But dont kill yourself about ethical questions -
I hardly had any ethical questions in my interviews. But be ready.

Jadeite · May 31, 2002

<blockquote>quote:<hr />Originally posted by TommyGunn04:

Just because people are going to do something doesn't make it right, nor does it obligate us to do it ourselves, or even make it safer to do. You don't see us giving high school kids pot, do you? We don't teach killers and theives to murder and steal more effectively, do we? Why then should it be any different concerning abortion? If you think abortion is wrong, the fact that it's "going to happen" doesn't make YOU obligated to perform one, just like "of age" Jehovah's Witnesses aren't obligated to receive transfusions, even if the majority of us think that one would be prudent.<hr /></blockquote>Yes, but according to the law it is legal. And we are bound to what the the higher committee determines for us - it's the only way ethics really works, is if a body votes on something, if they agree on it, you have to stick with the committee. (Of course, you can object and have things changed), but as long as it is considered "ethical" by the committee on ethics, it's something that I would do. Of course, I'll probably avoid this particular problem by not being an OB/GYN. (It's all for the sake of argument, you see.)

I guess my biggest point is I wouldn't want my unwillingness to do a procedure leave someone in the position they couldn't get good medical care.

This is my personal belief, do you think this would be good or bad to say during an interview? I wasn't asked it last year, but I may be applying again, so it's good to know...

Jade~

Tweetie_bird · May 31, 2002

<blockquote>quote:<hr />Originally posted by boo_yah:
And as for the transfusion, I would definitely give the kid blood. The mom could condemn the doctor for the decision, and still keep her faith.<hr /></blockquote>nooooo!! this could make you lose your license! The "correct" answer would be (there is a correct answer here), I would do everything I can to change the mom's mind..if that didn't work, I would call the local court of justice (there's always a 24 hour justice on call for such problems) and put a court order in line (which is done within minutes) to give the kid some blood. If you just gave the blood to the kid, you're assuming that "your morals and principles are better than the mom's" and thus she may file a law suit against you with discrimination/assault charges. Trust me, it has happened....we docs always think we wanna help others at no cost, but then we suffer the consequences. Just always make sure that in ethical cases, you are always covered.....you never know what might happen.
It's unfortunate to be practising in such situations, but hey, it's the best it can get.

Tweetie
PS: and I've actually read a case, where the kid who got a transfusion was later taken out of the community after his/her recovery b/c it was "tainted with somebody else's blood." So eventually, it might end up doing the kid more harm than good.

Tweetie_bird · May 31, 2002

this is an awesome discussion guys, i do have one question which has never been answered---
Is abortion really legal or illegal? I took a class that barely touched on this issue, and said that something like Roe Vs Wade didn't make abortion LEGAL. It ISN'T legal, but there is a certain clause in there that allows us to do it . . . anybody know what i am talking about?

I should look this up, b/c now it's bothering me that i don't know it.

The Philosopher · May 31, 2002

Jade,

I can understand what you are saying and the issue is very controversial.

My personal view about "ethics" is that no one can decide ethics or morals or whatever for me, but myself. And as long as I act within the law in the country I am abiding in, then I am free to do whatever.

Now, sure...ok, we'll say abortion is legal and that although you are pro-life, you said that you would still do abortions. But the key fact is that the law DOES NOT OBLIGATE you to carry out abortions. Your fellow OB-GYN, who might be neutral in doing abortions, could do it instead. There's no big deal in that, is there?

I really don't know how you would handle your stance in interviews, or how you would come across. To me, it seems a bit condecending, because you are not obligated to perform abortions under the law, even if they are legal. So why perform them? Why sell yourself out to a bunch of Congress yuppies who took some vote that goes against your beliefs, when you know in your heart that you're pro-life and when you feel that it is wrong to do abortions?

Now, if the mom's life was in danger, that's a different situation...

boo_yah · May 31, 2002

<blockquote>quote:<hr />Originally posted by Tweetie_bird:
this is an awesome discussion guys, i do have one question which has never been answered---
Is abortion really legal or illegal? I took a class that barely touched on this issue, and said that something like Roe Vs Wade didn't make abortion LEGAL. It ISN'T legal, but there is a certain clause in there that allows us to do it . . . anybody know what i am talking about?

I should look this up, b/c now it's bothering me that i don't know it.

<hr /></blockquote>The supreme court ruled that during the 1st trimester states cannot prevent a woman from getting an abortion for any reason; that during the 2nd trimester state laws can regulate abortion to protect the woman's health; and that during the 3rd trimester state laws can prohibit abortions, except when it is necessary to preserve the life or health of the woman.

So some states have laws that prohibit abortions in the 3rd trimester (many do not), but during the first trimester abortions cannot be illegal.

I know there is more to the story- can anyone add to this?

TommyGunn04 · Jun 1, 2002

<blockquote>quote:<hr />Originally posted by Jadeite:
This is my personal belief, do you think this would be good or bad to say during an interview? I wasn't asked it last year, but I may be applying again, so it's good to know...

Jade~<hr /></blockquote>I'd recommend completely staying away from the abortion issue in interviews. It's just too hot an issue. Almost everyone has a very passionate, unwavering opinion about it, and if you happen to disagree with your interviewer, things could turn out badly. Of course, you would HOPE that an interviewer can put aside such partiality in evaluating candidates. But the truth is, complete objectivity is VERY hard to achieve. In this process, where the odds are so against you even from the start, it's best to refrain from giving them a reason not to like you.

Jadeite · Jun 1, 2002

<blockquote>quote:<hr />Originally posted by The Philosopher:
My personal view about "ethics" is that no one can decide ethics or morals or whatever for me, but myself. And as long as I act within the law in the country I am abiding in, then I am free to do whatever.

Now, sure...ok, we'll say abortion is legal and that although you are pro-life, you said that you would still do abortions. But the key fact is that the law DOES NOT OBLIGATE you to carry out abortions. Your fellow OB-GYN, who might be neutral in doing abortions, could do it instead. There's no big deal in that, is there? <hr /></blockquote>I wasn't under the impression that the question allowed for letting someone else do it, of course that would be a preferred option, since I don't even intend to be an OB anyway. I'm just saying if the hypothetical situation were to arise and I was the only one who could do it, I would even though it went against my beliefs because it's more important to me that someone has good care than I maintain my own personal idealisms.

<blockquote>quote:<hr />Originally posted by The Philosopher:

I really don't know how you would handle your stance in interviews, or how you would come across. To me, it seems a bit condecending, because you are not obligated to perform abortions under the law, even if they are legal. So why perform them? Why sell yourself out to a bunch of Congress yuppies who took some vote that goes against your beliefs, when you know in your heart that you're pro-life and when you feel that it is wrong to do abortions?
<hr /></blockquote>I really hope I don't come off as condescending.

The only way democracy works is if we vote, and abide by the will of the majority. At least until things can be changed....

Jade~

Jadeite · Jun 1, 2002

<blockquote>quote:<hr />Originally posted by TommyGunn04:
]I'd recommend completely staying away from the abortion issue in interviews. It's just too hot an issue. Almost everyone has a very passionate, unwavering opinion about it, and if you happen to disagree with your interviewer, things could turn out badly. Of course, you would HOPE that an interviewer can put aside such partiality in evaluating candidates. But the truth is, complete objectivity is VERY hard to achieve. In this process, where the odds are so against you even from the start, it's best to refrain from giving them a reason not to like you.<hr /></blockquote>Oh yeah! I'm sure it's best to stay a million miles from Abortion, Euthanasia... etc... But, do you think any interviewers ever ask those sorts of questions?

Let's throw around some ethical delimmas!

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