Medical Ethics for Interviews and for Life

[aSagacious]

^ . I appreciated the imagery if nothing else. Yes, I understand the study would be nearly impossible to implement in practice.

---

Members don't see this ad.

 

[Dial71]

I hate to rain on the parade, but nearly all of these "ethical dilemmas" have well-defined and widely accepted answers, which are described by law. No sense in reinventing the wheel.

The real moral issue in health care today is the question of how to provide medical coverage for our population.

 

[CodeBlu]

I hate to rain on the parade, but nearly all of these "ethical dilemmas" have well-defined and widely accepted answers, which are described by law. No sense in reinventing the wheel.

The real moral issue in health care today is the question of how to provide medical coverage for our population.

Yeah. The whole point of this thread is to learn. We're not all fortunate enough to be medical students like you, just yet that is.

These answers might be widely accepted for those currently in the profession or studying. But we're still learning.

 

[oaklandguy]

I will take it upon myself to flirt excessively over the next month drawing blood on every Saturday and Wednesday with Tuesday being a control by flirting with members of the same sex. I will centrifuge the blood then freeze it in hopes of using it as a capstone project in medschool and creating a drug that will enable beta males to get laid

 

[CodeBlu]

I will take it upon myself to flirt excessively over the next month drawing blood on every Saturday and Wednesday with Tuesday being a control by flirting with members of the same sex. I will centrifuge the blood then freeze it in hopes of using it as a capstone project in medschool and creating a drug that will enable beta males to get laid

 

[FlowRate]

I hate to rain on the parade, but nearly all of these "ethical dilemmas" have well-defined and widely accepted answers, which are described by law. No sense in reinventing the wheel.

The real moral issue in health care today is the question of how to provide medical coverage for our population.

That's not a moral issue, unless you accept that it is the responsibility of those in health care to provide care to all regardless of circumstance. And if you accept that, then there's no question about what you have to do.

Yeah, we should probably start feeding people and giving them housing. Plus, I need a slave. These are my rights.

 

[AZFutureDoc]

Here's one that was an actual interview question I had in the past. Its simple.

Is it fair for people who eat like garbage, smoke, drink, don't work out, etc to pay more for their health insurance? And justify your answer of course.

This one gets ugly, cuz no matter what someone says, you can play devils advocate hard. When I had this question, it felt like a chess game between me and my interviewer. He eventually won when I basically contradicted myself on two statements I made. It was really strange, because it really felt like we were in a courtroom, going back and forth. He said he wanted for us to argue back and forth lol.

Well, I'm still here in the pre-medical forums, so I guess I didn't do as well as I could have lol!

 

[FlowRate]

Here's one that was an actual interview question I had in the past. Its simple.

Is it fair for people who eat like garbage, smoke, drink, don't work out, etc to pay more for their health insurance? And justify your answer of course.

This one gets ugly, cuz no matter what someone says, you can play devils advocate hard. When I had this question, it felt like a chess game between me and my interviewer. He eventually won when I basically contradicted myself on two statements I made. It was really strange, because it really felt like we were in a courtroom, going back and forth. He said he wanted for us to argue back and forth lol.

Well, I'm still here in the pre-medical forums, so I guess I didn't do as well as I could have lol!

Insurance, ideally, is risk-based. This is why insurance companies don't cover PEC's. I would split the conversation into how I believe insurance should work and how it works in this country currently, as the answers are opposite for the two situations. I like that question--I wish I had more discussions like that during my interviews.

 

[Soulstice]

At the same time, while insurance should mirror risk and higher hazards burden the system more.. you can't start blaming patients morally for their conditions. It's a slippery slope without a fine line. Do you blame the AIDS patient for unsafe sex? Do you blame someone for developing MDR-TB when their socioeconomic circumstances and access-to-care issues prevented them from getting treatment? Do you blame a drug addict for his relapses (after all, there ARE genetic predispositions to drug addiction)?

You can't draw the line.. and especially recently, where research has shown that the desire for sugars and the urge to overeat follow similar biochemical pathways in the brain as addicts' urges for drugs. While it is fair to "blame" someone for their flaws, you can't blame someone for their disease or hold it against them. And that line is too blurred for doctors to fairly interpret it without outstepping their roles as healers--after all, doctors are not judges.

 

[NightGod]

I hate to rain on the parade, but nearly all of these "ethical dilemmas" have well-defined and widely accepted answers, which are described by law. No sense in reinventing the wheel.

The real moral issue in health care today is the question of how to provide medical coverage for our population.

I also would say I hate to rain on your parade, but I really don't.

Sometimes (in fact almost always, in the case of pure debate) ethics is about debating hypothetical dilemmas outside the context of current law. Take the Heinz theft dilemma, for example. The letter of the law is crystal clear: he stole something that legally belonged to another person so what he did was clearly wrong and should be punished. Of course, in the context of ethics, the answer is not so black and white. We're dealing with purely gray areas here and the intellectual exercise alone can make it a worthwhile pursuit.

 

[FlowRate]

At the same time, while insurance should mirror risk and higher hazards burden the system more.. you can't start blaming patients morally for their conditions. It's a slippery slope without a fine line. Do you blame the AIDS patient for unsafe sex? Do you blame someone for developing MDR-TB when their socioeconomic circumstances and access-to-care issues prevented them from getting treatment? Do you blame a drug addict for his relapses (after all, there ARE genetic predispositions to drug addiction)?

You can't draw the line.. and especially recently, where research has shown that the desire for sugars and the urge to overeat follow similar biochemical pathways in the brain as addicts' urges for drugs. While it is fair to "blame" someone for their flaws, you can't blame someone for their disease or hold it against them. And that line is too blurred for doctors to fairly interpret it without outstepping their roles as healers--after all, doctors are not judges.

What's the point of your argument? You can't blame people for making bad decisions and having poor self control? Why are we "blaming" people? An alcoholic with liver failure certainly had a role in his condition.

Is it unfortunate? Yes. Should they be treated? If they can pay.

Healthcare is a good. It requires capital of every sort.

I am willing to consider the idea that a just society/culture helps out people who truly can't pay, but I don't think its optimal execution is through force and bureaucracy.

I personally believe in charitable giving and volunteering of time and services, but I really don't like being made to do it.

 

[FlowRate]

I also would say I hate to rain on your parade, but I really don't.

Sometimes (in fact almost always, in the case of pure debate) ethics is about debating hypothetical dilemmas outside the context of current law. Take the Heinz theft dilemma, for example. The letter of the law is crystal clear: he stole something that legally belonged to another person so what he did was clearly wrong and should be punished. Of course, in the context of ethics, the answer is not so black and white. We're dealing with purely gray areas here and the intellectual exercise alone can make it a worthwhile pursuit.

What is just is not always legal and what is legal is not always just.

 

[AZFutureDoc]

If I were asked this question again, I would stick to my guns that they do need to pay more. It's just how insurance works. It is basic math and science that these people will require more money to be treated. And it is only fair that they pay more. I got tripped up in my interview by starting to make exceptions, and agreeing with some good counterarguments made by my interviewer. But in the end, this is the only way that insurance can work.

Soulstice brings up a very good point tho. There are tons of ways that people contribute towards their lack of health. It's weird, because for some reason, I feel okay with the examples of smoking and obesity, yet I'm uneasy with treating drug addicts and AIDS patients the same way. It's funny how I feel differently, even though the premises are the same. I'm pretty bad at these ethical discussions, so I'll be lurking around here a lot lol.

 

[dbeast]

Here's one that was an actual interview question I had in the past. Its simple.

Is it fair for people who eat like garbage, smoke, drink, don't work out, etc to pay more for their health insurance? And justify your answer of course.

This one gets ugly, cuz no matter what someone says, you can play devils advocate hard. When I had this question, it felt like a chess game between me and my interviewer. He eventually won when I basically contradicted myself on two statements I made. It was really strange, because it really felt like we were in a courtroom, going back and forth. He said he wanted for us to argue back and forth lol.

Well, I'm still here in the pre-medical forums, so I guess I didn't do as well as I could have lol!

Ohhh I really like this question...

Think about it this way: Say if 10 people put $20 into a pot and 9 out of 10 have equal likelihood of winning, but one out of 10 has twice as good odds to win, is that fair to the other 9? Now, imagine that the "winner" in the scenario is twice as likely to need more procedures/hospital visits/etc. while everybody pays the same amount. It seems unfair to the others who do take care of themselves to pay the same for unequal likelihood of staying in the hospital.

 

[AZFutureDoc]

Ohhh I really like this question...

Think about it this way: Say if 10 people put $20 into a pot and 9 out of 10 have equal likelihood of winning, but one out of 10 has twice as good odds to win, is that fair to the other 9? Now, imagine that the "winner" in the scenario is twice as likely to need more procedures/hospital visits/etc. while everybody pays the same amount. It seems unfair to the others who do take care of themselves to pay the same for unequal likelihood of staying in the hospital.

I agree. I think most people do. Until people start asking questions like:

Do you know how hard it is to quit smoking?
Do you know how much cheaper eating fast food is vs cooking and eating healthy?
Do you know how many people do not have the time to work out very often, between their jobs and parenting?

And the biggest question, are you aware of the fact that overall, poor people drink more, smoke more, eat less healthy, get less exercise, etc? This is the biggest problem. The initial question I asked is easy to answer, but with this new piece of information, I feel like the question gets very complicated. I honestly don't know how I feel, and I'm conflicted over whether or not it's fair when I consider that these problems disproportionately affect the poor and uneducated.

 

[CodeBlu]

Ohhh I really like this question...

Think about it this way: Say if 10 people put $20 into a pot and 9 out of 10 have equal likelihood of winning, but one out of 10 has twice as good odds to win, is that fair to the other 9? Now, imagine that the "winner" in the scenario is twice as likely to need more procedures/hospital visits/etc. while everybody pays the same amount. It seems unfair to the others who do take care of themselves to pay the same for unequal likelihood of staying in the hospital.

Sounds like a psychology class I took. Interesting.

 

[luli]

Yeah, we should probably start feeding people and giving them housing. Plus, I need a slave. These are my rights.

Are you are also opposed to free education, then? Just another social program.

The fact is, people with insurance already pay for healthcare for the uninsured. It would be a lot cheaper if uninsured people could go to a PCP rather than the ER if they sprain an ankle or get a UTI.

 

[FlowRate]

Are you are also opposed to free education, then? Just another social program.

The fact is, people with insurance already pay for healthcare for the uninsured. It would be a lot cheaper if uninsured people could go to a PCP rather than the ER if they sprain an ankle or get a UTI.

Yes, public education sucks. Especially the way we have it now where the public employees are unionized. Idiocy. There is no incentive to improve.

You can make the argument that compulsory education helps the country somehow. Then I realize just how little 50% of the people at my highschool learned.

 

[Soulstice]

I agree. I think most people do. Until people start asking questions like:

Do you know how hard it is to quit smoking?
Do you know how much cheaper eating fast food is vs cooking and eating healthy?
Do you know how many people do not have the time to work out very often, between their jobs and parenting?

And the biggest question, are you aware of the fact that overall, poor people drink more, smoke more, eat less healthy, get less exercise, etc? This is the biggest problem. The initial question I asked is easy to answer, but with this new piece of information, I feel like the question gets very complicated. I honestly don't know how I feel, and I'm conflicted over whether or not it's fair when I consider that these problems disproportionately affect the poor and uneducated.

Right. We often consider poor health management as a personal flaw. But when data shows that it's not so much negligence as it is socioeconomic factors that force "noncompliance" with practices like exercise and drug abstinence.. then is it fair to blame these people for their conditions?

 

[Soulstice]

What's the point of your argument? You can't blame people for making bad decisions and having poor self control? Why are we "blaming" people? An alcoholic with liver failure certainly had a role in his condition.

Is it unfortunate? Yes. Should they be treated? If they can pay.

Healthcare is a good. It requires capital of every sort.

I am willing to consider the idea that a just society/culture helps out people who truly can't pay, but I don't think its optimal execution is through force and bureaucracy.

I personally believe in charitable giving and volunteering of time and services, but I really don't like being made to do it.

I disagree. The alcoholic with the liver failure may have also had genetic inclinations towards addictive behaviors. He may have been influenced by social or cultural factors emphasizing drinking. It's difficult to say how much people are responsible for their own health, and it's also difficult to draw the line at which diseases/conditions are "patient's fault" and which ones are not. Hence, doctors can't do it.

 

[FlowRate]

Right. We often consider poor health management as a personal flaw. But when data shows that it's not so much negligence as it is socioeconomic factors that force "noncompliance" with practices like exercise and drug abstinence.. then is it fair to blame these people for their conditions?

correlation v. causation

being poor does not force you to use drugs. being poor means you might be more likely to find solace in a chemical escape.

I disagree. The alcoholic with the liver failure may have also had genetic inclinations towards addictive behaviors. He may have been influenced by social or cultural factors emphasizing drinking. It's difficult to say how much people are responsible for their own health, and it's also difficult to draw the line at which diseases/conditions are "patient's fault" and which ones are not. Hence, doctors can't do it.

Are you seriously making the claim that people aren't to blame for their actions because society and wealth have an influence on behavior?

Socioeconomic factors also play a role in the likelihood that you'll murder, steal, birth unplanned children, not feed your dog, etc.. Does that mean poor people should not be responsible for any of those actions?

No. People are responsible for their actions. There is a point where you are no longer "open-minded" and "considerate" and instead become naive and enabling.

 

[Soulstice]

But is it the role of a doctor to make those character judgments for their patients?

 

[theseeker4]

correlation v. causation

being poor does not force you to use drugs. being poor means you might be more likely to find solace in a chemical escape.

Are you seriously making the claim that people aren't to blame for their actions because society and wealth have an influence on behavior?

Socioeconomic factors also play a role in the likelihood that you'll murder, steal, birth unplanned children, not feed your dog, etc.. Does that mean poor people should not be responsible for any of those actions?

No. People are responsible for their actions. There is a point where you are no longer "open-minded" and "considerate" and instead become naive and enabling.

This. Sure, socioeconomic factors may increase the likelihood of a certain condition/behavior, but personal responsibility must be stressed or no one will ever think they need to change anything. Socioeconomic factors do not MAKE people commit crimes, just as they do not FORCE non-compliance. It is not politically correct, and I can toe the party line in interviews when necessary, but dancing around and contorting oneself to avoid at all costs the implication that anyone is responsible for their own actions is complete and utter BS.

 

[Soulstice]

I'm not saying the pt. has no responsibility.. only that:

A) it's unclear how much is systemic and how much is their own fault, and so doctors shouldn't be the ones filling in the gaps by making their own decisions on morality..

and B) medicine, being a science-heavy field, tends to neglect the systemic social factors of illness. Thus, it's important to keep those in check and remember to consider them in a HOLISTIC analysis of a disease's etiology.

I agree that taking all blame off the patient is also a bad thing, because then it removes the stigma/pressure from bad behaviors like addiction or obesity. But at the same time, taking note of the social determinants of illness/poor health is important.

 

[theseeker4]

But is it the role of a doctor to make those character judgments for their patients?

It is the role of a doctor to treat patients. It is not the doctor's job to determine who should pay how much for insurance, and likewise it is not the doctor's job to assign blame. However, it is negligent on the doctor's part to NOT encourage an individual patient to take responsibility for their health, not in a judgmental "this is what you need to do and it is your own fault that you are sick" fashion, but in a "this is what you need to do to be healthy; I can provide the support that I am able, but if you ignore my advice, I can't force you to take your medicine/exercise/quit smoking/etc." Assuming someone from a certain group is UNABLE to be compliant is the height of bigotry. Antebellum southerners defended slavery using almost the exact same language that is used by PC leftists in academia these days ("They can't take care of themselves, so we have to keep them slaves and be benevolent masters for their own good.")

 

[Soulstice]

It is the role of a doctor to treat patients. It is not the doctor's job to determine who should pay how much for insurance, and likewise it is not the doctor's job to assign blame. However, it is negligent on the doctor's part to NOT encourage an individual patient to take responsibility for their health, not in a judgmental "this is what you need to do and it is your own fault that you are sick" fashion, but in a "this is what you need to do to be healthy; I can provide the support that I am able, but if you ignore my advice, I can't force you to take your medicine/exercise/quit smoking/etc." Assuming someone from a certain group is UNABLE to be compliant is the height of bigotry. Antebellum southerners defended slavery using almost the exact same language that is used by PC leftists in academia these days ("They can't take care of themselves, so we have to keep them slaves and be benevolent masters for their own good.")

I'm not saying everything comes down to systemic factors.. it's important to discern when they're relevant and when they're not. Maybe someone isn't compliant because of social circumstances, or maybe there's other factors at work. It just makes it all the more important to get a good patient history and communicate effectively with the patient to see what the individual case is.. and then working accordingly to build a treatment plan for your patient. It is just as bad to excessively attribute a social explanatory model as the cause of issues like noncompliance as it is to underestimate it.

 

[theseeker4]

I'm not saying the pt. has no responsibility.. only that:

A) it's unclear how much is systemic and how much is their own fault, and so doctors shouldn't be the ones filling in the gaps by making their own decisions on morality..

and B) medicine, being a science-heavy field, tends to neglect the systemic social factors of illness. Thus, it's important to keep those in check and remember to consider them in a HOLISTIC analysis of a disease's etiology.

I agree that taking all blame off the patient is also a bad thing, because then it removes the stigma/pressure from bad behaviors like addiction or obesity. But at the same time, taking note of the social determinants of illness/poor health is important.

These are true as far as it goes. The question above was in response to "should someone who smokes (etc.) have to pay more for their insurance" and the answer to this should be yes. It is difficult to quit smoking, but there are many who have done so successfully. Therefore, it is not fair or just to make those who do make healthy choices pay for those who do not by raising their rates (which is the real result of not charging the smokers more). This does not mean that the smoker is not deserving of care, or that a doctor should blame and treat differently someone who is unhealthy in their choices, but there is a real cost to ones' health due to their choices. When it comes down to a choice between charging people who make unhealthy choices more, or charging those who make healthy choices more, hands down those who are causing greater harm (or risk if you prefer) to their health should pay more for their health care. What other factors may or may not influence the unhealthy patient's habits are immaterial in asking who should pay more for their insurance.

 

[theseeker4]

I'm not saying everything comes down to systemic factors.. it's important to discern when they're relevant and when they're not. Maybe someone isn't compliant because of social circumstances, or maybe there's other factors at work. It just makes it all the more important to get a good patient history and communicate effectively with the patient to see what the individual case is.. and then working accordingly to build a treatment plan for your patient. It is just as bad to excessively attribute a social explanatory model as the cause of issues like noncompliance as it is to underestimate it.

I agree with this. If a doctor finds a patient is non-compliant, they absolutely should do what they can to find out why, and what they can do to help them to become compliant. There are two different questions here. First, the question of society and different groups, which is the field of the social scientist, not the doctor.

The second is the question of an individual patient, which is the doctor's field. In this case, the patient should be treated as an individual, with the doctor doing what they can to find out why the patient is non-compliant. The doctor by necessity should have an understanding of the current social science understanding of socioeconomic conditions, etc. (after cutting out the PC dogma to get to the reality, of course) but it would be more harmful to approach a patient from the point of view of "oh, you are from ___ neighborhood, of course you aren't taking your insulin" than it would be to say "you aren't taking you insulin, so it is your own fault we are cutting your feet off today."

 

[AZFutureDoc]

When I was asked this question, my interviewer took his point that the poor are disproportionately affected by smoking, drinking, etc further. How do you respond to this new perspective/piece of information:

The reason that poor people are, on average, less healthy, is because they have not had as good of an education. If they go to school at all, it's probably a crappy one, that doesn't teach kids about positive lifestyle choices. And if they have jobs at all, they're crappy too.

So now, he makes the argument that the reason these people are in these bad situations in the first place, is that school and society have failed them. He claims that they foot the bill for their neighborhood having a bad school, and that they basically pay out of pocket for the state's failure to help these people live healthy lives. He claims that if kids and adults from bad neighborhoods had the same schools, same crime rates, same role models, etc, that these kids would be just as healthy as anyone else. So these people, who are already poor enough, are getting even poorer as an indirect result of poor educations.

What do? lol

 

[Web MD]

decouple public school funding from property taxes and couple it to something more arbitrary

 

[FlowRate]

When I was asked this question, my interviewer took his point that the poor are disproportionately affected by smoking, drinking, etc further. How do you respond to this new perspective/piece of information:

The reason that poor people are, on average, less healthy, is because they have not had as good of an education. If they go to school at all, it's probably a crappy one, that doesn't teach kids about positive lifestyle choices. And if they have jobs at all, they're crappy too.

So now, he makes the argument that the reason these people are in these bad situations in the first place, is that school and society have failed them. He claims that they foot the bill for their neighborhood having a bad school, and that they basically pay out of pocket for the state's failure to help these people live healthy lives. He claims that if kids and adults from bad neighborhoods had the same schools, same crime rates, same role models, etc, that these kids would be just as healthy as anyone else. So these people, who are already poor enough, are getting even poorer as an indirect result of poor educations.

What do? lol

There have actually been related studies done on this. The school doesn't matter as much as the people (parents and kids going to school)

 

[theseeker4]

When I was asked this question, my interviewer took his point that the poor are disproportionately affected by smoking, drinking, etc further. How do you respond to this new perspective/piece of information:

The reason that poor people are, on average, less healthy, is because they have not had as good of an education. If they go to school at all, it's probably a crappy one, that doesn't teach kids about positive lifestyle choices. And if they have jobs at all, they're crappy too.

So now, he makes the argument that the reason these people are in these bad situations in the first place, is that school and society have failed them. He claims that they foot the bill for their neighborhood having a bad school, and that they basically pay out of pocket for the state's failure to help these people live healthy lives. He claims that if kids and adults from bad neighborhoods had the same schools, same crime rates, same role models, etc, that these kids would be just as healthy as anyone else. So these people, who are already poor enough, are getting even poorer as an indirect result of poor educations.

What do? lol

That the education system needs revamping is hardly news to anyone who pays attention. The biggest problem, as someone else already stated, is the home situation present in many poor areas. I don't pretend to know how to solve that situation, but individuals taking personal responsibility for children they bear or father would be a nice start. There are plenty of non-broken homes with bad and/or essentially absent parents, so that is another problem. The debate as to how to improve entire neighborhoods and cities is somewhat beyond the scope of a doctor's practice.

If asked specifically how to improve education in poor areas, I would eliminate the public school system as it is currently run and have some type of voucher program that allows parents to pick whatever school they want their children to go to while making a school's eligibility for vouchers rely on some performance criteria. I would of course have to control for the children who have parents who simply do not care, never discipline their children, etc. to avoid punishing schools for the choices of their childrens' parents, but you get the idea.

 

[AZFutureDoc]

Felt like digging this thread up cuz we had some good discussions going. Plus I recently realized how unprepared I am for ethical questions in my interviews. With a few schools I applied to doing MMI's, I am extra-stressed. Gonna check out my school's library for books on the topic, and report my findings back to SDN!

 

[CodeBlu]

Bump. Ethical dilemmas are making me go crazy.

 

[theseeker4]

Bump. Ethical dilemmas are making me go crazy.

Is that itself an ethical dilemma with the medical school applications process? Direct harm on the applicants' mental health?

 

[CodeBlu]

Is that itself an ethical dilemma with the medical school applications process? Direct harm on the applicants' mental health?

You know what... SERIOUSLY! It might be.

The opacity/limbo that they put us through is ridiculous. I understand they have way more applications than spots, and they can afford to be all black ops about it. But I mean, if a school has a checklist of items they want to see, and that how they evaluate who gets an interview... tell us.

 

[CodeBlu]

You (arguably) don't need to exercise or flirt to survive.

Just digging this up... to say... Saggy...

no dice... I need to flirt to survive.

 

[TheChronic]

I hate to rain on the parade, but nearly all of these "ethical dilemmas" have well-defined and widely accepted answers, which are described by law. No sense in reinventing the wheel.

Law doesn't describe morality, it is merely a shadow, at best, of morality. There are several moral dilemmas beyond the typical euthanasia/abortion bullcrap.

IF a physician is to act in the benefit of his patients, he can still succumb to the free lunches provided by drug reps, and the various subjective bias that comes with it. This doesn't mean that Dr. X is doing something illegal by accepting this free lunch, but is he doing something immoral?

We can look at patent law, the Myriad case......

Should genes be patentable? BRCA1 in this case. They are technically patentable, but is it ethical to patent genes? Is it ethical to patent life itself? Harvard patented a mouse that readily formed tumors.

If one cannot remain objective when studies are sponsored by Pharma then is there an ethical obligation (although not a legal obligation) to not seek out the money provided by such for-profit research institutions?

Is it ethical for big Pharma not to publish studies that are not in it's best interests? It certainly is legal.

 

[zamzee]

In case none of you have seen this, this is a great page of nicely written medical ethics Qs plus questions: http://www.scu.edu/ethics/publications/submitted/cirone/medical-ethics.html