OH I ALSO WANTED TO RANT ABOUT A CLASS I HAD TODAY
Background: It's a once-a-week interprofessional education class and the past few weeks we've been learning about ethics by following an 8-step ethical analysis template with various cases. The first time we did this (case details are irrelevant) my group chose to refer the patient to a different provider and our facilitator suggested it wasn't the best option because we were "kicking the can down the road" so to speak, so since then we've tried to "take a stand." Also last week we got a new facilitator so now we have two.
So anyway, the case this week featured a 15-year-old boy with terminal brain cancer. He's had three surgeries so far, and each improved his condition, but the improvements were smaller and smaller each time, and each time the tumor regrew. Now the doctors are considering a fourth surgery which would only serve to prolong his life. He is "not thrilled." The parents are clearly distraught and the dad says "We'll do whatever it takes to make our little boy better."
So the options are:
A. Go with what the patient wants and do not perform the surgery.
B. Go with what the parents want and perform the surgery.
C. Consult the care team and let them decide.
So my group says "eff C, that's kicking the can down the road, and besides the care team shouldn't be allowed to unilaterally make a decision like this." We all agreed we wanted to respect the patient's wishes but state law does not allow a minor to give informed consent for medical decisions without a parent present (with some exceptions like birth control). So our plan involved a mediation session between the patient, his parents, and his care team to explain the options available, manage expectations, and hopefully come to a consensus of the best course of action for the patient. But ultimately, we decided we were going to let the parents have the final say. Option B.
Now first facilitator is super awesome. She critiques our ethics cases with stuff like "but have you considered XYZ?" and stuff like that. She's really constructive in her feedback. Second facilitator…I feel like that's what she's trying to do but she comes off kind of argumentative. When we said the law was the main basis for our decision she said something to the effect of "
well the law isn't everything."
Like I understand if you want us to discuss what we should do
ethically, like if the law wasn't an issue, but then
say that, otherwise we're going to assume we're talking about what we should do
realistically. Realistically, I do not want to lose my license for breaking the law, thank you very much. Then later she started talking about how hospital ethics committees sometimes make decisions that are in the best interest of the patients that are above the law and we were like "so you're telling us to break the law then" and she's like "well no" and we're like "that is literally what you just said." Anyway the gist of it is we got the impression that we chose the "wrong" answer and the "correct" answer was C, consult with the care team because then we're considering the values of all involved parties. Which like 1) kicking the can, but 2) we
are looping the care team in to our decisions and we are
not unilaterally deciding that the parents know best.
It's so irritating because this was the first case my group 100% agreed on, we felt our justification and counter-counter-arguments were solid, and we were taking a stand on a decision. We incorporated all the feedback we've received so far this semester. Plus we were under the impression that ethics doesn't really have a "right" answer so to be made to feel like we chose the "wrong" answer (even if they didn't outright say it) and be grilled about it for 4x as long as any other group is just really demoralizing. My entire group was frustrated to no end.
TL;DR My group worked up an ethics case and felt solid about our decision and reasoning but were made to feel like we chose the "wrong" answer.
