While I may consider myself to be an ethical practitioner, I
am in imperfect member of the genus, Homo, practicing medicine in an imperfect
world. I don’t commit Medicare fraud or
lie to my patients. When I commit an
error, I admit it. I often counsel patients
against proceeding with endoscopic studies, because I don’t feel they are
medically necessary. I do my best to
keep my patients’ interests as my paramount concern.
But the world of medicine doesn’t always have bright lines
and borders to keep us confined to an ethical zone. Physicians and ethicists argue over
where to draw these boundaries. What was
regarded to be unethical 10 years ago has become standard medical operating
procedure in many instances. Consider
how the field of reproductive medicine has evolved. The definition of death has been relaxed in
order to increase the human organ donor pool. We will surely see human cloning
in our lifetime. Medical ethics is not easy to define.
Community physicians like me must tread into the ethical
gray area at times. Do these indiscretions
contaminate our personal integrity?
Could Noah Webster Precisely Define Medical Ethics?
Imagine you are the physician in the following common scenarios. How would
you respond?
A 30-year-old comes to the office with nausea. He insists that an upper endoscopy be
performed so that he can be reassured that no serious issue is present. I advise that the test result will likely be
normal. I offer a less invasive and safer x-ray
examination, but he wants the Cadillac scope exam.
Do you acquiesce and arrange the requested scope test?
A 60-year-old comes to see me because she seeks antibiotics. She has a cold and
antibiotics are not medically indicated.
She rejects my explanation and is unconcerned about the risks of
antibiotics. She points out that her
previous doctor, who recently retired, always gave her antibiotics a few times each year for the
exact same symptoms, which she believed was responsible for her rapid
recoveries. Do you cave?
You are a gastroenterologist who is asked to place a feeding
tube in a failing and demented nursing home patient. The primary physician has already recommended
the tube to the family who have been told that we cannot ‘just let her
starve’. The family accepts this
physician’s advice. The
gastroenterologist is highly skeptical that the individual will derive any
medical benefit or comfort from the procedure, but he has been called in simply
for his technical expertise, not to offer an opinion. Do you keep mum and place the tube as ordered?
While the principles of medical ethics are firm, the landscape can be murky and it can be challenging to find the light among the shadows.
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