Sunday, January 16, 2022

Gray Areas in Medical Ethics

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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