Sunday, June 5, 2022

Medical Ethics -vs- Medical Behavior

When a judge hears a case, neither party is 100% correct.  Each litigant may have a meritorious claim, but one of them will be found to have the better argument. If the dispute could be easily and amicably resolved, or one party was clearly wrong, then the matter would be unlikely to have reached a courtroom.  One litigant may be found to be 'more right' than the other

Which litigant's right will prevail?

Medical ethics has a similar construct.  Rarely, is an issue clearly and easily decided.  For example, with limited financial resources, tough decisions must be made on how to ethically allocate these funds.  Those who will not receive any funds may still have an ethical right to receive them, yet other groups may have a stronger right.  If our society decides that it will not pay for dialysis in moribund individuals, it does not mean that these individuals have no right to this treatment.

These complex decisions create winners and losers.  Those who are ruled against are likely to view the process as unfair.  Conversely, those whose wishes are granted will gush about the reasonable and just decision that served their interests.  Such is life.   In these matters, we need an advisory process with many voices to assure that medical ethical recommendations are made fairly and equitably, recognizing that these imperfect human beings are operating in a world where unfairness lurks.  Medical ethicists and their colleagues struggle to do right when every choice seems wrong.

Sometimes, the ethical issue is agonizing and painful.  Should a child with an aggressive cancer be approved by the insurance company for a promising, yet experimental treatment?  Do we feel differently if the patient is our kid? On other occasions, the ethical path is clear.  Should a physician write a prescription under the spouse’s name who has met her deductible to save the patient money? 

What is your judgment on the following hypothetical ethical scenarios?
  • A family demands and receives intensive care treatment for an ailing loved one.  The medical care team has advised hospice.  Leaving aside the futility aspect of the case, the insurance company is spending thousands of dollars each day.  Is this ethical?  Should the family be told that if this care is continued, that they will be financially responsible?
  • A physician routinely gives out drug samples to his patients.  These are left in the office by pharmaceutical representatives who want their products within easy reach of physicians.  Many patients who receive these free samples have drug coverage, but receive the samples anyway. Obviously, pharmaceutical companies must raise their drug prices in order to pay for these office giveaways.  Is this fair to the rest of us?
  • A nurse on an evening shift at the hospital is told that he will be responsible for 2 additional patients since they are understaffed.  The nurse feels that this workload is excessive, but has little recourse but to submit to the request.  No additional compensation will be provided.  Is this ethical to the nurse or to his patients?  
We often know what the right choice is, and yet we often choose differently.  Why do we stray when we know what is right?

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