What Would You Do?

Hippocrates, the “Father of Western Medicine”, who established professionalism and ethics in medicine in his famous oath.

The medical field is filled with difficult scenarios, and to someone who is encountering them for the first time, it may be difficult knowing what the best thing to do is. That is why we all take Medical Ethics to prepare ourselves for the real world in which any of these scenarios could take place (and many of these scenarios already have taken place). Here at AUC, we have an amazing medical ethics professor, Dr. Sue Edwards. She encourages discussion in class and makes us really think and evaluate our ideas and values. Ultimately almost every ethical decision we make in our future careers will be based on four universal principles in medicine: Beneficience, Autonomy, Non-maleficience, and Justice. I really enjoyed this class.

What would you do if…

…you prescribe a patient a strict treatment regimen and you find out he hasn’t been following it?
Answer: Find out why the patient isn’t complying. Is it because of misunderstandings? Is it because it is difficult to follow? Is it because he or she is not used to it? Whatever it is, see if your patients understand everything and know all their options, including what will happen if they don’t follow the treatment. Monitor how willing they are to follow the orders throughout the consultation. Don’t ever force them to comply or refer them to another doctor. If your directions are too difficult to follow, give the patient written instructions or simply the treatment regimen.

…a patient’s family is worried and wants to know about the patient’s condition or prognosis?
Answer: Don’t discuss any information about the patient to others, including family members, without the patient’s permission

…a child wants to know more about his medical condition?
Answer: Ask the child how much his parents have told him, and encourage the parents to have good communication with their child. Only the parents should tell decide what their child should know.

…a 15-year old girl is pregnant and wants an abortion?
Answer: According to the decisions of Roe vs. Wade, a woman has a right to PRIVACY in deciding whether or not to have an abortion. However, since your patient is a minor, in many states the law requires that the parent’s should be notified and give consent for an abortion. Since this is a very touchy subject, always follow the laws of your state. Don’t specifically encourage or advise her to get an abortion, unless she is at great medical risk if she doesn’t.

…a 15 year old pregnant girl wants to keep the child but her parents want her to put up the baby for adoption?
Answer: Even if the girl is a minor, she has the right to decide what to do with her child, even if her parents disagree. Of course, always encourage communication and support your patient in learning how to care for a child.

…a terminally-ill patient who is suffering wants your help in ending his life?
Answer: Don’t get involved in physician-assisted suicide. In most places, it is illegal to actively cause someone to die. Instead, do whatever you can to reduce the patient’s suffering, like giving pain medication. This includes giving pain medication that secondarily happens to shorten the patient’s life a bit. If the patient is deemed to have decision-making capacity, then it is OK to passively allow him or her to die.

…you suspect a patient is suicidal?
Answer: Ask clearly and directly, “Are you thinking about killing yourself?” Suggest that the patient remain in the hospital. Anytime a person is suicidal, he is not considered to have capacity to make rational decisions. Therefore if he refuses to seek help at the hospital, he can be involuntarily hospitalized.

…a patient flirts with you or finds you attractive?
Answer: First, don’t ever flirt back. Make it clear that the clinic or hospital is a professional setting and you and the patient maintain a professional relationship. Don’t say ” there can be no relationship while you are a patient” as this could encourage the patient to stop being your patient and lead him or her to think that a relationship is still possible. Don’t date your pediatric patient’s parents. Don’t date your geriatric patient’s children.

…a patient is angry for waiting over an hour to see the doctor in the clinic?
Answer: First and foremost, name and acknowledge the patient’s emotions! Don’t ever yell back at the patient or take whatever he or she says personally. Simply apologize for the inconvenience and don’t try to explain why he or she had to take so long.

…a patient reveals to you that they want to kill or hurt someone?
Answer: According to the Tarasoff II decision, you as a doctor have the duty to warn AND protect any possible victims that are in danger of your patients. So this means calling the police is not enough. You must first detain your patient to make sure they don’t go out and kill anyone. Then, you should call the police, then lastly, warn the potential victims.

…a patient is venting to you about how another doctor was mistreating him or her?
Answer: Tell the patient to talk to the other doctor directly about his or her concerns.

…a child’s parents refuse to treat their child of a life-threatening or limb-threatening condition or injury because their religion or beliefs forbid them to?
Answer: Go ahead and treat the child as you are doing what’s best for the child. Not to mention, it is the legal thing to do. Parent’s c annot make any decision or refuse any treatments that would put their child in serious risk where the child could lose his or her life or limb.

…if an adult patient with stable mental capacity refuses treatment of a life-threatening injury or condition because of their long-held religious beliefs?
Answer: You must respect the autonomy of any patient who has decision-making capacity, even if you don’t agree with their decisions. In this case, the patient’s decision is consistent with his or her values, goals, and beliefs that the patient has held stable over time.

…a patient complains to you about the front desk clerk in your clinic?
Answer: Tell the patient that you will talk to the clerk directly.

…a drug company is doing a study and offers to pay you for every patient you refer to them?
Answer: Don’t ever accept money that way. If a patient can benefit from the study and is willing to do the study, you can enroll them, but don’t ever accept any money or gift the drug company gives.

…you receive a gift from a patient?
Answer: Thank the patient but tell them you cannot accept it as it is your office policy not to accept gifts from patients.

…your patient invites you to a house-warming party next weekend?
Answer: Thank them for the invitation but make it clear that you both should maintain a professional relationship and courteously turn down the invitation.