somber Posted July 29, 2007 Report Share Posted July 29, 2007 OK, so I've been thinking lately about dilemas doctors must face, and I came up with an example. I've been trying to come up with a solution, but failed. What would you guys do? A criminal, who was sentenced to life imprisonment for murder, broke out from jail. He stole a car and was being chased by police. It was a rainy day, and the road was very slippery. Yet, he was driving in 200km/hr. He was not afraid of hitting people. Just around the corner, a family was driving back home from the mall. It was their 7 year old daughter's birthday. They were, with no doubt, a happy family. Both cars were reaching intersection. The traffic light turned red. One slowed down, while the other speeded up. The insane driver, without seeing the car of happy family, turned the wheel. Right before two cars collided, father, the driver, saw the smiling face of the opponent driver. The cars then crashed. Parents were instantly killed while their daughter survived. However, she was suffering from liver rupture and huge loss of blood, and immediate care was required. The criminal was badly injured also - he had heart rupture and huge loss of blood. Both, with no doubt, were in a extremely dangerous condition. Urgent care was crucial. Both were sent to emergency room of nearby hospital. The ambulence which delivered the criminal reached the place first. He was immediately sent to ER. 5 minutes later, the other ambulence delivered the child. Both needed immediate surgery. They both had blood type A. The hospital, however, did not have enough type A blood for transfusion. Only one life can be saved. One of doctors was disgusted with this criminal for causing all these and argued that the child should be helped first. He also argued that child has physically weaker body. However, the other doctor argued that criminal should be helped first, since he arrived earlier. He also argued that doctors have no right to discriminate one patient from the other - doctors should only heal people. No matter what, both patients are in extremely dangerous condition and immediate care was crucial. Can people come up with the solution for above situation I came up with? Link to comment Share on other sites More sharing options...
Vitum Medicinus Posted July 29, 2007 Report Share Posted July 29, 2007 Here's a hint for your dilemma: look up what organ recepient criteria are. You'll soon realize that in the medical world, there are a lot of factors that come into play when it comes to allocation of limited resources; solving an ethical dilemma doesn't always come down to first-come, first-served. In some cases, in fact, the 'weaker' patient might not get preference, either. By the way, did you really come up with this, or are you getting us to do your homework for ya? hehe Link to comment Share on other sites More sharing options...
somber Posted July 30, 2007 Author Report Share Posted July 30, 2007 lol I really did come up with this. Now that I'm starting with med school this upcoming September (McGill, Class of 2011!!), I thought I should think over what becoming a doctor really requires. It took me like 2 hours to come up with the story line lol (not really a "writer's type") Link to comment Share on other sites More sharing options...
Satsuma Posted July 30, 2007 Report Share Posted July 30, 2007 You could give type O....but interesting scenario Link to comment Share on other sites More sharing options...
Fred Posted July 30, 2007 Report Share Posted July 30, 2007 While the story posted seems like a nice subject for an ethical debate, I don't think it really reflects ethical dilemmas doctors are likely to face. I think the parameters given are too farfetched (i.e movie like) to be the basis of a frank reflection on dilemmas you will encounter. I also suspect this is an assignment of some sort, no matter how unlikely the situation you present. I agree with the hint Vitum Medicinus gave you that it's not first come first serve in the ER nor when it comes to transplant. Something in the condition of one of the patient is going to tip the scale towards him receiving the blood. Also bear in mind that transfusion is not the ultimate "life saver" in case of trauma, there are other ways to treat/prevent hypovolemic shock. So it's absurd to think you're gonna be face with a situation like this where there is one sole thing that will save either one of two patients. I'll also say this: As a doctor you are not entitled to say who gets treatments based on aspect other than medical status. I'll let you figure out why. If you really are pondering medical ethics, try thinking about these situation you are likely to encounter : -ICU is full, surgeries that will require a bed in said ICU are to be performed today. What do you do: reschedule surgeries, take a chance and discharge an ICU patient. (happens daily in many montreal hospitals...) -patient is morbidly obese, smokes, eats so bad your own cholesterol goes up when you talk to him. Has COPD, diabetes and just recoverd form is third MI. The guy won't change is habits. What can you do, should you be allowed to do more than suggest? Can you refuse to give him pills unless he stops smoking and eats better. Consider the impact on the system. (this bring up the responsability of ones health) -Parents want to try alternative medicine to treat their kid's cancer and refuse your proposed treatment. (this brings the 'right of choice") Two more general question: -Regarding consent, competency of the patient is often questionned when they refuse treatment. Shouldn't we question it the same when they agree to the treatment? -is health a right? In my opinion, those are the questions you need to look at. If you want to be truly honest in your thinking then stay away from those romanticised story where with one decision you decide who lives and who dies... Link to comment Share on other sites More sharing options...
D-Rock Posted July 30, 2007 Report Share Posted July 30, 2007 Something I've been wondering about lately is the following scenario: You have Mr. X, a 52 year old male, who loves his Triple Whopper for lunch every day. Well, somedays he just has a venti frappaccino instead. He's showing signs and symptoms of heart disease and is out of shape. But, he's pretty satisfied with his life--he has an elevator in his apartment, works a desk job, and loves to fish (probably because of the beer-drinking weekends, though), so the symptoms don't bother him much. You talk to him, he doesn't really care if he dies at 60 (maybe he doesn't have kids and has no desire to see grandkids, or his wife passed away, or whatever reason you can think of to not want to live longer). Heck, his dad did, too. Maybe he'll make changes if you recommend them, but probably not because it removes his enjoyment of life connected to the fatty foods and sedentary lifestyle. Can you as a doctor say, "Your happiness and enjoyment of life is more important than the medical condition. You've come to terms with what it means, and accept the consequences. On you go, enjoy your life, let me know if you change your mind or feel any worse."? In effect, you're supporting his poor lifestyle and ill health in preference for his satisfaction of life. Is that acceptable? (I've left lots of details out--i.e. does he have high TG/chol/BP/etc.--purposely so that it's not a precise scenario. I think vagueness helps to form more options/opinions" Link to comment Share on other sites More sharing options...
bayervillager Posted July 30, 2007 Report Share Posted July 30, 2007 I really don't think that somber is being dishonest and using the forum to do his assignments. It's July 30th now. At least with the schools that I'm familiar with (Queen's, Carleton), summer courses have already ended, exams are done and essays have been handed in. Anyways, I don't even think there are too many medical ethics courses that run during the summer anyways Perhaps as someone who is going to medical school in one month, somber is just curious, eh? Link to comment Share on other sites More sharing options...
JewelLeigh Posted July 30, 2007 Report Share Posted July 30, 2007 Something I've been wondering about lately is the following scenario: You have Mr. X, a 52 year old male, who loves his Triple Whopper for lunch every day. Well, somedays he just has a venti frappaccino instead. He's showing signs and symptoms of heart disease and is out of shape. But, he's pretty satisfied with his life--he has an elevator in his apartment, works a desk job, and loves to fish (probably because of the beer-drinking weekends, though), so the symptoms don't bother him much. You talk to him, he doesn't really care if he dies at 60 (maybe he doesn't have kids and has no desire to see grandkids, or his wife passed away, or whatever reason you can think of to not want to live longer). Heck, his dad did, too. Maybe he'll make changes if you recommend them, but probably not because it removes his enjoyment of life connected to the fatty foods and sedentary lifestyle. Can you as a doctor say, "Your happiness and enjoyment of life is more important than the medical condition. You've come to terms with what it means, and accept the consequences. On you go, enjoy your life, let me know if you change your mind or feel any worse."? In effect, you're supporting his poor lifestyle and ill health in preference for his satisfaction of life. Is that acceptable? (I've left lots of details out--i.e. does he have high TG/chol/BP/etc.--purposely so that it's not a precise scenario. I think vagueness helps to form more options/opinions" This does not seem very realistic to me. The example implies that the doctor has the final say when it comes to any treatments the patient will or will not receive. This is very far from the truth. As a physician, it is our job to inform the patient of the options, and the risks/benefits of these options. The PATIENT then chooses what path to pursue based on this information. Whether or not we agree with the decision is irrelevant. In this example, it would be the PATIENT saying "MY happiness and enjoyment of life is more important than the medical condition TO ME. I'VE come to terms with what it means, and accept the consequences." Supporting the patient's informed decision is an absolute necessity for any physician imo. However, supporting the patient's decision and supporting ill health/poor lifestyle are two very different things. Would a physician ever actually say "Yes, I support a lifestyle that is unhealthy"? Obviously not. But would a physician say "I support your decision to do (insert decision here) based on your own values and knowledge of the consequences"? I would think yes. This kind of thing happens everyday - for example when smokers are encouraged to quit but do not wish to. Doctors don't say "No! You MUST quit. I am giving you this prescription for Zyban and you MUST fill it." Nor do they say "Yeah, you're right - your enjoyment of smoking is more important than your health...go ahead, why not bump it up to two packs a day while you're at it!" They probably say something like "Alright, I understand that it isn't something you want to consider right now. That is your choice for which I have respect. As your doctor, my job is to tell you the consequences for your health if you don't quit, which are blah and blah. I am happy to help you should you decide to quit to quit in the future." Link to comment Share on other sites More sharing options...
Alastriss Posted July 31, 2007 Report Share Posted July 31, 2007 I agree with Jewelleigh on that one, cept what I would do differently is probably stress health risks and strongly urge considering a lifestyle change. I would go in with a strong bias but the decision is always theirs in the end. On the flipside, paternal intervention is not an absurd idea and it is exercised by the government because it is necessary. I really want to see what you guys think about the one example fred mentioned: -Parents want to try alternative medicine to treat their kid's cancer and refuse your proposed treatment. (this brings the 'right of choice") oh and the one concerning the morbidly obese patient recovering from this third MI Link to comment Share on other sites More sharing options...
NLengr Posted July 31, 2007 Report Share Posted July 31, 2007 I really want to see what you guys think about the one example fred mentioned:-Parents want to try alternative medicine to treat their kid's cancer and refuse your proposed treatment. (this brings the 'right of choice") Related story: http://www.cbc.ca/health/story/2007/07/25/ot-chemo-070725.html Link to comment Share on other sites More sharing options...
somber Posted July 31, 2007 Author Report Share Posted July 31, 2007 I really don't think that somber is being dishonest and using the forum to do his assignments. It's July 30th now. At least with the schools that I'm familiar with (Queen's, Carleton), summer courses have already ended, exams are done and essays have been handed in. Anyways, I don't even think there are too many medical ethics courses that run during the summer anyways Perhaps as someone who is going to medical school in one month, somber is just curious, eh? Exactly. lol I dun understand why a person thinks that I'm using this forum to do my assisgnment. I have never taken a philosophy course (e.g.: bioethics) in my life cuz of its massive essay requirements (I'm not a good writer ). Thus, I am just not very familiar with bioethics and medical laws (which I will learn later on) I was just curious, as bayervillager said, about situations doctors must confront during the medical career. Well, I guess my story about a criminal and a child wasn't very realistic (e.g.: no set priorities to patients who came in first). But doesn't this prove that I'm not taking any bioethics course? I mean, no professor would give out unrealistic topics for students to discuss.... Link to comment Share on other sites More sharing options...
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