Should you voice your opinion if its different from law?

[Guest Koggetsu]

I'm wondering on ethical issues, if your opinion is different from what is required in canadian law, then should you say that when u are asked such a scenario? or is it safer to stick with the law?

 

eg. On a question regarding a underage pregnant girl wants to have a pill for abortion and does not want to tell her parents. In Canada, the doctor does can just prescribe it to her without parent's consent or whatever. But actually in terms of personal opinion, I would have to disagree with that and I think that her parents should know about it.

 

what do u people think?

[Guest TimmyMax]

Hey,

 

As physicians, we are and will continue to be bound by the Canadian law. I don't think that it would be in your best interest as an interviewee to endorse breaking the law in your practice.

As a practical example, Canadian law requires that a physician or therapist report instances of child abuse to the authorities, regardless of patient confidentiality. Now if you had a patient who was a child that came to you to tell you that his/her parents were abusing him/her but didn't want you to tell anybody, you would be legally bound to breach confidentiality and inform the authorities. If the above scenario was posed to you and the question was what you do in such a situation, it would be illegal for you as a physician to not report this to the proper authorities. If I was interviewing a candidate for medical school and they replied that they would not inform anyone given the above scenario, then I would be forced to eliminate that person from the eligible applicant pool. Knowledge of the law is essential as a practicing physician and going against the law is generally unadvisable as the consequences can be such that your license to practice in Canada can be revoked completely.

Remember that you are being interviewed by a panel that is attempting to discover if you are suitable for medicine or not at a given institution. While as a candidate you are not expected to know the law inside and out, some knowledge on general topics such as child abuse is highly advisable as it demonstrates that you have given some serious thought towards your chosen profession. I can't really think of a situation where going against the law would be advisable, in either a clinical or an interview setting. The law is just that, the law, and to go against it would be to do something illegal, which is not why we become physicians in the first place. The law is there to protect, and even though it can be convoluted, at the end of the day, it serves a definite purpose that should not be compromised.

In terms of the scenario you provided, there is much discussion that can be generated, but it is generally not a legal issue. In such ethical dilemmas, the choice will ultimately be yours to make- just make sure that you can back up your stand with a sound argument.

Hope this helps!

 

Best of luck!

Timmy

[Guest Kirsteen]

Hi Timmy,

 

I like your response on this topic, but to add an associated and timely point is the article that appeared recently in the Globe and Mail (and was mentioned on CBC this morning) arguing whether or not Henry Morgentaler should be nominated for, or receive, the Order of Canada. Now there's a Canadian physician who did seem to give some serious thought to his professional endeavours and still decided that bucking the Canadian legal system was the most fitting thing to do.

 

Fodder for thought, only.

 

Cheers,

Kirsteen

[Guest aneliz]

Going with the scenario with the teenaged girl...I agree with Timmy that your answer would NOT be looked upon favourably by an interviewing committee....patient confidentiality is a fairly major issue and to take your own views on this would probably be viewed as either a) ignorance of a very prominent and not-hard-to-know-something-about medical issue or outright and deliberate rejection of societal expectations of physician behaviour. Both are not beneficial to your application! Getting an interviewer to rank any answer as 'unacceptable' is a sure ticket to the bottom of the waiting list if not to the rejection pile.

 

Agreeing with the law is *usually* safe...it shows some awareness of the world and the conditions that you will be working under as a physician. Knowing the legal obligations of the physician are especially important in areas like child protection, patient confidentiality, informed consent, competence, etc. All are areas that you will need to have a working knowledge of to guide your practice in the future. Demonstrating your ignorance of these subjects or suggesting that you intend to 'rock the boat' by defying them won't win you any points. However, there are some areas that, though there are laws in place, are a bit more *controversial* and you could probably support either side (as long as you had reasons). Some of these areas include abortion, euthanasia, stem-cell research, etc. If you are asked your opinion on one of these areas and your only response is to quote the law...well, that probably won't go over too well either. (Demonstrates a lack of original thought and an inability to form and defend your own opinion!) Best advice: when you are asked a question, consider the implications of the answer that you provide -social, legal, economic, effect on an individual patient, effect on society as a whole, etc. Don't feel pressured to start talking the instant that the question is asked - its okay to take a few seconds to think about and compose a logical and coherent answer. Ultimately, taking those few seconds to think will be better then trying to climb back out of a deep, dark hole that you fell into when the interviewers start challenging your answer.

 

Good luck!

[Guest bcdentalgirl]

I'd like to recommend an awesome book for anyone looking to bone up on ethical analysis. It's called "How Good People Make Tough Choices" by Rushworth Kidder.

Check it out!

[Guest Sil]

I know that at least in Ontario individuals can decide on their health care as long as they are deemed to be mentally fit. For example this girl is 15 and wants an abortion is she in possession of all of her mental capacities? If she is, ethically and legally you are bound to protect her confidentiality. However she is 15, I would probe a little more why is she pregnant? Is it "accidental", is there some case of abuse (either by parents or boyfriend)? Would you have to report to authorities (as TimmyMax suggested)?

 

At the end of the day, how come you would choose to tell her parents? Is it to ensure that she is not "hanging out with the wrong crowd? Is it because you personally don't believe that abortion is right? (In which case, legally you have to refer or give this patient the option of finding another physician or risk losing your license and fase a professional review). And if you did tell her parents what are the likely consequences? Are her parents understanding and help her out? Are her parents very religious and launch a legal challenge to prevent her from getting an abortion? Are her parents very upset and throw her out to become one of our many homeless? Is she likely to commit suicide if her parents find out? Is her mental health going to improve or not improve if you tell her parents? Are you acting in the best interest of your patient?

[Guest aneliz]

All very relevant points...and exactly what will be launched at you if you gave your answer in an interview....

 

Use Sil's post as an example of what will happen in any interview after you have provided any answer....it will happen exactly like this!!! The interviewers will then ask you to clarify your position, define any ambiguities and/or challenge you on the implications of that answer....make sure that you have considered these before you answer! It is what separates the good candidates from the weaker candidates...

 

....my two cents.

[Guest Koggetsu]

Based on these replies, it would seem that its safer to stick to simpler and more "normal" answers?

[Guest Koggetsu]

Yeah, actually I understand about the issues of confidentiality and the legal issues and if i was asked this question, I think that I would still give her the drugs after I try to find out by talking to her if there are other problems associated with this.

 

However just to get an idea: what would happen if I answered something like this?

 

"Well I think first of all that at such a young age, a decision like this is very hard to make alone and in a frame of mind that the patient would be in after finding out that she is pregnant. So even though the law may say that it is ok, being a teenager, it would seem likely that it is hard to make the best decision by themselves. So I would think that it is better for her to talk to someone with more experience and mature regarding this decision. Also, in some cases, there maybe other problems associated with this which she may also need support or help with. Of course, I would not force her to talk with her parents, but I would strong advise her to talk to someone else and perhaps have both of them come see me before making the decision."

 

Would this be an acceptable answer, or would they attack me somehow for this answer? Or anything else I can add to make it better?

 

Also, can I refuse to give her the drugs and refer her to someone else? or would I get kicked out for that?

 

I'm just trying to get a feel of how deep they want my answer to be and how deep they ant to go to attack my position! THANKX

[Guest Sil]

As a doctor you do not have to provide patients with treatments that go against your moral convictions. If you can't do it, refer. There are many people in my class who are very religious and who do not believe in abortions, etc. Interviews will challenge what you say, I think they just want to see how you react, if you can stand your ground, why do you think the way you do, what is the reasoning behind your answers. Mostly they are not so interested in what you will answer but why do you answered that way. Hope that makes sense

Darn exam on Friday, procrastination...

[Guest MayFlower1]

I thought I would share this link I found...it's a great link for ethics stuff...enjoy...

 

 

www.cmaj.ca/misc/bioethics_e.shtml

 

Peter

[Guest BCgirl]

Here's another ethics link

 

eduserv.hscer.washington.edu/bioethics/

[Guest aneliz]

True...maybe she should talk to somebody else that is more mature and could offer her more options and some guidance...hmmm....could this maybe be you? Her physician? Or maybe a nurse in your practice, or a counsellor at planned parenthood or whatever....I agree that she probably should receive some guidance in making her decisions because she is young BUT this in no way has to come from her parents or any other relative if she isn't comfortable with that for whatever reason...it is not your position to judge her or go against her wishes (especially if it also is against the law). You can encourage her to talk to her parents and point out the potential benefits to them...you could offer to be with her when she tells them or you could offer to do it for her...if that is what she wants....but going against her wishes is not okay...no matter what your personal feelings about the issue are. If you didn't feel that you can deal with her...you are obligated to refer her to somebody else.

 

So, my conclusion is that I still don't like your answer and it would likely be challenged by any interviewers....

[Guest Koggetsu]

ok thanx for the reponses and links, I think i have a better idea of how these questions are going to go now.

thanx for the help!