Medical Ethics: What You Should Know
Today we continue “DRops of Wisdom,” our physician blog, with Dr. Stewart Stein, the associate vice president of medical services for Chapters Health System, who shines a light on medical ethics.
What is Medical Ethics?
One day while walking along a street in Seattle, you discover Bill Gates’ wallet lying on the ground containing $5,000. Would you send it back to him? Or perhaps, it is midnight and has been a long and stressful day at work. As you approach the traffic light a block away from home, it is quiet and there are no other cars at the intersection. Would you drive through the red light?
At some point in our lives, many of us have been faced with an ethical dilemma. Working in healthcare, we are not immune to being faced with decisions. Medical ethics involves the incorporation of a moral code into medical practice. Some may be tempted to simply interpret medical ethics as the practice of treating others the way we would wish to be treated ourselves. However, variations in individual circumstances, values and laws require a more thoughtful approach.
It is generally agreed that there are four key principles in which medical ethics is founded:
- Respecting a patient’s wishes
- Following the basic premise to do no harm
- Contributing in some way to the patient’s welfare
- Providing healthcare with fairness and equality
Posing an Ethical Dilemma
When challenging situations are presented to medical professionals, most will consider these principles automatically. When these principles align, decision making is straight forward. When these principles are in conflict, the healthcare team is challenged.
Here is an example of a medical ethics dilemma:
An 84-year-old man with severe heart disease has an implanted defibrillator device. It has been firing occasionally as his disease has progressed. He experiences considerable pain when this occurs and had asked the medical team to deactivate the device and allow him to die. Dismayed by his decision, his family persuades him to keep the defibrillator operational. As his condition continues to deteriorate, he becomes minimally responsive and the device begins firing several times a day. The device is clearly causing pain and is not improving his quality of life according to his physicians. From the perspective of respecting a patient’s wishes, it would be appropriate to leave the device in an active state. From the perspective of doing no harm and contributing to the patient’s welfare, the correct decision would be to deactivate the device and allow nature to take its course. How should the team proceed?
At Chapters Health, we have a specific committee in place to discuss at length these types of situations. The Staff Ethics Committee (SEC) is comprised of representatives from all hospice affiliates — Good Shepherd Hospice, HPH Hospice and LifePath Hospice and Chapters Health Palliative Care — and includes nurses, physicians, social workers and chaplains. The make-up of the SEC lends itself to considering each case from multiple perspectives and working with the patient care team to provide guidance and alternatives. When the ethical path is not clear, the SEC is there to help.
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At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to email@example.com.
About Stewart W. Stein, MD
Vice President of Medical Services, Chapters Health System
As the vice president of medical services at Chapters Health System, Stewart W. Stein, MD, bring more than two decades of experience as a physician. His extensive background in end-of-life care and a commitment to the delivery of exceptional hospice services are of great benefit to the patients and families. Dr. Stein joined the organization in January 2011.
He previously served as chief medical officer and medical director at Nathan Adelson Hospice in Las Vegas, Nevada. Dr. Stein also provided geriatric, rehabilitative and hospice care for patients in home settings and skilled-nursing facilities as a staff physician with the Kaiser Permanente Department of Continuing Care in San Diego, California.
Dr. Stein is a Florida native who was born in Jacksonville and attended the University of Florida, where he earned his Bachelor of Science and medical degrees. He completed his medical internship and residency programs at the University of California at San Diego’s University Hospital.
Famous Medical Ethics Cases
Medical ethics is not something new. Some cases have made headlines and some may not be as familiar. The following are some medical ethics cases that prompt open discussion and offer food for thought.
Tuskegee Syphilis Study
For 40 years, from 1932 to 1972, the U.S. Public Health Service in Alabama studied untreated syphilis in poor African-American men by withholding treatment. Unsuspecting men believed they were receiving free government healthcare when, in reality, they were being infected with syphilis and not being treated. The Tuskegee Syphilis Study stopped only when evidence of the experiments was leaked to the press. Soon after, federal laws were created to prevent history from repeating itself and the Office for Human Research Protections was established.
Bouvia v. Superior Court
Suffering from cerebral palsy and severe arthritis, Elizabeth Bouvia was totally dependent on others for all activities of daily living. In 1983, she admitted herself to Riverside General Hospital in California with the desired wish to starve herself to death. As a result, the hospital inserted a feeding tube against Elizabeth’s wishes, which prompted a legal battle. Ultimately, the courts decided that if a patient was of sound mind, hospitals and other healthcare organizations needed to respect a patient’s wishes.
A number of years ago, British-born Charlie Gard became an internationally known little boy due to the debate over who has the freedom to change his life support.
Great Ormond Street Hospital in London requested the permission from the British High Court to remove the 11-month-old from life support based on the premise that he shouldn’t suffer any more from his fatal mitochondrial DNA depletion syndrome. His parents wanted Charlie on life support in order to try an experimental treatment, nucleoside bypass therapy, which would also require the family to travel to the United States. Both the British High Court and the European Union Court sided with the hospital, and a day after Charlie was taken off of life support, he died.