This week the 3rd year medical students sit their first clinical year exam: Ethics and Law, and I was reminded of sitting the same exam a few years ago.
For many studying ethics and law seems a bit strange. The course involves studying ethical issues in medicine from a range of different viewpoints. This can be great at times, with lots of discussion and interaction, but can also be rather challenging as you begin to work through your own viewpoint and why you hold it. At the time I remember this seemed more challenging and exacerbating than anything else as I desperately tried to justify my viewpoint on a range of hot topics. However, not so long ago I realised the importance of considering medial ethics.
I was sat in a medical outpatient clinic like any other. The room was warm, I was feeling sleepy after lunch and every patient was scheduled for medication follow ups, so I settled myself in for a long clinic. However in the space of one clinic I faced almost every medical ethical scenario I could. I could not make this up, it was like sitting a practical ethics exam!
First came in ethical patient number one. He had recently been diagnosed with a common but infectious disease. He had started treatment and was sticking to it well so was very unlikely to infect those around him. However his boss had decided he would be infectious to other colleagues, so had fired him.
This was clearly inappropriate and unfair, but as doctors what was our role? Should this be a case to peruse forwards? Are as medical professionals we also responsible for a patients well-being and mental health? Or is this a poor use of resources? Is it fair to delay the clinic and take away time from other patients who have medical problems?
Then a little later in came ethical patient number two. This was a lady who had recently been started on a treatment, but during the last clinic a monitoring urine dipstick had discovered she was pregnant. The medications she was taking were safe in pregnancy and she was in a safe stable home with another child already. However she decided that she wanted to have an abortion, as she only wanted to have one child.
The patient had already been counselled, and as the doctor explained that the pregnancy was healthy and that the family seemed stable for a new addition, this raised questions: Is this a valid reason for abortion? When does a fetus become viable? What is a valid reason and time for abortion? Why are so many babies and children unwanted?
A little later in came ethical patient number three. This patient had seen the doctor a number of times before and was about to be discharged from hospital care. He had bought a gift to show his appreciation to the doctor and also another gift for the nurse who helped him.
This was a very kind gesture, but is it appropriate to accept gifts from patients? Is there a limit to how much I would feel comfortable accepting? Can some gifts be too big? Would receiving a gift change how I approached and treated the patient in the future?
By now we were nearing the end of the clinic and my mind was beginning to spin with all the issues. Then came in ethical patient number four. This patient was a little different as he did not speak English and was with two security guards, one of which he was handcuffed to. It turned out he came from the local detention centre and from his open wounds it seemed that he had escaped a horrific life of torture.
As we examined him, his guards present at all times, I questioned common public opinions on migration: what has this man done to deserve this? Why do we keep him locked away? Is this all his fault? Has he not suffered enough? As a doctor I should treat everyone equally, how do I manage that here? How do I protect patient privacy when we can’t see our patient alone?
Head spinning I left the clinic for a long night of pondering ethics.