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11/19/2015

Is There An Ethics Consultant In The House? Striving For Verisimilitude In Chicago Med

by Kayhan Parsi, JD, PhD and Nanette Elster, JD, MPH

The new NBC medical drama Chicago Med premiered this week. A spin off of other established NBC dramas (Chicago Fire and Chicago PD), Chicago Med focuses on the working lives of health care professionals in a busy emergency department in the city of Chicago. Sound familiar? It should, because that was the premise of the hugely successful NBC series ER that premiered over 20 years ago in 1994 and launched the careers of several successful actors.

Hitchcock once said that “Drama is life with the dull bits left out.” The same could be said about Chicago Med. In the very first episode, a catastrophic train derailment occurs on the El in downtown Chicago. Countless injured bodies are whisked to the Gaffney Chicago Medical Center hospital. They’re cared for by an exceptionally attractive team of health care professionals. Amidst the high energy on display in this drama, the series premier is also a veritable showcase of ethical issues:

  • Early in the episode, one of the neurosurgery attendings bitterly complains about the new rules limiting residency hours (“new rules—ridiculous and bad for medicine”). Of course, there’s nothing new about the rules as they’ve been ACGME requirements for a dozen years.
  • A woman with a traumatic brain injury who is unconscious is discovered to be a gestational surrogate. The genetic mother is incorrectly referred to as the biological mother. The scenario strains credulity as the surrogate reportedly lives with the intended parents. The contract even delegates surrogate decision-making authority to them which is a clear conflict of interest. The contract is even reviewed by the hospital’s in-house counsel who adamantly guarantees that if a potentially life-saving neurosurgery is performed “regardless of the outcome, we’ll be sued and they’ll likely win—millions,” ignoring the fact that a very well-developed gestational surrogacy law exists in the state of Illinois. The hospital administrator asks exasperatedly “how about we call the ethics committee” to which the counsel responds dismissively “faster to call a judge.” Let’s not forget that the Joint Commission requires hospitals to have some kind of mechanism to resolve ethical issues that arise.
  • A regular patient (“Jamie”) at Gaffney is a young cystic fibrosis patient. The trauma fellow and psychiatrist discuss the patient’s care and the prospect of him being on a ventilator. The kindly psychiatrist is played by veteran character actor Oliver Platt who argues that Jamie has been brutalized by treatment and he ultimately has the right to refuse treatment. The trauma fellow Dr. Connor Rhodes is played by Jon Hamm look-alike Colin Donnell. Dr. Rhodes persuades Dr. Charles to convince the young patient that he still has some fight in him and that he should be ventilated with no consultation with any other physicians who have presumably been involved in the regular patient’s ongoing treatment.
  • Another young patient is near death and the same team of Drs. Rhodes and Charles go in to persuade the patient’s fiancée to agree to donate his lungs to the aforementioned CF patient. Of course, this is completely contrary to standard organ procurement protocol. The relevant opinion from the AMA Code of Medical Ethics states “The health care professionals providing care at the end of life should be distinct from those participating on the transplant team.”

For years, physicians have complained about the lack of verisimilitude in medical dramas. Now, it’s ethics consultants turn to complain. Chicago Med could have actually integrated an ethics consultant into this first episode (as opposed to referring to the ethics committee as nearly invisible and non-responsive, not to mention ineffective). By our count, this one show triggered several potential ethics consultations. Including an ethics consultant could have provided a corrective to some of the more outlandish scenarios that played out in this first episode and added an element of reality so desired in television today.

Even with a fast-paced medical drama, including some clinical ethics reality could have better educated an audience who may believe that any one of these scenarios is remotely ethically acceptable or permissible “People get a lot of information from TV shows on many subjects — including medicine and health care — without realizing it.” The information gleaned from TV shows may impact trust and understanding in a real-life health care encounter. This begs the question of what social responsibility television/popular media has to its viewers . . . is it just to entertain, or should it be something more? That something more could have made Chicago Med stand out as being something other than just a standard issue medical drama.

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