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04/29/2016

BioethicsTV: Boundaries are Black and White on Grey’s

by Craig Klugman, Ph.D.

Reaching back to its roots, Grey’s Anatomy in its 12th season has been investigating more professional and ethical challenges in medicine. The April 28th episode (Season12: Episode 21) focused on questions of boundaries of why physicians should not treat their loved ones.

The first story was about a resident dating a former patient. Since the key term is former such a move may not be a pragmatic choice, but it does not violate professional boundaries (unless the physician is a psychiatrist in which case the APA says it may never be okay to date a former patient). The AMA does note that even after the physician-patient relationship has ended, the physician may have knowledge or influence from the prior connection that might influence any romantic relationship. On Grey’s, the resident finds herself bringing her boyfriend to the hospital when he experiences tremors in his left hand that mirror those that he was previously treated for in the right hand. In his last surgery to treat the tremor, the resident was on the surgical team. This time, she wants to be, but the attending tells her that she can’t be the doctor of a family member. When the attending asks the patient if he wants another surgery, the resident answers yes. When the attending asks him again if he wants the surgery, he responds, “what she said.”

The attending even takes the resident’s key-badge so that she cannot be in the OR or in the observation gallery. Instead, the attending tells the resident to go sit with the families in the waiting room. The camera pans around the waiting room, showing scared and worried faces. As a viewer, I believed that the resident was learning a lesson in empathy that would make her better at working with families. That lesson is lost, though, as the resident chooses to break up with the boyfriend in favor of surgery. She is sad not because he was in surgery but that she was not.

A second boundary storyline dealt with the obstetric-fetal surgeon, Arizona, and a divorced physician couple, Avery and Kempner, who are having a child. When the ultrasound shows a potential anomaly, worries kick into high gear as every possible test and procedure is run. As one would expect on a drama, tempers flare, yelling ensues, and tears are shed. During a definitive MRI, Arizona sees that nothing is wrong with the fetus. She also hands a list of obstetricians to the couple, stating that she can be either their doctor or their friend, but not both. And she chose to be the friend.

The AMA says that one should not self-treat or treat immediate family members. This is for the safety of the physician and the patient. For the physician, it’s too easy to see zebras where there may only be horses since the emotional connection can overwhelm clinical objectivity. For the patient, there is a pre=existing trust that could lead one to consent in uncertainty, to downplay risks, and to leave decisions to the physician-loved one. It’s also difficult for a patient to tell their loved one to stay out of the OR and not to treat them.

The third example of a boundary story dealt with the chief of surgery and her husband who is one of her residents as well as an anesthesiologist. After performing a surgery in a hallway in a moment of bravado (episode 18, April 14) that led to two deaths (a mother and her fetus), the Chief sentenced him to 6 months probation and prohibited from participating in surgeries. Feeling slighted by his wife/boss, he simply starts back up as an anesthesiologist. This rankles the Chief to no end. Both come to realize that the other has a good point: He learns that his arrogance is dangerous to patients. And she realizes that as a surgical resident he just wants to learn as much as possible.

In last week’s airing (episode 20, April 21), a boy accidentally shoots his best friend when they are playing with a gun they found under one of their mother’s beds. The episode is a dialogue about the danger of guns. Characters cite statistics on the number of gun deaths (about 34,000 per year; 36 per day), the percent of those deaths that are from accidental shootings (homes with guns experience 12 ties the firearm deaths than those without them), the number of children killed by firearms (758 in 2015), and the number of toddlers who accidentally shoot someone ( in 2015). Representing the only voice of opposition, a resident states over the boy’s open body in surgery that she has a gun and it makes her feel safe. The attending that she is dating/living with/on-again-off-again engaged to states that he does not believe that guns keep anyone safe and does not want one in his house (even though they live together). This seems like an opportunity for a pro/con discussion. But instead, at the end, the resident sits on their bed with her gun and says that she realizes she does not need it anymore; that her boyfriend makes her feel safe and the can get rid of the gun.

Now, I happen to believe strongly with the bias represented in the episode 20, but as a bioethics educator, I also know how important it is to look at all sides of an issue. Thus, the reason for BioethicsTV as a blog—to expand on the topics introduced in these dramas as a place for education and reflection.

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