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04/06/2016

BIOETHICSTV: Chicago Med-BIID, post mortem egg retrieval, scope of practice and forgiveness

by Craig Klugman, Ph.D.

This week on Chicago Med brought 3 new ethical issues as well as the unsatisfying resolution to a story arc.

Story 1 begins with a patient brought into the ED after trying to saw off his arm in the hardware store. The doctors are able to save it but the patient is upset. Dr. Charles, the psychiatrist, realizes the patient suffers from Body Integrity Identity Disorder (BIID) which is characterized by people feeling a part of their body is not theirs. They often desire to amputate that foreign part of themselves. The patient agrees to counseling and therapy. He asks if they could give him a nerve block in the arm so he could see what it would feel like to not have the arm and he asks to have his restraints removed and a blanket placed on him. Dr. Charles makes both happen. We flash to alarms going off (beyond the ones that were in my head the instant he asked for the blanket) and we find the patient has used a tube to tie off blood flow to his arm and it is now septic and must be removed. This story ends with Dr. Charles questioning himself for missing the signs of the depth of the patient’s suffering. He asks the question “In cases like this, are the decisions were making really in the patient’s best interests or are they in ours, to make us feel better. Because like it or not, that’s a happy ending.” Dr. Charles says he should have gone to orthopedics and found someone who would have removed the arm to which Dr. Choi responds that no one would remove a healthy body part. Ethically, Dr. Choi is right. Under nonmaleficence, removing a healthy body part is a harm to a person’s physiology. Dr. Charles is also right in asking whether the emphasis on the body diminishes the real suffering a person may be having.

Story 2 concerns a woman who is impaled when an icicle falls off a downtown skyscraper (a real threat I never knew about until I moved to Chicago and saw the “Warning: Falling Ice” signs beneath the skyscrapers). She is brain dead and on life support until organ donation services can speak with the husband. He states that he wants her eggs harvested so that he can have the child for which they had been trying. A gynecologist is called for the consult, and she refuses to proceed after seeing an ultrasound image of the woman’s IUD. Clearly, the physician says, the woman did not want to get pregnant. The husband refuses to believe this and in the end the administrator gives permission for hormone injections to be started on the women’s body in the hope that multiple eggs can be released and harvested. Apparently, the hospital found another doctor who did not have an ethical problem with performing the procedure despite the IUD or they forced the same doctor to act against her ethical will.

This case is similar to a 2011 Israeli girl who at 17-years-old dies when struck by a car. The family wanted to freeze her eggs to create a child in the future. Israeli courts sided with the family and the family then changed their mind. Still, the court precedence stands. Several scholars hold that such actions are ethical only if the person gave indications that she wanted to have children and that there are people willing to raise and be responsible for this child. Courts in the U.S. have fairly consistently ruled that no one can become a parent against their will and procreative liberty states that people have the autonomy to choose to have or not to have children. Art Caplan has suggested that hospitals need to create policies for these requests. And in fact, the administrator in Chicago Med states that the fictional hospital does indeed have such a policy.

The third story with ethical tones is when a fourth year medical student drills a burr hole into the skull of a patient in crisis. She does it correctly and saves a life. When the administrator takes her to task for practicing medicine without a license and putting the hospital at risk of liability, Dr. Choi steps in and says that she was acting under his orders. He lied. But the patient was saved, so in this story, good intentions outweigh the violation of the law, hospital guidelines, common sense, scope of practice and also forgives lying. What if he had died or been permanently injured? This story reinforces the stereotype that doctors stick together and close ranks to protect one another, even when that professional has done wrong.

A multiple episode arc was closed. This one concerns Dr. Halstead, a physician who resuscitated a palliative care patient even though the clearly patient had a DNR. The patient and family subsequently sue the doctor and the hospital. But, the patient enrolls in a drug trial and only last week we learned that she had the placebo (in a violation of study protocol and subject confidentiality). This week she dies and Dr. Halstead goes to her funeral. The husband of the deceased marches up to Dr. Halstead and takes a stance to punch him, but instead tells him “Thank you for not giving up on Jen.” The show took a cowardly approach to ending this storyline by the family changing its mind and saying that it was okay. The doctor in these shows, is almost always right.

And that’s it for this week’s episode.

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