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10/28/2016

BioethicsTV: 10/20 – Distributing organs, scope of practice, poverty, and kidnapping

by Craig Klugman, Ph.D.

Grey’s Anatomy (Season 13, Episode 5). In this episode June is an 80 year old woman who has been waiting for 3 years for a liver transplant. Her ship has finally come in and her children and grandchildren celebrate in her hospital room. But when Chelsea, a 25 year old runner, comes into the ER suffering from heat stroke that leads to acute liver failure, an internecine conflict develops between the surgeons. According to Meredith Grey, UNOS will allow June to forgo her liver and give it to Chelsea. June is a saint who cares and gives and nurtures. But when her surgeon, Bailey, asks June what she wants to do, June says that she wants her liver and the other girl can wait. A debate among the surgeons raises the question as to whether an 80-year-old should get an organ at the expense of someone who is young and has not had a chance to build an adult life. Bailey accuses Grey and Weber of ageism. Grey considers stealing the organ when it arrives, trying to coerce the patient to change her mind, or pretending to be Bailey so she can take the organ. However, in an only for TV moment, a patient undergoing a heart procedure not only dies after his procedure, but he’s an organ donor who is a perfect match. His liver saves Chelsea. Although the debate on age in distributing organs is an important one, the deus ex machine ending undermines the notion of organs as limited resources.

Chicago Med (Season 2, Episode 5, October 20). During a marathon, a medical student inserts a chest tube in a patient after being run over by a small vehicle. The med student was not only acting out of his scope of practice, but he was also practicing without a license and was acting against the explicit orders he had received. That there was no help around nor would be for a while, does not excuse the med student acting far beyond his competence and ability. However, the patient survives through heroic efforts and in the end he is congratulated for what he did. This isn’t surprising since in this show the ends always justifies the means and doctors can do little wrong—saving a life excuses all actions.

An elderly woman is brought into the ER suffering from heat stroke. Blood test reveal high taurine, malnutrition, and her medication levels being low. The taurine suggests that she’s eating cat food and either splitting pills or selling them. A neighbor shows up and we learn that they like to buy expensive, beautiful things. The patient may be using her money to keep with the Jonses instead of taking care of herself. Dr. Choi talks to the neighbor about his concerns. Though, this is not personal medical information, I did wonder whether he was breaking a confidence by doing so. After all, the patient would not admit these issues nevermind giving him permission to discuss it with others. The issue of poverty in the elderly is a serious one that we need to be concerned about as a society.

A third line has a young girl and her mother who has kidnapped her own daughter to get her away from, we are told her abusive father. The girls has multiple fractures that point toward child abuse. The team wants to help them without calling the police but the department administrator lets them know that the law requires even the suspicion of abuse be reported. An observant pediatrician finds that the girl actually has a genetic disease that causes hers bones to break easily and to suffer from hearing loss. The mother instantly regrets stealing her child and falsely accusing her husband. She is then led off by the police.

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