by Craig Klugman, Ph.D.
BioethicsTV is an special section of bioethics.net that looks at the ethical issues raised in television medical dramas
Code Black (season 2, episode 3) revolved around a bus crash. The team captain, a promising athlete, has a crushed leg and requires a leg amputation. His father initially refuses to consent, stating that he can’t destroy his son’s dreams. He later tells the doctor that he is okay with the needed surgery but he can’t be the one to make the decision. He does not want to be to person who decided that his son’s dreams would end with the loss of his leg. Rob Lowe, who plays a military physician, explains to the young man about differently-abled athletes and the prosthetics now available. He undergoes the amputation.
The consent issue is a big one in this case. The father is the decision-maker (we do not see mom) and he refuses to make that choice. In the show, it is a single physician who then makes the decision. In reality, a sole doctor can never make a choice unless it was life or death in minutes and no one else was around. In most places, there is a requirement of two doctors making a decision and such physician consent is only valid in an emergency (meaning loss of life or permanent injury if nothing is done in a short time). In this case, an ethics consult would have been appropriate. One avenue would have been to work with the dad to make him understand. Another option would be to pursue an emergency court order giving consent or another family member (from the hierarchy listed in many state’s laws) could have been called to consent.
The crash was caused by a trucker who fell unconscious and is in a coma. He starts to crash and is put on a ventilator. His wife is present and she decides to remove his tube. Her concern is that he has no pain. He awakens and says he was in an accident and wonders if anyone was hurt. Dr. Rorish says no. When a resident confronts Rorish and says that she told them to always tell patients the truth, Rorish says that his death is a high price to be paid for the accident and the least they can do is to let him go with “grace.” In reality, yes, telling patients the truth is usually the ethical choice. However, there are exceptions such as a patient not wanting to know the truth and appointing someone else to carry that burden and make decisions. In this case, Rorish filled the wife’s wish that her husband not suffer by keeping the truth from him. This little white lie was compassion in action.
This column occasionally offers views on non-medical dramas that are relevant to bioethics. These recommendations are often made by others. The Good Place is our favorite philosophy television show and this week it offered a mini-lecture on utilitarianism. Offering not only the idea of the greatest good for the greatest number, maximizing the pleasure of the group and minimizing pain, the resident moral philosopher even offered good critiques of the theory such as it allows cruelty toward one person if it benefits the many.
Superstore (Season 2; Episode 4) is a comedy that pokes sarcastic fun at the effect of large mega-shops on employees, customers and communities. This past week, the storyline revolved around moral conscious clauses when a liberal, well-educated, left-leaning employee objects to being assigned to work the gun counter. He asks to be reassigned stating his moral discomfort and objection to everything about guns. When he refuses to sell guns to any of the customers who come to buy them, a group of gun toting locals enter the store to protest. The store manager is a right-leaning, conservative Christian who is shocked to learn the store sells the morning-after pill. He stalks the pharmaceutical counter to convince people not to purchase the pill and then buys the store’s entire supply. However, when he is charged $40 for each of the 28 pills he purchases, he goes around the store trying to resell the pills at a small profit by going up to people and asking if they were planning on having unprotected sex, even encouraging one women shopping for prophylactics not to buy them.
On the comedy Better Things (Season 1; Episode 5), a middle age daughter approaches her mother who is sunning herself in the garden and says they need to discuss mom’s advance directive. Mom immediately launches into a lecture on her detailed wants and wishes, something that she clearly has thought about. The daughter, however, loses patience and walks away. The moment is clearly intended to be funny but sadly it may represent reality. We need to set aside substantial time and patience for end-of-life conversations.