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03/30/2018

BioethicsTV (March 26-30): #TheGoodDoctor; #ChicagoMed

by Craig Klugman, Ph.D.
The Good Doctor (Season 1; Episode 18-Season Finale): Medical errors and battery; Chicago Med (Season 3; Episode 13): Who gets the heart? Mercy killing

The Good Doctor (Season 1; Episode 18-Season Finale): Medical errors and battery
A fraternity pledge brings his fellow student to the ER with a compound ankle fracture. He then develops a bowel problem and then disseminated intravascular coagulation (DIC-where he both bleeds out and clots at the same time). From his pledge brother, we learned that he has eaten detergent pods which is what likely caused the bowel problems. When he does not improve, Kalu and Park decide to talk with the pledge who brought in the patient: Kalu treats a cut on his hand and draws blood after fixing the cut to “check for infection.” The pledge agrees. Kalu hands the vial to resident Park who says “I can hand this over to the police or you can tell me what your friend is on. I see you’re on something—you’re eyes are dilated and you’re sweating in a 68 degree room.” The pledge says that they took “Molly.” The pledge turns to Kalu and says, “I would have told the truth if you asked me.”

While needing to solve a medical mystery and save a life is important, it is also important to preserve the physician-patient relationship and to respect persons. These two residents did not even try asking the pledge, who was also a patient because they did first aid on his hand. The consent for a blood draw was not ethically valid because it was given based on a lie of its use—the resident committed a battery and because it was not requested by the police or a court order, was not collected to prove a crime. The ends do not justify the means in the fiduciary relationship.

The patient’s problem was apparently caused by a surgical error Murphy made when closing. His colleagues debate whether to report the medical error: Protocol requires that they report the error. However, they are also concerned because Murphy is autistic. They believe that an abled surgeon would receive just a reprimand, but that Murphy would be fired and the hospital would be biased any potential future surgeons with his condition. The team considers reporting the error but instead decides to lie and say it was Kalu’s fault since he is leaving the hospital for another position anyway. Kalu is selected to take one for the team.

Murphy has an unorthodox suggestion for fixing the problem without surgery which saves the patient’s life. In the characters’ view, the need to report a mistake became unnecessary since severe consequences were avoided—again, ends justifies the means thinking. However, in reality, the mistake was made. That death was averted does not mean the mistake should not be reported, investigated, and a way to prevent similar errors found. Murphy feels that he needs to tell the truth and that he should report what he did, even if the team does not.

Chicago Med (Season 3; Episode 13): Who gets the heart? Mercy killing
A young male is transferred from another hospital with a GCS of 3 after his motorcycle accident. He was not wearing a helmet. ED chief Stohl says, “You know what they call a motorcyclist riding without a helmet? An organ donor.” When the parents show up, Stohl tells them “Take as much time as you need. When you’re ready, someone will come to talk to you about organ donation.”  This appeared rather heartless and abrupt to me until I realized that the patient was merely a vehicle to being a heart for two potential patients; characters who are developed more fully. The heart is a match for two patients in need: (1) Peter—while having his second heart transplant surgery he experiences “acute rejection.” Rhodes and Latham choose to put him on an artificial heart (instead of ECMO) and put him back on the transplant list. (2) A young father of one has rapid heart failure. Rhodes side-steps some possible interventions and places the father on ECMO which bumps him above Peter on the transplant list. However, his antibody levels are too high, so Peter is next on the list for the heart. Rhodes thinks his patient, the father, should get his first heart before Peter receives his third. Latham says “It’s impossible to compare patients in need. That’s why there’ a list—to crunch numbers and break ties.” However, Rhodes puts the father on emergency plasmapheresis so that his antibodies would drop and make him look like a better candidate than he is. Each doctor, Rhodes and Latham is doing their best to advocate for their particular patient. However, Rhodes manipulates the system to get his desired outcome. There is advocating for one’s patient and then there is manipulating the UNOS algorithm to keep another patient from receiving an organ. The former is noble but the latter is unethical.

A second storyline concerns Sam, a 27-year-old male with a TBI sustained 5 years earlier from a surfing accident. He has pneumonia. While Manning was changing his trach tube she discovered that it was clogged, like it hadn’t been cleaned in a long time. Manning fears that his mother, his primary caregiver, may no longer be able to provide the care he needs. However, mom believes that he son would not want to live in this condition. She “sees it in his eyes; “He’s begging me to help him.” She clearly put something in the tube. Manning is reluctant to report the attempted murder to police. While talking to Halstead she says that if they had moved to a state with assisted suicide and this was his stated wish, then there would have been a way to end his suffering. Halstead points out that no one could know what Sam would have wanted. When Manning still refuses to call, Halstead picks up the phone. Later, Halstead walks the police into the treatment room, where they find mom is holding her finger over the trach and the monitoring sensors have been transferred to her other son (so they would not go off when Sam crashed). Halstead starts CPR while mom begs, “Just let him go.” After the family has been arrested, Manning accuses Halstead of hypocrisy because in last week’s episode he let a patient die after the patient requested no medical intervention. Halstead explains that his patient refused medical treatment and he was complying with a patient’s wishes: Withholding medical care is different than plugging a trach to end a person’s life. This is the difference between allowing natural death and euthanasia.

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