Posted on February 24, 2019 at 1:48 PM
by Craig Klugman, Ph.D.
“Examining ethical issues in TV medical dramas”
Jump to The Resident (Season 2; Episode 14): Catastrophic Health Plans; Jump to Chicago Med (Season 4; Episode 14): Above the Call of Duty, Tough Choices in Opioid Epidemic, What is Right is Not Always Clear
Andre and Otto are a middle-aged gay couple. Otto is tired, weak, dizzy, and with swollen joints. They have only a catastrophic health care plan, so only want the minimal because they have to pay out of pocket. Conrad finds signs of kidney failure and needs tests. Otto has a treatable autoimmune disease and is also diagnosed with confabulation—as a result of brain damage brought on by his past history of drinking. We see Andre telling Otto stories about a trip to Paris that they planned but never took, creating a world of joy and love for his partner.
The Trump administration has waived minimal coverage portions of the ACA to permit the selling of policies with minimal coverage. Such plans have low premiums (approximately $173 per month) but very high deductibles, $7,900 in 2019. They cover 3 preventive care visits per year. However, to qualify one must be under 30 years old or have a “hardship exemption”—being unable to afford health insurance. These plans are also not eligible for any federal credits or subsidies. While cheap upfront, if a person should need medical care, these plans offer little, expecting a patient to pay out of pocket.
Chicago Med (Season 4; Episode 14): Above the Call of Duty, Tough Choices in Opioid Epidemic, What is Right is Not Always Clear
This episode called back to several story lines from earlier episodes.
Sydney Is an African-American woman brought to the ED after having collapsed: She is a dialysis patient. Maggie is kicking herself because the woman was a childhood friend and had been into the clinic earlier (last episode) and Maggie did not bring her in immediately (suspected drug seeking behavior). Dialysis is not working well for her. Maggie tries to get the patient on the transplant list but Sydney is a low priority patient because of her profession: She is a sex worker and thus, in the minds of the transplant committee, a high risk patient. Maggie has herself tested to see if she is a match. Goodwin (who is on the transplant committee) takes Maggie aside and informs her that giving a kidney to a patient is a violation of professional boundaries. Maggie is doing this out of a sense of guilt. Goodwin tells her the side effects which Maggie brushes aside. Goodwin says it’s an ethical violation and she won’t let her do it: Maggie is out of paid sick leave days so if she has the surgery, Goodwin will fire her. The patient codes just as the doctors are starting her dialysis treatment. The third year med student successfully runs the code (this is unheard of). Maggie files for the family leave act to get the time away. Goodwin wants to know why this patient is different than any other. Maggie answers “she isn’t” and that everyday she sees so much suffering and there’s nothing she can do about it, but this time she can. Maggie donates and Goodwin walks her to the surgery.
Britt is teenager who is 6 weeks clean from drug use has myocarditis. The solution is a PICC line for twice daily antibiotics, but this offers an open pathway for taking drugs. The doctors want to give her Naltrexone, a drug that will prevent her from being able to get high, but it means if she did it would be easier for her to overdose. In addition, it could be dangerous if she has used at all in the last two weeks (a urinalysis shows no drugs), but after giving the drug, the patient has a bad reaction. The patient’s mother provided the urine after her daughter said she had used last week but it wasn’t much. Britt runs away, off to get high.
Several weeks ago, Rhodes and Bekker performed surgery on a patient where they used light anesthesia in hopes the patient would provide information to find a colleague who had been kidnapped. This week, a complaint was filed against them for endangering a patient. We are told there will be an investigative hearing. When Rhodes is brought in for his interview, the panel apologizes. During her interview, Bekker said that Rhodes only acted in the patient’s best interest. Rhodes confronts Bekker, saying they both knew that was not his only motivation. Bekker says there’s no proof that the choice led to any complications or problems and that she would do anything to protect him. Rhodes visits Goodwin and says he was not comfortable with the oversight committee and how the case was presented. Goodwin tells him, “I am reminded today, in our effort to help people that we sometimes find ourselves in situations where what’s right and what’s wrong isn’t entirely clear. And we can only hope that the decisions that we do make are coming from the right place.”