Posted on March 11, 2019 at 7:39 PM
“Examining ethical issues in TV medical dramas”
Jump to The Resident (Season 2; Episode 16): Money corrupts, patient autonomy; Jump to The Good Doctor (Season 2; Episode 17): Reporting suspicions of abuse; Jump to New Amsterdam (Season 1; Episode 15): Committing fraud to live, Who protects the elderly
Henry’s mom wants to go public with the damage that the Qouvadis vagus nerve stimulator did to her son. Before she steps out into the press conference, however, the CEO gives her $3.5 million dollars to take care of Henry’s future medical needs. Without great insurance, it’s an offer she cannot refuse. She takes the money and does not speak. Of course, the term “Quo vadis” is Latin for “where are we going”, a question that is asked of this hospital, this family, and of course, the medical industry as a whole.Later in the episode, we see that several physicians have also been bought by the company to not speak. This storyline demonstrates the corrupting influence that money can have in medicine, an influence that overrides scientific judgement and good clinical decision-making.
In a second storyline, Bell notices that the custodian has swollen hands and feet, so he admits the man for tests. Austin diagnoses an atrial myxoma that is effecting heart function. Before surgery, the patient comes down with myocarditis. A challenging surgery just became much more risky. Austin says that normally they would put off the surgery with such an infection, but the mass is compromising heart function too much. Conrad asks, do we go forward? With no surgery, the patient lives a few more months. Operate under these circumstances and he may never wake up. Bells says he’ll talk with the patient as it’s his decision. In speaking with the patient, Bell tells him that the surgery is risky and without it he’ll have one or two months. The patient chooses the surgery. The patient dies and in a moment of humility and perhaps redemption, Bell cleans the operating room.
In the US medical system, patients have autonomy. That is, the patient gets to make the decision. In this case, there is no right or wrong choice. The patient was most likely going to die. The choice really was whether that death happened quickly with a slim chance of survival or would he die with enough time to say goodbye and put his affairs in order. The patient chose the option that was most authentic for him.
In this episode, Lim’s very good college friend, Laura, has brought her baby to the hospital where it has been diagnosed with a subdermal hematoma. The only explanation appears to be shaken baby syndrome and as a single parent, Laura is the prime suspect. Lim has a legal obligation to report her friend to the authorities, which she does, and the friend is arrested. However, Murphy (who is now working in pathology) discovers that the injury was a result of the delivery, not abuse. Laura is released and we see her cradling her baby. Lim apologizes saying that she should not have jumped to conclusions. However, Lim’s actions were the correct ones and her later regret might have led her to not report a suspected abuse. The legal requirement is to report a suspicion of abuse. There is no threshold for likelihood nor is there a friend-and-family excuse: If a health care provider suspects child abuse, then it must be reported. Ethically, the reasoning is similar as the most important value is protecting the child and if the caregiver is potentially harming the child, an investigation must occur. The police taking away Laura was dramatic, but in these cases, the child is taken away while an investigation occurs. Lim acted professionally as required by both ethics and law. Following her emotions would have led her to make a bad choice (not reporting).
A 10-year-old boy, post heart transplant, comes to the ED in respiratory distress. He is rejecting the heart. Reynolds increases the anti-rejection drugs. The parents explain that their insurance paid for the transplant but will not cover the $9,000 per month cost of anti-rejection medication. They make too much money to qualify for assistance but not enough to pay for the meds. A church fundraiser gave them some money but they gave their son one pill every-other-day to make the pills last. Goodman suggests that the parents get a divorce since as a single mom, the child would then qualify for public assistance. The father says they love each other and as Catholics they do not believe in divorce. And of course, this would be fraud. The parents finally agree to file for the divorce but not before the son runs away, leaving behind a sign that says “No divorce”. His Catholic school has taught him that for divorcing, his parents will go to hell. In a side story, the Pope is in NYC and the hospital is under partial security lockdown in case the Pope needs medical services. The Pope’s “right hand man” tells the patient that “the Pope’s cool with the plan.” We are supposed to believe that all is fine now, nevermind that the family will spend a lifetime lying and cheating the state. It is a given that the system is imperfect and more often than not does not serve people well, but ethics (and the law) does not allow for such blatant lying and cheating. There has to be another way.
In a second storyline, Walter is an elderly man who comes to see Sharpe asking to have his catheter port removed and cease his chemo. He acknowledges the chemo may be extending his life, but being tied down with the infusions is preventing him from spending time traveling with his girlfriend. Things take a turn when Carl, Walter’s adult protective services legal guardian (not a relative), shows up and says that the girlfriend kidnapped him. The guardian believes that stopping treatment is not in the patient’s best interest. Sharpe says she has to listen to the patient, and Carl tells her that legally she has to listen to him. Walter says that Carl wants to keep him locked in his apartment not doing anything. The patient says running away was his idea. Sharpe ends up in court testifying that the patient is competent and capacitated—she requests that the guardian be removed. The guardian believes that Walter is a danger to himself and others and the judge rules in favor of the guardian. What becomes clear is that Carl does not really know Walter and he carries a hefty caseload. In a heartfelt ending to this case, Walter and his girlfriend decide to marry and Carl asks the judge to transfer guardianship to her.