Tag: bioethics-discussion-blog

Blog Posts (62)

July 16, 2013

Are Clinical Ethicists Looking in Wrong Directions?

Clinical ethicists are those who perform ethics consultations regarding patient care and who also may teach and write about a host of issues that pertain to that care.  These ethicists are often physicians but also may be philosophers, social work...
July 9, 2013

"As a Patient: I Am My Own Doctor. Trust Me"

Could there be the possibility that medicine and the medical system including the schools that teach medicine and the organizations and governmental agencies which set standards all have become paternalistic toward the patient as a person and toward th...
July 9, 2013

"As a Patient: I Am My Own Doctor. Trust Me"

Could there be the possibility that medicine and the medical system including the schools that teach medicine and the organizations and governmental agencies which set standards all have become paternalistic toward the patient as a person and toward th...
July 6, 2013

Patient Modesty: Volume 56

I am sure that everyone can spot the "chaperon"  for the patient in this classic photograph of the operating room used at Johns Hopkins Hospital from 1892 to 1927.  And I am sure that everyone can find the "gawkers"  who are present in t...
July 6, 2013

Patient Modesty: Volume 56

I am sure that everyone can spot the "chaperon"  for the patient in this classic photograph of the operating room used at Johns Hopkins Hospital from 1892 to 1927.  And I am sure that everyone can find the "gawkers"  who are present in t...
July 1, 2013

Moses' Basket: Not the Right Basket for Professional Support








This is an apparently supportive advice delivered to one who is in some emotional or physical distress. And though one may find this advice displayed on numerous church boards for the public's humorous consideration, it "Have hope, don’t give up – remember Moses was once a basket case, too"  provides an example, in my opinion, of how clinical advice if given from a physician to a patient should not be expressed.  I believe the patient deserves such communication of advice be based upon facts which are presented with clarity and free of ambiguity and, in fact, free of humor. To me, humor can degrade any empathy by the physician that is appropriate  to be transmitted to a patient in distress. I think it says to the patient, what you are experiencing is, to me, partly a joke.

In contrast, the example, I selected, while attempting to convey some sort of a supportive message for those who read it and need it, there is a derogatory but also that humorous tone, along with the use of non-factual ambiguity in order to make the point of the message.  The facts which are missing are that "basket case" as defined by Merriam-Webster in its original World War I expression represented "a person who has all four limbs amputated" or it's more modern use "a person who is mentally incapacitated or worn out (as from nervous tension); also : one that is not functioning well or is in a run-down condition." Obviously, this does not apply to Moses, in the biblical description of his relationship to a "basket".

 Trust is an essential part of the doctor-patient relationship, trusting the doctor's decisions and intentions is critical for the acceptance by the patient of the doctor's advice. While there are some patients who, on questioning, may not want all the facts of their condition displayed to them in one sitting and a few actually desiring others to know but not themselves, I doubt that any want the doctor to finally tell untruths, misleading information or add humor related to the patient's emotional and physical distress.  Now I suspect that some of my visitors here may disagree with my commentary and may find some value to the patient for the doctor to present the advice in the form found written on those church displays.  If so, I would like to read your view.  ..Maurice.

 Graphic: Photograph taken by me today at a neighborhood church and modified with Picasa3.
July 1, 2013

Moses' Basket: Not the Right Basket for Professional Support

This is an apparently supportive advice delivered to one who is in some emotional or physical distress. And though one may find this advice displayed on numerous church boards for the public's humorous consideration, it "Have hope, don’t give up – ...
June 27, 2013

"Looking Back": Clinical Review and Reconsideration

It is only natural, if one has a memory,  to look back with the remembrance of the event and think to oneself whether the decisions made and the outcome of the event could have turned out better if the issue was thought out and acted upon in a dif...
June 27, 2013

"Looking Back": Clinical Review and Reconsideration

It is only natural, if one has a memory,  to look back with the remembrance of the event and think to oneself whether the decisions made and the outcome of the event could have turned out better if the issue was thought out and acted upon in a dif...
June 20, 2013

The Ethics of "Gawking" in Medicine





The following original article which I wrote and was published today at the Bioethics.net website is reproduced here with permission.  ..Maurice

Maurice Bernstein, MD
Gawking, defined in Merriam-Webster dictionary  as “to gape or stare stupidly.” It is the “stupidly” which I think sets the ethics of the behavior.  The “stupidly” can represent more than some ignorance of what is being observed but also a lack of true purpose at the time of the observation for either understanding or even participation.  Gawking is directed primarily for self-interest of the gawker and for no other purpose.  A general example of gawking can be given as motorists stopping briefly at an automobile accident simply to observe the trauma but not with an intent to provide assistance.  A more specific example of gawking was described in the Associated Press article November 12 2012 in the aftermath of Hurricane “Sandy”:
Garbage trucks, hulking military vehicles and mud-caked cars move slowly through a Staten Island waterfront neighborhood still reeling from Superstorm Sandy’s storm surge. Then comes an outlier: a spotless SUV with three passengers peering out windows at a mangled home choked with sea grass. Residents recognize the occupants right away. They’re disaster tourists, people drawn to the scene of a tragedy to glimpse the pictures they’ve seen on television come to life.
So then, in general, what has ethics to do with gawking?  Well, one can say that gawking having only to do with self-interest and absence of benefit or consent by those being gawked can be deemed unethical.  Considering the ethics, a more benign example would be a gentleman gawking at an attractive lady on the street.  For whose interest is the results of the gawking? Of course, it is that for the gentleman.  What benefit is surreptitious gawking for that woman? None, if she is not informed and perhaps some, if she was…but that would depend on her interpretation.  Does it make any difference, though, to the lady not to be informed?  Well, she can’t complain since she was walking out in a public place, so the gentleman’s gawking has really not produced any injury and which would be strictly termed unethical.
However the example of gawking which could be looked upon as unethical is, as in the case of observing the harm to others, such as the automobile accident or being a “disaster tourist” such as the Sandy experience is where that the ethical principle of beneficence is missing.  Instead of a humanitarian “Good Samaritan”  action on the part of the gawker to provide “good” to the harmed or injured, the behavior is strictly self-serving. That is unethical.
So now, what about gawking and its ethics in relation to the medical profession?  The duty of the medical profession is essentially to the benefit and good for the patient among other ethical principles and along with the attempt to preserve  the decisional autonomy of the patient.  Within the United States, The Health Insurance Portability and Accountability Acts (HIPAA) deals with assuring confidentiality of patient historical information (that which is spoken or written) but there are no laws of which I am aware which regulates how a patient’s physical body, during clinical evaluation, procedures or surgery can be maintained as private and away from the unwanted eyes of onlookers about whom the patient was unaware and had not given consent. These onlookers have been termed  “gawkers” by the patients on finding that they had been present. All you need to do is go to my “Bioethics Discussion Blog”(www.bioethicsdiscussion.blogspot.com) and read the comments by patients written over the years to my many threads on “Patient Modesty” for confirmation of the application of this expression.  And who are these “gawkers”?  The name has been applied to medical students, nursing students, technicians, medical industry representatives and other “visitors”, none of whom were consented to be present by the patient and who are standing around and not specifically contributing to the care and attention to the patient but looking at the patient’s body for their own various interests.  Yes, the patient’s physical body, uncovered to various degrees along with the observation of the activities of others attending to the patient may be of value to those simply “looking on” even beyond some personal prurient interest. However whatever the value to the gawker or the eventual benefit to others, the fact that these individuals have not been directly accepted to be present by the patient and not directly involved in the patient’s care makes their gawking unethical.  As far as some patients are concerned “gawking” on them is more than “staring stupidly” but “staring without informed consent.” What these patients would want is talking consent in place of doing gawking.
As a patient, what would be your opinion?

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