Ward Ethics: Dilemmas for Medical Students and Doctors in Training

by Edited by Thomasine K. Kushner , David C. Thomasma

• ISBN13: 9780521664523
• ISBN10: 0521664527
• Format: Paperback
• Copyright: 2001-07-02
• Publisher: Cambridge University Press

Summary

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This volume includes over 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward.

Table of Contents

Acknowledgments	xiii
List of contributors	xv
Prologue. Breaking the silence	1	(4)
Letter from a young doctor	5	(4)
Richard Selzer
Part I. On caring for patients	9	(8)
Section 1. Performing procedures	17	(62)
The responsibility of informing	18	(15)
Implications of physician experience	18	(1)
Case: ``First time''	18	(1)
Commentary:	18	(4)
William Nelson
Paul B. Hofmann
Commentary:	22	(2)
Robert L. Schwartz
Commentary:	24	(1)
Neal Cohen
Special vulnerabilities	25	(1)
``Who was really benefiting from the multiple exams?''	25	(1)
``Hey, you want to drain an abscess?''	26	(1)
``Medically correct, but an ethical catastrophe''	26	(1)
``I was not supposed to be there''	27	(1)
Commentary:	27	(2)
Amnon Goldworth
Commentary:	29	(4)
George J. Agich
Treating despite discomfort and self-doubt	33	(10)
``Aren't you done yet?''	33	(1)
``Have you ever done a lumbar puncture?''	33	(1)
``The emergency department at 4:00 a.m.''	33	(1)
``Operating without experience''	33	(1)
Commentary:	34	(3)
Marli Huijer
Commentary:	37	(2)
William Andereck
Commentary:	39	(4)
Gregory L. Larkin
Blaming the patient	43	(7)
``If you weren't so fat''	43	(1)
``The patient removed the traction''	43	(1)
Commentary:	44	(2)
Alan Steinbach
Commentary:	46	(4)
Francis Kane
Breaking the code: is a promise always a promise?	50	(6)
``How `confidential' is confidential?''
Commentary:	50	(2)
Robyn Shapiro
Commentary:	52	(4)
Pablo Rodriguez del Pozo
The newly dead	56	(10)
``Patient or cadaver?''	56	(1)
Commentary:	56	(4)
Kenneth V. Iserson
Commentary:	60	(3)
Michael L. Gross
Commentary:	63	(3)
Jonathan Wyatt
Asking for help: who's listening?	66	(13)
``I fled from the room''	66	(1)
``I still don't know what I did wrong''	66	(1)
Commentary:	66	(5)
Barbara Supanich
Commentary:	71	(3)
David N. Weisstub
Commentary:	74	(3)
David Bennahum
Discussion questions	77	(2)
Section 2. Problems in truth-telling	79	(18)
Omissions: failing to come forward	80	(8)
``Omit the mistake''	80	(1)
``Was I acting under false pretenses?''	80	(1)
``White lies and omissions''	80	(1)
``I hated disappointing them''	80	(1)
``Sin of silence''	81	(1)
Commentary:	81	(3)
Lawrence J. Schneiderman
Commentary:	84	(4)
Ben Rich
Commissions: deliberate deception	88	(9)
``The chief resident `lied'''	88	(1)
``A false report''	88	(1)
Commentary:	88	(2)
Lawrence J. Schneiderman
Commentary:	90	(4)
Jeffrey H. Burack
Commentary:	94	(2)
Ben Rich
Discussion questions	96	(1)
Section 3. Setting boundaries	97	(26)
From professional to personal	98	(6)
``Do you want to see me again?''	98	(1)
``I don't think I took advantage of her''	98	(1)
Commentary:	98	(3)
Richard Martinez
Commentary:	101	(3)
Rosamond Rhodes
Losing empathy	104	(9)
``Patients I don't like''	104	(1)
``Why should I invest in these patients?''	104	(1)
``A nurse said I should be more empathetic''	104	(1)
``Where were the third year students?''	104	(1)
``I hope this patient dies''	105	(1)
Commentary:	105	(3)
Richard Martinez
Commentary:	108	(3)
Marli Huijer
Commentary:	111	(2)
David Bennahum
The limits of compassion	113	(10)
``Does being a doctor include being a social worker?''	113	(1)
``I took a bus to his house on my day off''	113	(1)
``How do I suffer with her?''	113	(1)
``You don't help your patients by crying with them''	114	(1)
Commentary:	114	(2)
Richard Martinez
Commentary:	116	(3)
Guy Micco
Commentary:	119	(3)
Mary B. Mahowald
Discussion questions	122	(1)
Part II. On becoming a ``team player'': searching for esprit de corps and conflicts of socialization	123	(12)
Section 4. Abuse and mistreatment	135	(18)
Psychological abuse: subjected to humiliating and belittling behavior	136	(6)
``You idiot! What are you doing in medical school?''	136	(1)
``I would knock you to the floor''	136	(1)
``He treated me like a scut monkey''	136	(1)
``I knew better than to spoil his fun''	137	(1)
Commentary:	137	(2)
Ruth B. Purtilo
Commentary:	139	(3)
Gerrit Kimsma
Physical abuse: actual physical harm	142	(6)
``The commander''	142	(1)
Commentary:	142	(2)
David N. Weisstub
Commentary:	144	(4)
Emilio Mordini
Sexual abuse: sexist slurs and sexual advances	148	(5)
``Homework''	148	(1)
``What do you like best?''	148	(1)
``The histology lesson''	148	(1)
Commentary:	148	(2)
Domeena C. Renshaw
Commentary:	150	(2)
Evert van Leeuwen
Discussion questions	152	(1)
Section 5. Argot, jargon, and questionable humor: assuming the mantle at the patient's expense	153	(18)
Comedians: mordant humor and cynicism	154	(9)
``You killed one of our patients''	154	(1)
``Laughter and jokes at morning rounds''	154	(1)
Commentary:	155	(3)
Barbara Supanich
Commentary:	158	(5)
David N. Weisstub
What's in a name? Derogatory references	163	(8)
``Goombah''	163	(1)
``Shooter with a fever''	163	(1)
``The gorked gomer''	164	(1)
``Fob''	164	(1)
Commentary:	164	(3)
Jacquelyn Slomka
Commentary:	167	(2)
Harvey M. Weinstein
Discussion questions	169	(2)
Section 6. Making waves: questioning authority and the status quo	171	(44)
Personal identity	172	(6)
``Who am I?''	172	(1)
``Don't tell her you are a medical student''	172	(1)
``Premature description''	172	(1)
``The anonymous greeter''	172	(1)
``Without portfolio''	172	(1)
Commentary:	173	(3)
Griffin Trotter
Commentary:	176	(2)
Kate Christensen
Duties to treat?	178	(5)
``Unnecessary personal risk''	178	(1)
``He was telling me to take a risk he wasn't willing to take''	178	(1)
``I said I might be pregnant''	179	(1)
Commentary:	179	(1)
Gerrit Kimsma
Commentary:	180	(3)
Neal Cohen
Hierarchy and the dynamics of rank	183	(25)
Questioning authority	183	(1)
``Just a consult''	183	(1)
``Don't mess with the chain of command''	183	(1)
``Why use that medication?''	183	(1)
``Level with me''	184	(1)
``Why couldn't the patient be premedicated?''	184	(1)
``I followed orders even though I thought they were wrong''	184	(1)
``Help! My senior registrar has gone fishing''	185	(1)
Commentary:	186	(4)
Soren Holm
Commentary:	190	(4)
Griffin Trotter
Acting against authority	194	(1)
``When I speak you must follow''	194	(1)
``The patient is dead, leave him dead''	194	(1)
Commentary:	195	(2)
John Harris
Commentary:	197	(6)
Alan Steinbach
Striving to stay on top: competing with peers	203	(1)
``He would always arrange to have the easiest cases for himself''	203	(1)
``Just another cut-throat medical student''	203	(1)
``The new arrival was the ideal `victim'''	204	(1)
Commentary:	204	(2)
David N. Weisstub
Commentary:	206	(2)
Jean-Christophe Mino
Conflicts of interest	208	(7)
``Should I accept drug company goodies?''	208	(1)
Commentary:	208	(2)
James Weber
Commentary:	210	(4)
Carson Strong
Discussion questions	214	(1)
Section 7. Perceiving misconduct and whistle-blowing: observing peers or superiors commit an act deemed unethical	215	(40)
Abusing alcohol or drugs	216	(7)
``Whistle-blowers take a lot of heat-particularly when they are a nobody''	216	(1)
``Missing drugs''	216	(1)
``I found the attending overdosed and unconscious''	216	(1)
Commentary:	217	(2)
Rosamond Rhodes
Commentary:	219	(4)
Neal Cohen
Mistreating patients: nasty, rude, or hostile behaviour toward patients	223	(8)
``The patient had been verbally assaulted''	223	(1)
``Stop bothering us''	223	(1)
``The unknowing widow''	223	(1)
``The patient's wishes were ignored''	223	(1)
Commentary:	224	(4)
Ben Rich
Commentary:	228	(3)
Tod Chambers
Covering up	231	(17)
To acknowledge?
``The camouflaged patient''	231	(1)
``Didn't you write that order?''	231	(1)
``What should they have been told?''	231	(1)
``I knew the damage was iatrogenic''	232	(1)
``Boxed kidneys''	232	(1)
``By not telling am I an accomplice?''	232	(1)
Commentary:	233	(2)
Thomas A. Cavanaugh
Commentary:	235	(3)
Marli Huijer
To intervene?	238	(1)
``Does anyone have a problem with this?''	238	(1)
``No one stopped him''	238	(1)
Commentary:	238	(3)
Neal Cohen
Commentary:	241	(3)
Bethany Spielman
Commentary:	244	(4)
Akira Akabayashi
Misrepresenting research	248	(7)
``Was I a coward?''	248	(1)
``A faculty member listed his name as first author''	248	(1)
``Unethical author attribution''	248	(1)
Commentary:	249	(2)
Akira Akabayashi
Commentary:	251	(3)
Charles Weijer
Discussion questions	254	(1)
Epilogue: Using this book	255	(4)
Glossary	259	(2)
Index	261