Monday, 18 May 2009

Ethical dilemma...?

Over the years I have probably fooled many into thinking I have a "scientific brain". There are at least 2 arguments to the contrary:
1) I use phrases like "scientific brain"
2) I actually prefer tackling dilemmas to problem solving.
I can live happily without clear-cut answers as long as I can take pleasure in the process of seeking them.
It started with a general ethics course I took in years 7 and 8 of my primary education. Somewhat ironically, the most formative course I've ever taken was a chat-based extracurricular class run by a teacher who in her infinite wisdom and kindness decided to volunteer. And thus I achieved the greatest objective of the educational system: I learned to question what I think I know.
Sadly, this meant that I found ethics disappointing and repetitive for years after. During the 'ethics week' in the first year of University I eloped to Ireland and came back just in time to sign my name on a poster produced by my group. Which makes me wonder: is it the case that the better you are at mastering the ethical process, the less ethical you become? Probably not. I was a cocky teenager.
However, since joining the world of clinical (hands-on) medicine, I'm faced with a new generation of ethical dilemmas. Turns out I was just tired of weird hypothetical scenarios where you have the power to telepathically manipulate planes but not, say, make a phone call. It was the pragmatic world of nitty-gritty disease business that sparked my interest anew.
Recently I completed two exercises in medical ethics - one as part of a Clinical Genetics seminar and one as part of an online research survey. It felt... refreshing:) Below is a sample if you fancy a go. Answers welcome (you can post anonymously), if you feel like sharing:)

Skin Cancer Survey.
I like this scenario because the more you think about it, the more complex it becomes. What gives me the right to invade an individual's privacy? What ethos am I bound by in this grey area between my lay and professional identities? And even if I decide it's my duty as a medic to be proactive, how do I ensure that above all, I "do no harm"? By interfering I take away the patient's right to choose - bizarre as it may sound, some people do not want to be told they have (or are at high risk of) cancer.
In question 3 the kids are added as a twist. Talking to the individual concerned is one thing, saying something where you are sure to be overheard (especially by family) is another. Even if you are officially the patient's doctor, you are strictly not allowed to dispense their medical information to the family without the patient's clear permission. So, if as a result of your actions somebody gets the patient's information against the patient's will, you'd be, as it were, in a whole world of shit. And because the modern commodity of information is so precious you could even end up defending your job and future career in front of the General Medical Council...
But enough of my blabbing. Here's the raw material:

My seminar exercises will be up in a few hours ;)


  1. I may lack the medical background to be able to answer these in the same way that a doctor (or prospective doctor) would.. For instance, I don't know what the significance of the ages/sexes. Except for the fact that if she is 21 and already has two kids, she is probably a chav.

    Also, it doesn't indicate how old the kids are, with the exception of "young" Does "young" mean 6 years old? Or 2 years old? If the kids you are speaking in front of are too young to understand (or, potentially, even to talk), then it probably doesn't count as breach-of-privacy/confidence. And if she is 21 years old, even if she did get started chavtacularly early, those two kids are almost certainly going to be VERY young. Still an influential detail that they have left out, however.

    But in the end, I think that in both cases I would tell the person. I would certainly phrase it a lot more diplomatically than they do in the question, though. And I also wouldn't just announce it in the middle of the check-out line. "Yo! Homeslice! Y'all got SKI-ZIN CIZ-ANCER! Word to your moms, tumory Joe!" More of a "Excuse me sir/ma'am, can I talk to you over here for a moment?" and then explain, briefly.

  2. or the children could be her cusins ;>

  3. the closest thing I have to a view on our roles in the society is that, how do I say it, what we should be doing is sharing knowledge/information with each other. so I guess in both these situations I'd talk to the person to make sure she/he knows and can make decisions based on the true state of hers/his health..

  4. Hey! I was told about this story the other week. It's a local doctor, and the story was so popular with the press, apparently it went all over the world!