Ethical dilemma #1
When you are the junior medical
student assisting in a procedure that is sterile and the intern accidentally
breaks sterility, but acts like he did not. In the room with the junior
medical students are two residents, a nurse, and the attending.
Issues the student asks about:
1. patient safety
2. making your intern look bad
Ethical dilemma #2
I found myself an observer of an
"unethical" situation during my surgical rotation. My patient was a
59 year old woman who had to be admitted one night through the ER for small
bowel obstruction-secondary to advanced colon cancer. This patient had been
diagnosed with cancer approximately 3 year prior and had elected not to
undergo surgery at that time. She strongly believed in alternative medicine
and self-healing and felt that if she believed in the healing power of the
mind enough, she could overcome the ravages of her disease. Indeed she had
been living a fairly comfortable, functional life until her bowel obstructed.
She was very anxious about the inevitability of surgery, but reluctantly
agreed after making one request—she asked the surgeons to assure her that
during surgery even as she lie unconscious form anesthesia, that no one would
speak negatively about her cancer or her prognosis. The surgeons, of course,
agreed. As I stood by her side during the operation, I listened to a barrage
of comments concerning the hopelessness of her situation and how foolish this
woman was for refusing surgery in the first place.
Several nights later, while on
call, I went to the patient's room and found her lying in the dark crying. She
told me that in the recovery room she heard the surgeon approach the bed and
tell her nurse how extensive the cancer was and that she was not expected to
live more than a few months at best. She told me that she wanted to open her
eyes and tell him that she was awake, but the residual anesthesia wouldn't
allow it.
Ethical dilemma #3
While on a surgical service, I was
taking care of a 38 year old white man who was admitted for a procedure in
good general health. The patient had undergone similar operations in the past.
During the operation, the dural
covering of the spinal cord was nicked with a subsequent small CSF leak. The
incident took place despite careful dissection and meticulous technique. The
defect was easily repaired and the rest of the operation went without
complication.
Post operatively, the patient was
closely monitored with special attention to signs and symptoms of further CSF
leakage. The patient's hospitalization was extended slightly more than what he
expected and was longer than prior post-op stays. None of the housestaff or
faculty mentioned the intraoperative incident.
On the day of his discharge, the
patient was very appreciative of my care and asked if anything had happened
during the operation. He was mildly suspicious based on his post-op stay and
the team's questions. We had developed a good rapport, and the patient had
spoken openly to me about very personal issues. Although the CSF leak was
accidental and did not have serious adverse consequences, I felt uncertain
whether a student should be the correct person to inform the patient.
The rest of the team had already
seen the patient on rounds and were busy in the operating room.