On Doctoring II

Ethics: Capacity, Consent & Confidentiality

Instructions for Spring 2018 Sessions

Niel Rosen, JD, PhD

Co-Course Director
rosenjn@rowan.edu

We will meet twice during the Spring Semester, in the morning on both January 23 and February 13. The
class will be divided into three groups and I will meet with each group for an hour so in the
Multipurpose Room (MPR). Ms. Brittany Mitchell will send group assignments to you when they
become available. I will meet with each group for an hour or so. Complete the following homework
beforehand.

Your homework for January 23 has three parts.

1. Read the following sections of Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical
Medicine:
a. All of Topic Two
b. Section 4.3 on confidentiality
2. Read the transfusion and amputation cases
3. Bring your written answers to the following questions to class

General questions for both cases:

1. Who are the stakeholders?
2. Who should be involved in deciding what should be done?
3. What are your concerns?
4. What do you think would be the best outcome?
5. What do you think would be the worst outcome?
6. If you were the responsible physician in each case, how would you resolve the ethical dilemma?
7. What principles, norms or values support your resolution?
1) Who are the stakeholders?
The stakeholders are both the patient and the physician. Even the hospital if the physician works
in an inpatient setting. The patient seeks to benefit by getting him or herself better via any
service the healthcare can provide. The physician stands to benefit by being paid for his or her
services. Lastly, the hospital and other 3rd parties benefit by gaining any monetary benefits. In
summary, every single person involved in this interaction benefits and has a potential to lose
something. Unless malicious intent is involved, no one is left out as stakeholder.
2) Even though the readings emphasize patient autonomy, both the physician and patient are
involved to some degree what should be done. However, the physician should be more involved
moreso than the patient. The patient came to the physician to lean on his expertise and
experience. It makes no sense for the patient to take all the initiative on his own and not rely on
what the physician knows. The physician knows what is good and bad for the patient, so the
patient should not take the lion’s share in terms of what should be done, especially since the
patient is not as knowledgeable as the physician.
3) My biggest concern stems from the amputation case. In this case, the patient is refusing
amputation, even though refusing comes at the cost of his life. It also doesn’t help in that if I
managed to convince him to accept the treatment, it also means making him give up his dream
of playing sports. Doctor’s obligation is to heal. If you accept the patient’s wish, you are
neglecting your obligation. Reconciling yourself with this hard disposition will be one of the
biggest challenges physicians will have to learn to overcome.
4) If I can continue using the amputation example for my point, the best outcome would be the
physician offering his advice, the patient complying, and everyone gains something as a
stakeholder. This means that somehow the patient can still continue playing sports. Most cases
lead to an ideal outcome where no one goes through any tragedy. Depending on the specialty,
however, you may never encounter this ideal scenario.
5) The worst outcome would be the patient not getting better, suing the physician, and forcing the
physician to lose his or her license even though the physician did everything in his or her
capability to help the patient.
6) In the amputation case, I would do everything in my power to convince that person to accept
the amputation. We made an oath when we went to medical school to do whatever it took to
help the patient, even if the patient refuses. If we allow the patient to refuse, that is our way of
allowing the patient to harm himself. In the case of the transfusion, it is not illegal to give EPO. I
would most definitely give EPO to him. Because even though he is refusing treatment, he is still
proposing an alternative treatment that has no detrimental effect on him.
7) I live by the rule of “If you live longer, you are good.” And this shapes a lot of my decision,
especially as a physician. I would do whatever it took to live longer, because by living longer, I
can continue making a positive impact in people’s lives one way or another. And this extends to
making patients live longer for this very reason, so that they, too, can continue making positive
impact towards the people in their lives.