Chapter 4: Professionalism, Elitism and Health Care

Section 5. Decision Scenarios

1. A student preparing for a career as a nurse was working part time in the office of a proctologist. She told this tale to her class in Medical Ethics.

She was instructed by the office manager to clean the instruments used between services being performed by the physician. She was told to place them in a device and to set it on "RINSE". When she asked why not set the device to "STERILIZE" she was told that it takes too long and the doctor has need of the instruments again. In the beginning whenever she place the instruments into he device she set it to "STERILIZE". Her supervisor observed her doing so and then instructed her once again to set it on "RINSE". She asked: "Won't that put patients at risk of infection?" The answer was : "Yes it will . But , by the time they learn of the infection several days would have gone by and they probably won't relate it to their visit to this office."

The student went on working for that office and she attempted to set the device to "STERILIZE" whenever she could. She told the class this story and when asked by the instructor in front of the entire class for the name of the doctor so that the instructor could avoid that office if such services were ever needed by the instructor, the answer was : "Well I'll tell you after class but I do not want to day in front of everyone here."

How would you feel if you were a member of that class?

What is prompting her to continue to work at that office and accept the setting of the device on "RINSE" and subjecting people to possible harm of infection?

What model of the relationship of physician to recipient of care do you think the doctor holds? What is the model of their relationship to those whom they serve being used by the office assistants in this situation ?

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2.  How should a doctor, nurse, EMT, or medical technician behave when they are not working and they encounter an accident scene with people who are injured?

Why?

What model of their relation to the injured parties do you favor?

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3. Now back to the three cases with which this text and this chapter began.

A. Whistle Blowing

  • Dr. D: surgeon
  • Dr. A: anesthesiologist
  • Nurse N: scrub Nurse in OR

Dr. D is about to perform a surgery-an appendectomy. It is 3pm Dr. A and nurse N both observes Dr. D with slurred speech and detects alcohol on his breath. Dr. D prepares for the surgery. The patient is anesthetized. Dr. D. is handed the scalpel and drops it then fumbles to pick it up again. Dr. A asks, "Are you alright?" Dr. D answers, "Of courses I am!"  "Let's get this done."

Dr. A:  "Doctor, perhaps we could postpone this?"

Dr. D: " No, I'm perfectly all right."

Nurse N: "I'm not so sure."

D: " Who are you to tell me what to do?"

Should A and N continue to assist D in the surgical procedure? Should they physically restrain D? Should this event be reported? If so, by whom and to whom? What should be done then?

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B. Truth Telling

80 year old female B has cancer of the uterus-metastasized- and through the pancreas and liver

She asks her physician A "Just what are my chances?"

The doctor wonders what exactly to tell her: should the physician report the exact findings of the various tests and their meaning in terms of the prognosis in the clearest manner possible or should the physician present a less negative report in a compassionate manner even though the report will not be as accurate or as truthful as it otherwise might be?

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C. Letting Die

A 45 year old female with ALS. Diagnosed three years earlier she has endured continual loss of control over her muscles and deteriorated considerably. She is immobilized and has experienced several respiratory failures and now asks her doctor to leave her alone. The next time she experiences respiratory arrest she wishes to be left alone to die. Should the doctor grant her request? Follow her instructions?

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Think about how the individuals in this scenario would respond to the questions posed if the doctor is operating out of each of these models:  Code ,Contract ,Covenant

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Copyright Philip A. Pecorino 2002. All Rights reserved.

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