Good ethics scenarios

tallaght01

A girl in my job is some kinda scientist :P and she wants to do GEM medicine. She's done the exams, and got a GAMSAT score of god knows what. But in Oz, if you get above a certain GAMSAT score, that gets you into a round of structured interviews.

One of the interviews involves patient/doctor interactions in difficult ethical scenarios. So, she's asked me to help her prepare. I'm going to be the patient and give her some ethical dilemmas.

I'm scratching my head trying to think back to med school for the recurring themes that used to come up in these things.But I don't remember many from the early years that would e suitable fr someone with no med training.

So far I can think of

Confidentiality.....patient wanting to know her brother's syphilis result because he's going out with her best mate. Patient wanting to know the swine flu results of a kid who goes to her son's school.

Complaint about another doctor being made during a consultation.

Paternalistic stuff..patient asking you to make important decision for them. Patient coming to see you about the operation her brother is going to have, so she can decide whether it's right for him or not.

Contraception: 15 year old girl wants the pill. you know her parents, and they would be utterly opposed to this.

Anyone got any other ideas?

DrIndy

Thinking of a few:

Husband has an STD from a male-male encounter - its a serious one and he has forbidden you to talk to his wife.

Do not resuscitate orders. The family want it but you know that the outlook is very bleak.

Contraceptive pill and morning after pill.

Ethics and the law. We hide behind the law sometimes - but just because something is legally correct - is it ethically correct?

Blood transfusions for Jehovah's Witness patients - particularily when minors are involved.

Chunky Monkey

One I had at my interview...guy had cancer, cancer went into remission but then came back and guy decides he doesn't want to go through all the treatments again. Wife comes to you as the f1 and asks you to lie to him about it and say he has no choice but to continue treatment. What do you do? Who do you ask if you're not sure? etc.

drzhivago

Mother comes yo you GP, she took days off work last week because her daughter was sick, she wants you to give her a note for work do you


15 year old girl comes alone to surgery, wants the pill, is sexually active with 18 year old boyfriend

drkpower

36 weeks pregnant woman, for whatever medical reason,3 requires immediate delivery/caesarean section. She refuses, for whatever reason, to be induced/have C-section.

ttm

Check BBC Radio 4's website. Can't find what I'm looking for there myself but someone else might remember, there was a series on recently that covered serveral specific medical ethics senarios in great depth including the conclusions from the Medical Ethics Council. Sorry if thats a bit vague but if there is a listen again for the program - someone help me here:) - then I think you'd find it useful.

Jessibelle

Should brain dead babies be kept alive through mechanical means if that's what the family wants?

ttm

Found what I was looking for.....

BBC Radio 4 program Inside the Ethics Committee

Should a young man with a phobia of operations be forced to have life-saving surgery?

Should a woman be given a kidney transplant when there is a high risk of failure?

At what point is a woman's disability an obstacle to her having fertility treatment?

Should a terminally-ill and suicidal woman be monitored against her will?

All available on the web to listen again.

The interesting point even to me was that they don't tell you the outcome of the Ethics Committee untill they have discussed all the evidence so you can make you own mind up before you hear what the Commitee decide.

And I think the archive of previous years programs also have a listen again feature.

DrIndy

And another one here - should an alcoholic be allowed to have a new liver when someone else may need it also but have a non-alcohol cause of liver failure?

tallaght01

All great ideas, folks. I'll be using a lot of them.

They're pretty harsh, though, considering she hasn't even started med school yet.

But it's better prep if she gets tougher scenarios from me than those that come up in the real thing.

Inflatable Rat

A doctor has just come off his shift exhausted but due to a staff shortage he/she has been asked to continue on to the next shift. The doctor wouldn't contemplate driving the long distance home due the possible risk of falling asleep at the wheel but accepts to continue working.

tallaght01

Inflatable Rat wrote: »

A doctor has just come off his shift exhausted but due to a staff shortage he/she has been asked to continue on to the next shift. The doctor wouldn't contemplate driving the long distance home due the possible risk of falling asleep at the wheel but accepts to continue working.

That's not an ethics question. That's just normal :P

DrIndy

The key thing with ethics is there is no black or white answer, just shades of grey.

You need to be able to show that you have thought everything out from every perspective and then come up with a balanced response for the situation at hand.

Chunky Monkey

Might find some good ones here: http://www.ethics-network.org.uk/

bleh1234

When we were doing ethics in college the big thing was to refer to the 5 ethical principles in the answer so no matter what the question referring back to informed consent, confidentiality, autonomy, beneficience & non maleficience in the answer pretty much guaranteed good marks.

A question that often came up was one liver/kidney etc for transplant & 4 different pts 1 usually a young kid with cancer who's life expectancy even with transplant is poor, 2 a disabled person, 3 a person involved in some form of trauma, 4 a previous IVDU who's turned their life around. Who gets the organ.

I got asked in an interview you're the SHO on call your reg arrives to work drunk but thinks he'll be ok if he gets a few hours sleep. What do you do.

Inflatable Rat

tallaght01 wrote: »

That's not an ethics question. That's just normal :P

I suppose the doctor could just prescribe himself/herself amphetamine and wash it down with a coffee from the vendor machine

AmcD

A father brings in his 14 year old daughter, who has abdominal pain. You ask her for a urine sample. Out of habit you do a hCG, but don't specifically ask permission. It comes up positive. On abdominal examination she is about 26/40. She denies ever having sex.
How do you approach this?
-Doing a test without permission on a minor
-Pregnant minor under the age of consent
-Possibly drunk when she conceived
-STI issues
-VERY upset father.

AmcD

A woman in her 40's has recently been made redundant, as has her husband. She has worked all her life. The jobseeker's allowance won't come through for another 12 weeks. She has no money. "Can you put me on certs doctor?"

Lassiecomehome

A good one for a student would be you're a doc (consultant/reg/sho whatever) and she's the student. Doc asks student to perform a procedure for which they havn't been adequately trained.

- Scenario A: student lies and carries out procedure and something goes wrong
- Scenario B: doc pressures student into doing procedure when they're not comfortable doing it, how do you react to intimidation from a senior.

Another ethics scenario I remember coming up was a mother asking you to test her child for a genetic disorder (e.g. Huntington's or BRCA1). What would make you say no etc.

Vorsprung

Lassiecomehome wrote: »

A good one for a student would be you're a doc (consultant/reg/sho whatever) and she's the student. Doc asks student to perform a procedure for which they havn't been adequately trained.

- Scenario A: student lies and carries out procedure and something goes wrong
- Scenario B: doc pressures student into doing procedure when they're not comfortable doing it, how do you react to intimidation from a senior.

Another ethics scenario I remember coming up was a mother asking you to test her child for a genetic disorder (e.g. Huntington's or BRCA1). What would make you say no etc.

And on a related note, interns consenting patients for procedures they've never seen/heard of before. Happens every day in Irish hospitals.

GER12

The use of chaperones in physical and intimate exam - what do you do if a clinical head of a Govt Dept develops a "stated policy" that prohibits patients from having a chaperone present during physical exam and faced with a situation where none of your colleagues (Dr's and Nurses) ever objected to implementing this stated policy and the policy was never reviewed or updated.
When to recognise limitations in professional knowledge and defer to persons more competent.
Witnessing inappropriate behaviour or becoming aware of inappropriate behaviour re a colleague
Informed consent and medical assault

Chunky Monkey

Why would they prohibit chaperones?

tallaght01

Chunky Monkey wrote: »

Why would they prohibit chaperones?

Yea, I dont think that post will be making it into the ethicks dossier. Though I do have loads of ideas, thanks to this thread.

GER12

Chunky Monkey wrote: »

Why would they prohibit chaperones?

Asked the clinical head to clarify that question myself - got told "its alway's been accepted practice".... dont think they are too familiar with modern up-to-date practices myself.

In relation to the last poster - the use of chaperones in the literature is about protecting both doctors and patients - not to mention things around respecting rights and the autonomy of the patient.... and good ethical guidelines published by the IMC identifies that right as an ethical issue as does the GMC.