Ward Ethics: Dilemmas for Medical Students and Doctors in Training

, by Edited by Thomasine K. Kushner , David C. Thomasma

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ISBN: 9780521664523 | 0521664527
Cover: Paperback
Copyright: 7/2/2001

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The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This volume includes over 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward.

Acknowledgments

xiii

List of contributors

Prologue. Breaking the silence

(4)

Letter from a young doctor

(4)

Richard Selzer

Part I. On caring for patients

(8)

Section 1. Performing procedures

(62)

The responsibility of informing

(15)

Implications of physician experience

(1)

Case: ``First time''

(1)

Commentary:

(4)

William Nelson

Paul B. Hofmann

Commentary:

(2)

Robert L. Schwartz

Commentary:

(1)

Neal Cohen

Special vulnerabilities

(1)

``Who was really benefiting from the multiple exams?''

(1)

``Hey, you want to drain an abscess?''

(1)

``Medically correct, but an ethical catastrophe''

(1)

``I was not supposed to be there''

(1)

Commentary:

(2)

Amnon Goldworth

Commentary:

(4)

George J. Agich

Treating despite discomfort and self-doubt

(10)

``Aren't you done yet?''

(1)

``Have you ever done a lumbar puncture?''

(1)

``The emergency department at 4:00 a.m.''

(1)

``Operating without experience''

(1)

Commentary:

(3)

Marli Huijer

Commentary:

(2)

William Andereck

Commentary:

(4)

Gregory L. Larkin

Blaming the patient

(7)

``If you weren't so fat''

(1)

``The patient removed the traction''

(1)

Commentary:

(2)

Alan Steinbach

Commentary:

(4)

Francis Kane

Breaking the code: is a promise always a promise?

(6)

``How `confidential' is confidential?''

Commentary:

(2)

Robyn Shapiro

Commentary:

(4)

Pablo Rodriguez del Pozo

The newly dead

(10)

``Patient or cadaver?''

(1)

Commentary:

(4)

Kenneth V. Iserson

Commentary:

(3)

Michael L. Gross

Commentary:

(3)

Jonathan Wyatt

Asking for help: who's listening?

(13)

``I fled from the room''

(1)

``I still don't know what I did wrong''

(1)

Commentary:

(5)

Barbara Supanich

Commentary:

(3)

David N. Weisstub

Commentary:

(3)

David Bennahum

Discussion questions

(2)

Section 2. Problems in truth-telling

(18)

Omissions: failing to come forward

(8)

``Omit the mistake''

(1)

``Was I acting under false pretenses?''

(1)

``White lies and omissions''

(1)

``I hated disappointing them''

(1)

``Sin of silence''

(1)

Commentary:

(3)

Lawrence J. Schneiderman

Commentary:

(4)

Ben Rich

Commissions: deliberate deception

(9)

``The chief resident `lied'''

(1)

``A false report''

(1)

Commentary:

(2)

Lawrence J. Schneiderman

Commentary:

(4)

Jeffrey H. Burack

Commentary:

(2)

Ben Rich

Discussion questions

(1)

Section 3. Setting boundaries

(26)

From professional to personal

(6)

``Do you want to see me again?''

(1)

``I don't think I took advantage of her''

(1)

Commentary:

(3)

Richard Martinez

Commentary:

101

(3)

Rosamond Rhodes

Losing empathy

104

(9)

``Patients I don't like''

104

(1)

``Why should I invest in these patients?''

104

(1)

``A nurse said I should be more empathetic''

104

(1)

``Where were the third year students?''

104

(1)

``I hope this patient dies''

105

(1)

Commentary:

105

(3)

Richard Martinez

Commentary:

108

(3)

Marli Huijer

Commentary:

111

(2)

David Bennahum

The limits of compassion

113

(10)

``Does being a doctor include being a social worker?''

113

(1)

``I took a bus to his house on my day off''

113

(1)

``How do I suffer with her?''

113

(1)

``You don't help your patients by crying with them''

114

(1)

Commentary:

114

(2)

Richard Martinez

Commentary:

116

(3)

Guy Micco

Commentary:

119

(3)

Mary B. Mahowald

Discussion questions

122

(1)

Part II. On becoming a ``team player'': searching for esprit de corps and conflicts of socialization

123

(12)

Section 4. Abuse and mistreatment

135

(18)

Psychological abuse: subjected to humiliating and belittling behavior

136

(6)

``You idiot! What are you doing in medical school?''

136

(1)

``I would knock you to the floor''

136

(1)

``He treated me like a scut monkey''

136

(1)

``I knew better than to spoil his fun''

137

(1)

Commentary:

137

(2)

Ruth B. Purtilo

Commentary:

139

(3)

Gerrit Kimsma

Physical abuse: actual physical harm

142

(6)

``The commander''

142

(1)

Commentary:

142

(2)

David N. Weisstub

Commentary:

144

(4)

Emilio Mordini

Sexual abuse: sexist slurs and sexual advances

148

(5)

``Homework''

148

(1)

``What do you like best?''

148

(1)

``The histology lesson''

148

(1)

Commentary:

148

(2)

Domeena C. Renshaw

Commentary:

150

(2)

Evert van Leeuwen

Discussion questions

152

(1)

Section 5. Argot, jargon, and questionable humor: assuming the mantle at the patient's expense

153

(18)

Comedians: mordant humor and cynicism

154

(9)

``You killed one of our patients''

154

(1)

``Laughter and jokes at morning rounds''

154

(1)

Commentary:

155

(3)

Barbara Supanich

Commentary:

158

(5)

David N. Weisstub

What's in a name? Derogatory references

163

(8)

``Goombah''

163

(1)

``Shooter with a fever''

163

(1)

``The gorked gomer''

164

(1)

``Fob''

164

(1)

Commentary:

164

(3)

Jacquelyn Slomka

Commentary:

167

(2)

Harvey M. Weinstein

Discussion questions

169

(2)

Section 6. Making waves: questioning authority and the status quo

171

(44)

Personal identity

172

(6)

``Who am I?''

172

(1)

``Don't tell her you are a medical student''

172

(1)

``Premature description''

172

(1)

``The anonymous greeter''

172

(1)

``Without portfolio''

172

(1)

Commentary:

173

(3)

Griffin Trotter

Commentary:

176

(2)

Kate Christensen

Duties to treat?

178

(5)

``Unnecessary personal risk''

178

(1)

``He was telling me to take a risk he wasn't willing to take''

178

(1)

``I said I might be pregnant''

179

(1)

Commentary:

179

(1)

Gerrit Kimsma

Commentary:

180

(3)

Neal Cohen

Hierarchy and the dynamics of rank

183

(25)

Questioning authority

183

(1)

``Just a consult''

183

(1)

``Don't mess with the chain of command''

183

(1)

``Why use that medication?''

183

(1)

``Level with me''

184

(1)

``Why couldn't the patient be premedicated?''

184

(1)

``I followed orders even though I thought they were wrong''

184

(1)

``Help! My senior registrar has gone fishing''

185

(1)

Commentary:

186

(4)

Soren Holm

Commentary:

190

(4)

Griffin Trotter

Acting against authority

194

(1)

``When I speak you must follow''

194

(1)

``The patient is dead, leave him dead''

194

(1)

Commentary:

195

(2)

John Harris

Commentary:

197

(6)

Alan Steinbach

Striving to stay on top: competing with peers

203

(1)

``He would always arrange to have the easiest cases for himself''

203

(1)

``Just another cut-throat medical student''

203

(1)

``The new arrival was the ideal `victim'''

204

(1)

Commentary:

204

(2)

David N. Weisstub

Commentary:

206

(2)

Jean-Christophe Mino

Conflicts of interest

208

(7)

``Should I accept drug company goodies?''

208

(1)

Commentary:

208

(2)

James Weber

Commentary:

210

(4)

Carson Strong

Discussion questions

214

(1)

Section 7. Perceiving misconduct and whistle-blowing: observing peers or superiors commit an act deemed unethical

215

(40)

Abusing alcohol or drugs

216

(7)

``Whistle-blowers take a lot of heat-particularly when they are a nobody''

216

(1)

``Missing drugs''

216

(1)

``I found the attending overdosed and unconscious''

216

(1)

Commentary:

217

(2)

Rosamond Rhodes

Commentary:

219

(4)

Neal Cohen

Mistreating patients: nasty, rude, or hostile behaviour toward patients

223

(8)

``The patient had been verbally assaulted''

223

(1)

``Stop bothering us''

223

(1)

``The unknowing widow''

223

(1)

``The patient's wishes were ignored''

223

(1)

Commentary:

224

(4)

Ben Rich

Commentary:

228

(3)

Tod Chambers

Covering up

231

(17)

To acknowledge?

``The camouflaged patient''

231

(1)

``Didn't you write that order?''

231

(1)

``What should they have been told?''

231

(1)

``I knew the damage was iatrogenic''

232

(1)

``Boxed kidneys''

232

(1)

``By not telling am I an accomplice?''

232

(1)

Commentary:

233

(2)

Thomas A. Cavanaugh

Commentary:

235

(3)

Marli Huijer

To intervene?

238

(1)

``Does anyone have a problem with this?''

238

(1)

``No one stopped him''

238

(1)

Commentary:

238

(3)

Neal Cohen

Commentary:

241

(3)

Bethany Spielman

Commentary:

244

(4)

Akira Akabayashi

Misrepresenting research

248

(7)

``Was I a coward?''

248

(1)

``A faculty member listed his name as first author''

248

(1)

``Unethical author attribution''

248

(1)

Commentary:

249

(2)

Akira Akabayashi

Commentary:

251

(3)

Charles Weijer

Discussion questions

254

(1)

Epilogue: Using this book

255

(4)

Glossary

259

(2)

Index

261

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Ward Ethics: Dilemmas for Medical Students and Doctors in Training

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