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Sarah Murnaghan. 10 yo F with cyctic fibrosis Denied lung transplant with adult lungs Would be eligible for adult lung if 12 50% 5 year survival with CF Federal Court ruled Sarah should be placed on adult transplant list First transplant failed, received second. Anthony Stokes.
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Sarah Murnaghan • 10 yo F with cyctic fibrosis • Denied lung transplant with adult lungs • Would be eligible for adult lung if 12 • 50% 5 year survival with CF • Federal Court ruled Sarah should be placed on adult transplant list • First transplant failed, received second
Anthony Stokes • 15 yo with heart failure, 6 mo prognosis • Childrens Healthcare of Atlanta declined to place him on heart transplant list due to failure to comply with medications • Poor grades, minor legal difficulties • Civil rights groups taking up cause
Herbert and Catherine Schaible • Charged with murder in death of 8 month old who died of pneumonia • 2 yo son died in 2009 of untreated pneumonia, parents placed on probation, required to seek medical care • Members of First Century Gospel Church, believe in divine healing • If parents can choose abortion, can they choose to withhold medical care?
Ethics and Professionalism • 34 year-old single woman, on public assistance, comes to you for IVF • Previous IVF resulted in six children, all living with her • What would you do? • Why?
Ethics and Professionalism Richard L. Elliott, MD, PhD, FAPA Professor and Director, Medical Ethics Mercer University School of Medicine Adjunct Professor Mercer University School of Law
Ethics and Professionalism at MUSMFaculty • Richard L. Elliott, MD, PhD (Macon) • Room 62, East Hall, MUSM • Elliott_rl@mercer.edu • Martin H. Greenberg, MD (Savannah) • R. Stephen Williams, MD, MHSA (Macon) • Others
Ethics and Professionalism at MUSMOffice of Professional Practice • Medical ethics • Professionalism • Legal regulation • Malpractice, EMTALA, HIPAA, . . . • Health administration • Payment systems, accreditation, reform • Interest group
Ethics and Professionalism at MUSMCurriculum • Orientation • Community Medicine I • Informed consent, confidentiality, professionalism • Community Medicine II • Research ethics, abuse of trainees, pharmaceutical industry malpractice • Clerkships • Internal medicine, pediatrics, ob-gyn, family medicine, surgery, EC • Senior papers and electives • Capstone
What to do? A child in an MVA is losing blood rapidly, mom refuses permission for transfusion based religious beliefs
What to do? An HIV-positive man admits he is sexually active, states he cannot tell his fiancee his HIV status
What to do? A patient comes repeatedly to the EC demanding opiates for headaches
Medical EthicsCurrent Controversies • Use of embryonic stem cells – is it OK to “sacrifice” embryos to save lives of adults? • Transplantation – how do we establish priorities for recipient lists • Futility of care – when can MDs “pull the plug” over the wishes of patient and family? • When can we override wishes of parents and treat children (e.g., JW)? • How do we handle performance enhancers?
A helpful resource? A faculty member provides a list of the answers to an upcoming test and tells you to let everyone know on your campus, but not to let the other campus know about the list.
Is it cheating? A first year student asks a second year student for advice regarding his upcoming MDE exam. She gives him a list of old exam questions and review sheets that will help you greatly. She states that you should “keep it quiet” when around faculty, because some have been disgruntled with old questions floating around, but that each class has done so in the past. She encourages you to pass the materials on to your friends.
Can’t we be friends? • You are a woman third year student who studied in the company of a group of friends the first two years. During your first clerkship one of the group begins to make unwanted advances and, despite your insistence this can go no further, he persists and becomes aggressive.
Who will be disciplined by medical boards? • Greatest risk if disciplined during medical school • Drugs and alcohol • Who is your AIMS representative? • Reliability • Preparation, on time • Volunteering • Respect for colleagues
Professionalism in non-clinical years • Be on time • Dress appropriately • Courtesy and respect for all • Preparation • Help your brothers and sisters • Academically • Substances, recreation, etc • Social media
Between your first and second years of medical school, you do laboratory research at a hospital near your home. After a couple of months of hard work, you collate your data and write a draft paper for the faculty advisor to revise before submitting it for publication. After reviewing your draft and making many comments, you see that they have included the name of one of the second-year students, although he didn’t have anything to do with your work. Afraid of angering him, you don’t say anything. However, a few weeks later, you discover that your name has been added to a paper the other student has written with you were not involved with.
Financial Aid • A third year student receives the FAFSA packet in February of her second year, signing a form acknowledging that she received it. The Office of Financial Aid sends several reminder emails to the student that she needs to fill out the application. In the first week of her third year, her financial aid check is not at the bursar’s office. The student calls the Director of Financial Aid and yells at her saying that no one gave her the packet, she didn’t get any emails reminding her, and demands a check
I’m lonely • You are interested in a competitive specialty and you have heard that the best way to get in is to have a lot of research publications. A male faculty member has a reputation of having many students in his lab and many of them get published. One evening, he calls a female student and tells her that his wife is out of town, he is lonely, and he wants her to come over to keep him company.
