by Craig Klugman, Ph.D.
“Exploring ethical issues in TV medical dramas”
The Good Doctor (Season 3; Episode 17): Lying for Good; The Resident (Season 3; Episode 17): Operating impaired when there is no option; New Amsterdam (Season 2; Episode 16):Research Misconduct; Two Wrongs Do Not Make a Right; Grey’s Anatomy (Season 16; Episode 17): VIP Justice
An adult leader of an outdoor for troubled youth is pricked by a cactus and comes down with an infection that causes heart damage. On top of that, during surgery a loss of oxygen compromises his kidneys to survive, he needs a new kidney but given his heart problems and a history of drug use and hepatitis B, he is an unlikely candidate. However, one of his charges is an emancipated minor who turns out to be a match. He wants to donate his kidney. A meeting of two residents and two attendings questions whether even being emancipated, he should be permitted to donate. They vote 3 to 1 to allow the surgery. But Lim says “This is not a democracy” and lets the patient know she can’t approve the transplant. The leader asks Lim to do him a favor—to lie to the kid and tell him he is not a match so that he doesn’t go through his life thinking that he couldn’t save his mentor. She agrees.
Although the general rule is that physician’s should not lie, this is one of the few areas when that is permitted. Often it is when a person is a match but does not wish to donate; the lie is told to the person in need of an organ to preserve relationships. In this case, the situation is reversed but the sentiment is the same.
A newborn infant with of Fallout needs heart surgery to repair its many medical problems. The baby was supposed to be born in Boston with a specialist, but came early. There is only one surgeon in Atlanta capable of doing this surgery. When Pravesh goes to bring her into the OR, the surgeon is on a banana bag and sucking down oxygen. When she tears the pulmonary artery, it is clear that she is drunk and Austin removes her from surgery. Still, she is the only one who can do the surgery—there’s no time to bring the specialist in and the baby can’t be moved. The doctor says with a drink, she will be fine, she’s suffering from withdrawal. Austin gives her the drink and she directs the surgery, with Austin and another doctor acting as her hands.
First, Pravesh should have reported his suspicions from the very beginning, not waiting until the OR. Second, a physician should never work when altered (under the influence of alcohol or drugs). Or (third) is this a case of what we call in Jewish law, pikuah nefesh, that all laws (except for adultery and incest) are set aside to save a life. If there truly is no one else available and the infant is doomed to certain death without this chance, then is it okay? There is simply no way to accept an altered doctor from operating. By having her guide, but not perform the operation, the show threaded a small needle between endangering a patient and saving a patient in desperate need. Although a practical solution, it certainly is not ethical and if there is a bad outcome, everyone involved might be negligent.
After discovering her nemesis is faking patient’s tumor data in order to show that a clinical trial looks good, Sharpe decides she can’t tell anyone in leadership. Goodwin created a policy that all mistakes should be made public. In this case, faking an NIH trial would cost the hospital millions of dollars and a PR nightmare. Instead, she decides to blow up the trial. Sharpe changes the labels on the IV drug bags—mixing up the new drug and the placebo—thus, compromising the trial. When Cook confronts Sharpe, Castro admits that she changed the baseline data because the drug wasn’t showing itself to be as effective as she knew it is. In exchange for Sharpe not telling, Castro resigns from New Amsterdam.
In reality, both of these physicians were unethical. Making up data to show a benefit in a trial is a violation of public trust and scientific misconduct. There should be a report, investigation, and punishment for both the researcher (firing, blocked from applying to federal funding for a period of time, ethics training) and the institution (for not having sufficient review and oversight). However, Sharpe was wrong to sabotage an NIH funded experiment, thus costing millions of dollars and putting her institution at risk. Although reporting to the correct channels was the harder route, it was also the right route. Both Castro and Sharpe should be fired and a full accounting made to the NIH and FDA.
In a second story, a previous case comes back to haunt. A patient’s family dies for wrongful death when he dies on Reynolds’ table. We learn the patient was a white supremacist and Reynolds knew. Did he compromise care to punish the patient (who committed a mass murder by killing people at a public even with toxin)? The hospital attorney (also Reynold’s fiancé) takes depositions and finds that no one did anything wrong, but the hospital should settle anyway. The conscientious doctors were too honest in their thinking and each recognized some small things that could have done better—to a jury it would look like a series of mistakes rather than thoughtful physicians. Of course, this idea violates ethics—it is wrong to take blame for something they didn’t do. But in this case, a trial is about the theater—the appearances—and in this case, we are told that settling is the better choice.
In a third storyline, a teenage girl has PTSD after a shooting in the school. The issue is that the shooting was a drill, not a real incident. It was staged to be as real and unexpected as possible. When Frome visits the school, he learns that budget cuts led to the firing of all school counselors and a concern from the principal that if they don’t do drills and there’s a real shooting then they’d be liable for not having taken action. This storyline is a direct reference to a call by the American Federation of Teachers and the National Education Association to end such drills because they cause harm to children. There is no evidence that such drills are effective in preparing schools and students and in fact may give potential perpetrators knowledge of responses that would allow them to plan differently. Also, students may experience anxiety and trauma from these realistic drills. The drills, in part, have been encouraged by a number of private corporations that train people in how to conduct the drills. The ethical issues are why are we “solving” the gun problem by traumatizing children, the tension between
Ford is an eccentric billionaire whose new rocket exploded over the city. He is also a generous donor to the hospital. His investors are spooked, people were hurt, and there is talk of a criminal investigation. He believes that there must be something wrong with him that led to this failure. He wants Koracick to find what that is which would explain him not succeeding. He donates to the hospital’s foundation. Grey is seeing a patient in the ED who is rationing her insulin to help her parents get the care they need. Koracick calls and pulls Grey away for an emergency consult. The emergency room is filling up with patients because there are no beds available. Koracick closes off an entire floor of the hospital in order for Ford to have privacy and space. When Grey sees Ford, he seems fine and he’s playing with his dog. Test results show that Ford has low vitamin E levels and some normal wear and tear, but otherwise nothing wrong with him. With news that he is healthy, Ford asks Koracick whether he has something rare wrong with him and says that he could make Koracick quite rich if he does find that rare problem. Koracick, thinking about the riches Ford might send his way, seems to find an aneurysm that might need surgery someday. Ford asks “When will we know [if it needs surgery]” and Koracick answers, “When we see the size of the check.”
There are a lot of problems with a for-profit health care system and this episode shows some of the problem—that access comes with money. And that those who struggle and work multiples jobs to makes ends meet cannot get lifesaving medication, while the .01% can close an entire floor (preventing lots of people from getting care) when there is nothing wrong with him except hubris. One person gets three dozen rooms when three dozen patients get nothing.