Caring for 'Undeserving' Patients
Physicians don't check their humanity at the door. Neither do their patients. For many doctors, that simple truism is the source of frequent conflict and frustration. Says one doctor, frustrated by patients' refusal to quit smoking, watch their diet, or take their medication as directed, simply "remaining engaged in the face of patient apathy" is a daily challenge.
But when patient behavior deteriorates from unhealthy to self-destructive and the medical resources in question are especially precious, the ethical stakes are higher. Physicians responding to the survey describe such situations as "doing a liver transplant on a patient who tried to kill herself" and "offering liver transplant options to alcoholics."
In these situations, Goodman says, doctors are unfairly being forced to grapple with an ethical dilemma because the process for determining who gets an organ has failed. "If someone is going to waste a liver, they ought not to get it. That is putting the physician in a position they ought not be in," he says. "Fix the process."
Still, many doctors say it is not the self-destructive patients, but the ones who willfully harm others, that present the greatest challenge. Doctors describe the emotional challenges they've faced in "giving 100% effort to a cop killer" and using precious healthcare resources to save enemy combatants in Iraq and Afghanistan "at the possible cost of our own troops."
One anesthesiologist writes, "During my residency, a nurse was raped and strangled. Her attacker was caught and brought to the operating room. I provided the anesthesia. It was very hard to decide how much anesthesia to provide."
Providing care to people who have committed abhorrent acts has always been and will always be an emotional struggle for doctors. But, as one anesthesiologist notes, the ethics are clear. In administering anesthesia to a prisoner who had thrown acid in the face of a young girl he had raped so that she couldn't identify him, the doctor realized, "The power of life or death is in those syringes. I did the right thing and administered the same safe anesthetic I would to anyone. Only God can be judge and executioner. We are to love our neighbors, even the unlovable ones."
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Cite this: Shelly Reese. Doctors Describe Their Toughest Ethical Dilemmas - Medscape - Feb 23, 2017.