Ethical Dilemma and Legal Implications

by Mark Hughes, MD, MA

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    00:00 In this lecture, we're going to talk about ethical dilemmas.

    00:04 So dilemma basically means involving 2 assumptions.

    00:09 So in this case, we might have 2 approaches that seem reasonable in terms of how we're going to handle a particular situation.

    00:18 And so it's maybe 2 or more alternatives. They seem mandated.

    00:22 You know, both should be followed or both seem desirable but you can't follow both because they seem to be in conflict in some way.

    00:30 A classic example would be a challenge between respect for autonomy and beneficence.

    00:37 So if I'm taking care of a patient with substance use disorder and I recommend that they need antibiotics to treat endocarditis, an infection in a heart valve and I say "You need to be in the hospital and stay on the antibiotics for a period of time", that would be the beneficent thing, that's the medical good that I'm trying to achieve, but respect for autonomy might mean well the patient says no, "No, I don't wanna stay in the hospital. I wanna leave." And now we have a conflict, we have a clash, we have a dilemma.

    01:06 Can serve both interests, the respecting autonomy and the beneficence so we have to try to figure out how to solve that dilemma.

    01:16 And we can think about, you know, individual times in that may happen with a particular patient, but we can also think about it in terms of when it happens in a community.

    01:24 So, there may be hot topics in ethics where there is no agreement.

    01:29 There may be no consensus about how to handle that situation.

    01:33 And that then creates a dilemma for the clinician needing to confront that issue.

    01:40 And then it also might mean that the individual themselves has this ethical conflict.

    01:44 So I as the clinician taking care of the patient may have an inner conflict of "I wanna serve all principles, I wanna try to do good by this patient, but I'm having a dilemma and try to figure out how to do that.

    02:00 And that creates this inner conflict.

    02:02 And for some people, you know, that's going to create an emotion, an emotional reaction of "I feel stuck, I can't, you know, figure out a way through this." And that may then affect our problem solving.

    02:15 So as we talked about in other lectures about the ethic of care and paying attention to our emotions and how we're reacting to a case, but we're also talking about reasoning and problem solving and trying to figure out solutions.

    02:27 So with ethical dilemmas, we have to sort of think about all of these things, challenging the 2 assumptions and figuring out is there a way to find some resolution.

    02:37 Handling our own emotions and the moral distress we may feel.

    02:41 But then also, you know, solving the problem to, again, serve the best interest of the patient.

    02:49 And that means that we need a structured approach.

    02:52 We need to figure out a way to think through the dilemma.

    02:56 And so, medical ethics, as I've said in other lectures, is very practical.

    03:01 We need to have a solution at the end of the day.

    03:05 And so if you approach it in a structured, comprehensive way, you can figure out a way through the dilemma.

    03:12 And by using that systematic method consistently, you're going to be able to figure out how to handle the common problems that all of us encounter when we're taking care of patients, but also those rare circumstances where it's really tricky case, you're not sure how to handle it.

    03:27 But if you have this systematic process, then maybe you can figure out a way through.

    03:34 So it is a practical discipline.

    03:35 Every patient encounter requires, you know, thinking about that internal morality of medicine requiring that you need to make decisions, you need to take actions, you need to work with your patients in helping them through their problems.

    03:51 One thing to pay attention to when you're thinking about this is that there may be legal mandates.

    03:55 So, hopefully and often, the ethical principles and the legal principles are going to be, you know, in concert and in sync with each other.

    04:06 And they're going to help guide your medical practice.

    04:10 So there might be times where, you know, physicians, nurses, other healthcare professionals see mandates by law, you know, legal duties, that seem to interfere or conflict with their ethical responsibilities.

    04:25 Now it's going to depend on the jurisdiction, you know, where you practice medicine or nursing or healthcare as to how those laws match up with, you know, the core ethical principles.

    04:37 So, you have to find out from your own jurisdiction how the law is applied.

    04:42 But the idea would be, you know, take your core ethical values that you learn from the profession.

    04:48 Think about the legal principles. See how they might be closely related.

    04:52 But in general ethical responsibilities usually exceed legal duties.

    04:57 So what the law might say you should do, first and foremost, you should try to follow what ethics would say.

    05:04 A very classic historic example would be Nazi Germany in the mid 20th century.

    05:09 So there, there were laws for racial hygiene where there is a practice of sterilization of patients against their will.

    05:18 You know, the legal mandate would say that the physician, the nurses, others, should follow those sterilization procedures.

    05:24 Where the ethics would say "Well, that's not serving the best interest of my patient.

    05:28 As a matter of conscience, I should object to the law and follow what medical ethics would say I should do." So the hope is that you're going to strive to meet both the legal and ethical mandates, but that's going to require some exercise of judgment.

    05:44 You're going to have to think through it and figure out "How can I match the law with ethics?" And when you can't, then you got another kind of dilemma.

    05:53 But when you can, you know, use your judgment really again for the best interest of the patient.

    About the Lecture

    The lecture Ethical Dilemma and Legal Implications by Mark Hughes, MD, MA is from the course Introduction to Clinical Ethics.

    Included Quiz Questions

    1. It improves our ability to address ethical issues seen in clinical practice.
    2. It improves our ability to reach the correct answer.
    3. It improves our ability to treat patients quickly.
    4. It improves our ability to ignore irrelevant issues.
    5. It improves our ability to treat disease.
    1. Adherence to ethical values is of greater importance than following legal principles.
    2. Adherence to ethical values is equally important to following legal principles.
    3. Adherence to ethical values is of lesser importance than following legal principles.
    4. There is no general rule.
    5. Ethical values and legal principles never conflict.

    Author of lecture Ethical Dilemma and Legal Implications

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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