In this lecture, we're going to
talk about ethical dilemmas.
So dilemma basically means
involving 2 assumptions.
So in this case, we might have 2
approaches that seem reasonable
in terms of how we're going to
handle a particular situation.
And so it's maybe 2 or more alternatives.
They seem mandated.
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.
A classic example would be a challenge between
respect for autonomy and beneficence.
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.
Can serve both interests, the
respecting autonomy and the beneficence
so we have to try to figure out
how to solve that dilemma.
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.
So, there may be hot topics in
ethics where there is no agreement.
There may be no consensus about
how to handle that situation.
And that then creates a dilemma for the
clinician needing to confront that issue.
And then it also might mean that the individual
themselves has this ethical conflict.
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.
And that creates
this inner conflict.
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.
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.
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.
Handling our own emotions and
the moral distress we may feel.
But then also, you know, solving the problem to,
again, serve the best interest of the patient.
And that means that we need
a structured approach.
We need to figure out a way
to think through the dilemma.
And so, medical ethics, as I've said
in other lectures, is very practical.
We need to have a solution
at the end of the day.
And so if you approach it in a
structured, comprehensive way,
you can figure out a way
through the dilemma.
And by using that systematic
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.
But if you have this systematic process,
then maybe you can figure out a way through.
So it is a practical discipline.
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.
One thing to pay attention to when you're thinking
about this is that there may be legal mandates.
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.
And they're going to help
guide your medical practice.
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.
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.
So, you have to find out from your own
jurisdiction how the law is applied.
But the idea would be, you know, take your core
ethical values that you learn from the profession.
Think about the legal principles. See
how they might be closely related.
But in general ethical responsibilities
usually exceed legal duties.
So what the law might say you should do, first and
foremost, you should try to follow what ethics would say.
A very classic historic example would be
Nazi Germany in the mid 20th century.
So there, there were laws for racial hygiene where there is
a practice of sterilization of patients against their will.
You know, the legal mandate
would say that the physician,
the nurses, others, should follow
those sterilization procedures.
Where the ethics would say "Well, that's not
serving the best interest of my patient.
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.
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.
But when you can, you know, use your judgment
really again for the best interest of the patient.