Medical Ethics: Introduction (01:31)
Fred W. Friendly relates an anecdote about his son's conscience telling him to brush his teeth. Doctors cannot always follow their conscience. Patients have learned to question paternalistic decisions. Arthur Miller moderates a hypothetical case study.
Hypothetical Medical Ethics Scenario (03:19)
Miller presents a scenario to U.S. surgeon General C. Everett Koop in which Betty, a long-time patient, does not take her pap smear results seriously. Oncologist Diane Hegener cannot reach her. Koop would divulge her cancer to her husband Dan.
Doctor-Patient Confidentiality (04:05)
Hastings Center President Willard Gaylin and FDA Commissioner Frank Young believe Koop was right to inform Betty's husband of her cancer; physician-patient trust is bilateral. Law and Medicine professor Alexander Capron and New England Journal of Medicine editor Marcia Angell argue Koop's decision was unethical.
Stage 1A Cervical Cancer (05:13)
Hegener would recommend radiation therapy, but Betty researches her disease and wants a radical hysterectomy. National Cancer Institute Director Vincent DeVita says both therapeutic outcomes are identical. Gaylin argues against granting her a hysterectomy on ethical grounds, despite patient autonomy.
Stage 2A Cervical Cancer (05:49)
Betty is 14 weeks pregnant. Hegener would recommend radiation therapy, but Betty wants to save the baby. Koop recommends getting counseling with Dan about his future without Betty. Gaylin would support Betty, however she decides to proceed.
Fetal Viability (03:37)
Ob/Gyn professor Mortimer Rosen and neonatologist Mildred Stahlman would work with Betty to save her baby. Rosen explains the difficult choice of when to perform a cesarean as she nears death in her 28th week of pregnancy,
Patient Denial (02:03)
Dan agrees with Betty's wish to wait for surgery. Rosen would try to convince her to save her baby, but she believes she can hang on to life. Rosen is now responsible for both her and the baby’s lives.
Physicians are Fallible (02:02)
Rosen cannot guarantee the baby's health, but promises to do the best he can for Betty. He says Betty may survive cesarean surgery, and agrees that Dan should help make the decision. He explains his biased position.
Patient Rights vs. Paternalism (04:04)
Planned Parenthood president Faye Wattleton argues that Betty's healthcare team is intervening inappropriately in her decision to wait for surgery. She believes Rosen entered a covenant with Betty, regardless of her unborn child. Columnist Ellen Goodman advocates for Betty's will to live.
Speaking for the Fetus (02:07)
Rosen believes Betty should decide about her baby before she is unable to. He has had babies die because their mothers refused to decide on surgery. He would try to find someone to share legal responsibility for delivering the child.
Hospital Administration Position (01:30)
Memorial Sloan-Kettering Cancer Center president Paul Marks would support Betty's wishes to wait for surgery, despite potential for double tragedy. Former HEW Secretary Joseph Califano, Jr. says the healthcare team is likely to be sued, whatever their decision.
Double Patient-Physician Relationship (03:38)
Betty slips into a coma; Dan pressures Rosen to perform a cesarean. Rosen would perform the surgery, if Dan understood the risks and benefits and shared legal responsibility. Stahlman points out that Dan has decision-making rights, as the baby's father.
Requesting a Court Order (04:04)
Califano is prepared to defend Rosen's decision to deliver Betty's baby. U.S. district judge Robert Merhige, Jr. says there is no jurisdiction. Capron argues for patient autonomy and Wattleton would file an amicus brief in support of advancing fetal viability.
Patient Authenticity Concept (01:57)
With Stahlman acting as fetal advocate, Merhige would grant a court order to deliver Betty's baby. Gaylin argues that Betty's wishes were known before she became comatose, and should be respected.
Switching Patients (02:33)
Miller supposes that Betty changed her mind and did not want surgery. Rosen protests violating the baby's rights to protect the mother's rights—although she is his original patient. Wattleton says he is going beyond medical science to intervene against her will.
Substituted Judgment (01:47)
Angell believes that the decision-maker is more important than the decision. If Betty does not want a cesarean, Angell would honor her wishes—as is Dan’s legal right, once she is comatose. Merhige would grant Rosen permission to save the baby.
Patient Autonomy Decision (02:37)
Dan now wants to honor Betty's wish to avoid surgery and believes he cannot raise their baby. Merhige defends his decision to allow Rosen to deliver the baby. Rosen would only perform surgery with legal support.
Right to Change One's Mind (02:51)
Wattleton and Gaylin debate whether Betty is capable of reversing her decision about undergoing surgery after wanting to save her baby for 14 weeks. In the real world, doctors lack clear guidelines for when patient autonomy clashes with physician paternalism.
Credits: Does Doctor Know Best? (00:60)
Credits: Does Doctor Know Best?
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