Is Breaking The Law Ever Ethically Correct?

“Don’t ever tube me again.”

The seventeen year old male stares at the ER physician intently. A breathing tube had just been removed from the teenagers throat. The doctor and patient then have a discussion about what that means. The conversation reveals the teenager is clearly competent. He has had cystic fibrosis his entire life and is near the end. He desperately fears a slow death on a respirator like many of his friends. He is ready to die, but on his terms.

His mother has different ideas. She wants him alive as long as possible and at first refuses to sign a do not resuscitate (DNR) order. After a discussion with the physician, she finally relents. However, the boy starts to fade and the mother changes her mind at the last minute, threatening the physician and demanding he be intubated.

The physician looks at his patient, apologizes and intubates him.

The scene is fictional, but reveals a significant ethical dilemma. In this case, the show implies that the mother has the legal right to decide whether or not her child should be intubated or not. It is pretty clear the doctor made the correct legal choice in this case.

The question is, did the ER doc make the correct ethical choice?

We discussed this in our ethics class last week. Several students made the point that the doctor’s hands were tied by the law. While unfortunate, the decision was fairly straightforward. He clearly had to intubate.

I disagreed.

Was the choice really that simple? The argument was made that if he had chosen not to intubate, he may have lost his medical license. I find that highly unlikely. It may have led to a legal mess, but is that enough reason to subject your patient to a highly invasive and traumatizing procedure that he clearly did not want?

What really frustrated me about the discussion was how some of my classmates viewed such an ethically messy situation in black and white terms. Even the physician himself seemed terribly conflicted, but they did not. He was bound by law, what choice did he have? They seemed to say.

There is always a choice. History is marked by people standing up to unjust laws and often jumpstarting the process to changing them. Law is a crucial part of a functioning society, in no way am I advocating the law should be discarded. In this situation, it should have a prominent place in the discussion. I do not believe however, that the law should be the final word.

And those are my thoughts. What do you think?

Orientation, The First Day, The First Anatomy Lab: Medical School Begins!

Orientation at medical school started a week ago. My first class was yesterday, my first anatomy lab was today. The last week has been a blur.

I have to hold how I view the last two days in tension. In one way it has gone by crazy fast. However, when I think about the amount of information we have covered it feels like about two weeks.

Here are a few thoughts/observations from the first week:

-I’m much better at remembering names than I thought. I can’t tell you how many fellow classmates I’ve said hi to and they’ve responded, “I’m sorry, what was your name again.” Maybe I just have a forgettable face.

-No joke about how trying to assimilate information in med school is like “drinking from a fire hose.”

-When I start to feel a little overwhelmed, I think about how lucky I am to be here and how many want to be in my position.

-The Creighton Medical School chaplain said a prayer before we started anatomy lab today. She thanked the donors and reminded us of the privilege we have in dissecting them. Pretty cool.

-The squeamishness of cutting open a dead body passes very quickly. This is replaced by getting over the awkwardness of handling a scalpel and trying to tease away tissue without cutting through muscle. Periodically the thought of how strange this is still passes through your mind.

-My first quiz is next week. Yikes.

Until next time, peace.

A Phone Call

The phone rang clear and sharp, cutting through the quiet evening. The young woman looked at the screen, a puzzled expression across her face. She did not recognize the number.

“Hello?”

“Hello, is Rebecca available?”

“This is her,” she answered.

“Hi Rebecca. I’m calling on behalf of Creighton University School of Medicine. I have some good news for you. A spot has opened up in this year’s medical school class and we want to offer it to you.”

Rebecca drew in a startled breath. What?

“Rebecca, are you there?”

“Yes… I’m just, well, surprised.”

She heard a slight chuckle. “Yes, it is late in the process. While we understand you may need some time to think about it, as school starts so soon we will need to know your decision in two hours.”

“I don’t need two hours,” Rebecca responded quickly, finally finding the words. “I gratefully accept and will be there as soon as possible.”

“That is great news. Congratulations Rebecca, and welcome to Creighton’s School of Medicine.”

Rebecca said thank you and hung up. Thoughts flooded her mind. I’m going to medical school. I’m going to be a doctor.

She smiled.

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Orientation at Creighton starts tomorrow. Today I met up with a friend I have worked with in the past who was also planning on starting at Creighton tomorrow. We had a great chat, we talked about Omaha and our fears in starting medical school.

I received a phone call from him later this evening, he told me he was accepted off the waitlist at his state school. The day before orientation. He’s headed back home tomorrow.

I congratulated him. While he made it clear he would have loved to be at Creighton, he knows his state school is the right place for him.

I reflected on our conversation this evening. My thoughts wondered to what it would be like to get an acceptance phone call this late in the game, so my imagination conjured up that story. Congrats to whoever received that call, I’m looking forward to being your classmate.

Countdown To Med School

Six days until Orientation starts at Creighton University. I’ll finish my journey to Omaha on Saturday and try my best to get settled in a few days.

I’m excited/nervous/everything you’d expect to feel about starting medical school. I’m looking forward to meeting lots of new people and making friends. Having been out for two years, I’m actually looking forward to the school work, although I’m sure that will change in a couple weeks.

I’m anxious about being able to handle the workload and still have a life. From the conversations I’ve had with med students, it seems to be about boundaries. It’s about setting a schedule and sticking to it, and when you’re done studying, you’re done. I believe I can do that, but have yet to put it into practice. Do I have the discipline to stop studying even though I know there’s more to learn? I’ll keep you updated.

I’m curious, are any of you starting med school soon? What are you excited or nervous about?

Welcome To MD Journey

A new chapter in my journey means a new blog. I am excited to announce MDJourney.com, the next development in my blogging exploits.

I considered keeping Pre Med Journey and MD Journey separate, but ultimately decided to combine it into one site. I have a feeling managing one blog while in med school will be plenty. You’ll notice that premedjourney.com now redirects to mdjourney.com. Pretty neat, eh?

I hope you’ve also noticed the new theme which I think will improve the usability of the site.

While Pre Med Journey is no more, I will still be posting on pre med issues. I’ll also be talking about stories from med school.

Hope you like the changes!

Medical Schools in California (CA)

There are ten medical schools in California mostly in the large cities including Los Angeles, San Diego, San Francisco and Sacramento among others. Eight are MD schools and two are DO (Osteopathic) schools. Click on the links below to access each school’s website.

MD Schools- California

Keck School of Medicine of the University of California

Loma Linda University School of Medicine

Stanford University School of Medicine

University of California, Davis, School of Medicine

University of California, Irvine, School of Medicine

University of California, Los Angeles David Geffen School of Medicine

University of California, San Diego School of Medicine

University of California, San Francisco, School of Medicine

DO Medical Schools- California

Touro University College of Osteopathic Medicine

Western University College of Osteopathic Medicine of the Pacific