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?

5 thoughts on “Is Breaking The Law Ever Ethically Correct?”

  1. Steve, I’ve been periodically checking in on your blog to update on your adventure in Omaha! This post particularly caught my attention because situations like the one you describe are of particular interest to me. Having had goals of care and end of life discussions frequently as of late especially with my patients, I have only further confirmed what I had seen exhibited before so many times: that communicating about goals of care and life decisions is something we need to encourage among our patients and their families. It eliminates the most terrifying situations while always allowing the patient’s wishes to be met. All the while, it alleviates the pressure on the family to make horrifying decisions about whether or not to withdraw life support, intervene if a patient is found down, or offer medications that the patient may not have wanted. It is a difficult discussion to have but it is critical to assure that the well being of all patients is preserved and honored even at the end.

  2. Thanks for your perspective Sharl! I’m sure those conversations are difficult but clearly is in the best interest of the patient and their family.

  3. Yep, I mentioned that the scene was fictional- that’s where it came from. I didn’t think it was relevant to the discussion so I didn’t include it.

  4. I feel like a bad person saying this, but the issue is black and white to me as well. However, there are situations that I can imagine that would NOT be so black and white in my eyes. This fictional account though is an easy one for me.

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