Since this is a Medical Ethics class what better than an ethical dilemma in the medical field?! In class on Thursday we did a lot of "what would you do and why?" scenarios and this is one of those:
You are a doctor and have a 21 year old male patient who has just tested HIV positive. In order to leave the hospital, he requires a blood transfusion. In the trust of doctor patient confidentiality he reveals that once he receives medicine and is released from the hospital he intends to "live each day as his last" and is going to infect as many people as possible with HIV starting that evening.
Due to the sacred bond between doctor and patient you can legally do nothing. Even if you went to the police about this information they would not be able to arrest him because his medical information is protected.
You realize that as a doctor you have access to an untraceable poison that could be used to contaminate the medicine of the man with HIV which would kill him before he gets the opportunity to spread his disease.
What are you going to do and why? Which kind of ethical reasoning do you choose to support your decision?
The protection of doctor patient confidentiality is what makes this a difficult situation. The obvious thing to want to do is stop the man, however seeing as curing HIV is out of the question, you as a doctor have your hands tied. The utilitarian approach would be to, after careful calculation, choose what causes the greatest good for the most people with the least amount of harm. On the one hand, you do nothing and the man lives selfishly and spreads his disease thoughtlessly and you have the burden of knowing that this man is out there purposefully spreading a life destroying, deadly, incurable disease. On the other hand, you can slip him the poison and become a murderer. Because the poison can’t be traced it is highly unlikely that you will be caught in your crime, no one would ever know, not even the patient. Because HIV is terminal he is going to die anyway. However, you have to live knowing that you were the sole agent in this man’s death.
You can’t simply inform someone of his intentions because any nonconsensual release of his personal information would be rendered useless and the man would receive no punishment for his actions.
Although I think the decision would be tough I would slip him the poison. I do this because although Kant says we are unable to predict the consequences of our actions or those of others I think it is pretty clear that he intended to do harm to others. Also, even if others found out what he was doing they would have no way of knowing soon enough, and there is no telling how many people would have gotten infected before anything could be done. It would be difficult for me to willingly end the life of someone so young, but seeing as he has a deadly disease anyway, coupled with the fact that he intends to infect and possibly impregnate others (bringing in the innocent life of a child that would be ruined before it even began into the equation) would cause me to believe that the poison would do the greatest amount of good for the most people.
This is an interesting scenario. I look at it a little differently that how it has been developed here.
ReplyDeleteFirstly, the doctor is bound by not only a legal code (HIPPA) but by a code that was enforce before this one ever was thought of - "do no harm". That is about maleficence. He took that oath (moral and ethical) when he entered the medical field.
With those two undeniable facts, this seems to be within a contractionarian moral view. He should fill his obligations as he has promised regardless of what this man has divulged in confidence. What this man will or could do does not seem to trump this aspect.
Secondly, there is another part of Kant that seems that applicable. The "categorical imperative" seems to be an even more relevant consideration. If one chooses the poison (within the scenario), then this gives universal permission for this solution to be used in any situation.
Doctors (medical professionals) can kill anyone who they think are a danger to other people.
That would seem to be disastrous medically and otherwise.
Your reasoning makes a lot of sense! I hadn't even considered the categorical imperative. Under those circumstances I completely agree that it would be a disastrous outcome if that applied universally. I really appreciate your insight. Although I said I would give him the poison it is true to consider that he might be unsuccessful in spreading his disease and that could just be an actionless thought. Such supports the claim that one can't predict the outcome of any situation.
DeleteI definitely understand your reasoning behind giving the HIV-infected man the poison, if you truly believe he is going to spread the disease. The most good for the greatest amount of people, right?
ReplyDeleteHowever, I greatly disagree with the notion that the disease is deadly, and he is already on the fast track to death. The medical field has come a long way with research and treatment for HIV/AIDS, and most of those infected now live for several more decades -- if not longer.
Being a doctor, one is bound to experience many instances in which a patient has/will cause harm to himself or others. I do not believe this gives him/her the right to end the life of those inflicting the harm. A consequentialist would assume the doctor would be found out and lose his/her medical license. They would, in turn, no longer be able to help the sick and the ailing -- minimalizing the amount of good for the greatest amount of people.
You are right that people with HIV live much longer that past cases due to rapid and extraordinary medical advances. With that being said he would not be dying quickly but I did mean that because of his disease it would be logical to me to presume that his life is going to end sooner than it would if he didn't have the disease. Also, HIV isn't really what kills you it just nukes your immune system so that something as simple as a cold could kill you so you are right that the disease isn't deadly. Are you saying that you would do nothing and use consequentialism as your reasoning?
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