Work, ethics and patients. To treat or not?

One of the team has recently had one of the most uncomfortable consultations we think one can have as a doctor. This is the consultation where, after treating a patient, you have to then treat the cause of your first patient’s illness namely another patient. We had a long chat about this situation.

This is especially hard in certain situations. The most obvious is in combat where if you play by the “rules” you have to treat enemy combatants as well as your own.

Who do you treat first? The “right” answer is the most serious injured but the emotional answer is very different. In current conflicts it might be do you treat the Taliban or your own troops first? Medical ethics would determine that you treat impartially but human emotions may cloud that professional impartiality.

What about the situation when you treat a patient who has been hit by a Heavy Goods Vehicle (HGV or truck). You spend an hour treating them in an Accident and Emergency Department (ER) and despite your best efforts the patient dies?

The next patient in the A&E department you are asked to see is the driver of the HGV that killed the patient because they are “upset” but they are unhurt, not dead, and still alive. Sometimes they are racked with guilt sometimes merely inconvenienced.

You may then have had to deliver the deathogram to the family of the patient involved when they turn up in A&E an hour or so later having been told, euphemistically by the Police or a work colleague that a relative is seriously “ill” and they should go to hospital ASAP. Not just doctors involved here but nurses, police officers, fireman and ambulance crews too have these scenarios to deal with from time to time.

What about the situation where you see an abused child and treat them only to see their abuser as the next patient claiming an “alleged” assault by the mother of the child and wanting treatment?

These are some of the consults the team at ND have collectively done over the years and raise loads of questions about ethics, morality, impartiality and more importantly what one does as a doctor in these situations and how one copes.

The laws of physics are said to be absolute. Certain principles in medicine are said to be the same but are more likely relative.

Could you go home at night having saved the victim of a stabbing who only later turns out to have been the abuser of the stabber? Could you save the life of someone who had shot one of your own and still treat them after you know the facts?

We have had the self same situations in civilian practice and it is not easy. Fortunately such situations are rare but they always provoke thought and discussion for they are not easy to deal with.

Praise be to the Party who via the GMC provide us all as doctors with their “ethical” guidance. We thank our colleagues, both medical, nursing and in the emergency services and the UK medical defence societies for their more practical support in such scenarios.