Clinical Ethicist Reacts to House M.D. Informed Consent Episode

In this video, I return to Princeton-Plainsboro Teaching Hospital to clean house! By request, I comment on S3, E3: Informed Consent. This one has it all: assisted dying, lies, patient abandonment, and research ethics.
Thanks for watching!

[@milkgrapes6420]

Liking these House MD reviews. Also love the high quality production

[@jameseglavin4]

Really excellent stuff, honestly this whole channel could be just “ethicist reacts” to the prolific House MD channel and it would probably pop off… anyway very enjoyable, thank you for your work and your expertise

[@spoonflaps12]

Hoping to see a few more consent episodes about House. There's a small one in Season 7, Episode 19. There's also that subplot in season 5, I think, with Foreman tampering with a drug trial.
You should also check out David Shore's more recent series, The Good Doctor, for even more ridiculous consent issues.

[@ValueJudgments]

Thanks! I'll take a look at those.

[@Jungfrun1]

One of the tricky thing about letting a patient in the US discide is that they might just do it because they don't want to drown their family in debt.

[@ValueJudgments]

I think there are two levels to this. There's a big-picture issue about how medicine should be funded, and, as a Canadian who has seen the U.S. health system up close, it's ridiculous that people have to go bankrupt to stay alive. But the second level is for the individual. If someone were to say, "I'm making this decision because I don't want to drown my family in debt", I don't think the right move is to deny them an assisted death because they care about their family. They should still be able to make their own decisions, even if it's a decision that is only caused by an unjust system.
Importantly, very few people in the U.S. actually do cite financial reasons as a factor in having an assisted death. Almost all of them are covered by medicare, so cost isn't usually a factor. In Oregon, it's about five percent of people: www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year26.pdf

[@thomascampbellthomascampbell]

i was shocked to see how little subscribers this channel has with such high quality, well informed and entertaining videos, really great stuff here and i wish you success in your future

[@ValueJudgments]

Hey thanks! I just started a few months ago.

[@pseudomastix2916]

Hey Eric, as an ethicist, how relevant is the philosophy of Immanuel Kant to modern clinical ethics? As a philosophy student, I have studied Kant's ethical theories and, because I often see medical dramas discuss 'dignity' and 'autonomy' in the context of healthcare and patients, I have always assumed that there might be some connection between Kant's philosophy and modern clinical ethics. Is there any connection? Or does the notions of 'dignity' or 'autonomy' which I often hear about in medical contexts stem from distinct sources other than Kant?
Additionally, if I wanted to learn more about clinical ethics, are there any books you'd recommend that I read as a lay person/newcomer to clinical ethics?

[@ValueJudgments]

It's useful to have an understanding of normative ethics, including Kant, but the details of any particular historical view aren't going to play a main role. Part of the value is just knowing that terms like 'autonomy' and 'dignity' are used in different ways. In my own work, I've gotten more mileage out of Mill, in part because so many people bring up the harm principle. They rarely come up in any direct way, however. If you're interested in bioethics research, then the theory foundation is much more important. Whichever you choose, getting a grasp of deontology, consequentialism, egalitarianism, liberalism, feminism, and other views is worthwhile.
I'm going to make a video about books at some point. Here are a couple I like:
- www.amazon.com/Medical-Ethics-Law-curriculum-Century/dp/0702075965
- The ASBH bundle: asbh.org/resources/books
The actual practice of clinical ethics is hard to get from a book, so it's worthwhile to focus on getting familiar with the theory and case studies.

[@blacktimhoward4322]

I remember that you told me this information was coming - thanks for coming through!
I think false dichotomies are a standard thing in House MD by the way; the show is built on professional disagreements, so nuanced opinions aren't really a good fit.

[@ValueJudgments]

Yes, it's much more dramatic to have two incompatible views!

[@blacktimhoward4322]

@@ValueJudgments Question from rewatching: does the fact that the patient was himself incredibly unethical have any ethical bearing on this case? I doubt that the law allows for this distinction, but ethically speaking, are Hitler and Mother Teresa entitled to the same patient rights?

[@ValueJudgments]

@blacktimhoward4322 Ethically, we should treat them the same regardless of their past. Healthcare isn't the justice system, and even if doctors knew that a patient had done something unethical-which they sometimes do-it's not their place to punish people. Sometimes this is uncomfortable. For example, I've had a few patients have affairs _while_ in the hospital. I think this is unethical, but it isn't my role to address this type of unethical behaviour.
I think there's more debate when we have to choose between two people for, say, an organ transplant. In that type of case, more people are on board with giving the criminal lower priority. But even then I think most ethicists would say to treat them the same if all else is equal.

[@kolper6799]

One more time It had been proven that House MD is just wont die.

[@ValueJudgments]

The gift that keeps on giving!

[@Rawnervscope]

I understand that it’s this guy’s job to measure Ethics specifically, but this makes me think we’re focusing too much on being fair and ethical, everybody treats, and just like anything too much of it might not be good for society, and I think apart there should be challenges someone who is more like house and meet someone in the middle

[@ValueJudgments]

Maybe we have different views about ethics! What do you think he should be allowed to do?

[@Rawnervscope]

@@ValueJudgments
You live up to that name 👏
First, I do think your job is very important
I wouldn’t say we differ about ethics just was suggesting just like theres a 2 party political system so to an ethical spectrum ?
Like I said, I’m not against your ethics as a whole
I was reminded of someone close to me being in pain and alleged ethics didnt allow him many options for relief , no history of addiction but treated as such
My mother is dealing with the same thing and she’s on a selfless non addicted person I know
Thats just my personal examples there are more than matters of pain.
Ethics should have a compassionate mother and a struct father maybe🧐

[@ValueJudgments]

@@Rawnervscope Sorry to hear that. There's definitely a problem now with providers withholding pain relief even when prescribing it is justified. I've also had cases of families wanting to deny fentanyl for their loved one because they're worried about addiction, even though the person is going to die within a week.
And there's absolutely an ethics spectrum. I by no means speak for the entire profession in these videos.