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Case Study - Moral Dilemma


Posts: 696

Not a patient of mine, but described to me by a colleague in obstetrics;

It was determined in her second trimester (weeks ~12-26 of pregnancy) that this patient was due fraternal twins, one of which was likely to be profoundly disabled.

She was given the option to terminate, with lots of psych/social work consultation throughout. However, the termination would inevitably be of both twins.

She decided to carry the twins to term, adopting out the disabled infant, and keeping the healthy one.

She requested the treating team inform her extended family that the disabled twin had passed away. They (sort of) obliged, without being explicit. That's a dilemma for medical teams because we're perfectly entitled to lie by omission, but it's an individual clinician's decision whether or not they adhere to a narrative. We certainly aren't obliged (or even advised) to.

I'd be interested in opinions about the ethics of a case like this. Obviously extremely rare (blue-moon sort of scenario), but very complex and quite emotionally taxing for the clinicians involved.

Posts: 3246
Case Study - Moral Dilemma

In the instance the patient is receptive, yes.

Posts: 10218
Case Study - Moral Dilemma

I'd not oblige initially towards her wishes. The adoption isn't my responsibility, her family's feelings aren't my responsibility, so I figure let her do her own dirty work there.

If she wants to have lies told, let her tell them herself.

Posts: 10218
Case Study - Moral Dilemma

Instead of lying for her, it'd be better to discuss with her why she's doing it, and bolster her resolve regardless of what she chooses. She's the one being worked on after all, not her peers.

It's living with a lie or family judgement. Both can be negative.

Posts: 696
Case Study - Moral Dilemma

My thoughts exactly.

But then, the medical responsibility extends to outcomes post-discharge. Is she going to suffer negative psychiatric consequences etcetera?

My gut-feeling is yes, regardless. But we can't think like that. We have to mitigate where possible. But at what expense?

Posts: 696
Case Study - Moral Dilemma

And, so, if she's resolute in her decision, it might make it easier to inform the family.

Agreed.

Posts: 3645
Case Study - Moral Dilemma

Damned if you do and damned if you don't, eh?

In moral grey areas like this, where somebody will be pissed off no matter what I do, I usually let a dollar cost averaging formula determine the 'best' choice. How much would it cost the taxpayers for this course of action or that one if this situation happened every day?

Yeah, it's a bullshit argument. But it's one people usually put up with when they don't like the decision somebody's just made.

Posts: 3246
Case Study - Moral Dilemma

Unless you are a private practitioner at your own businesss, you don't get to do the accounting work.

Posts: 557
Case Study - Moral Dilemma

I think it's about a careful choice of words. It's about saying things like "The child has left... to a better place." The better place being a family that actually fucking cares about them. I don't think that family deserves the child. I never stated the child died I just had to make sure the family implied it on themselves. 

I might try to give the child to extended family members. In the case I think the are fit to raise the child. 

Posts: 696
Case Study - Moral Dilemma

No, it's an interesting argument.

On a daily basis, to all patients, it's not practical to maintain lies/untruths/even by omission.

If something can't be applied to all, is it permissible to a few?

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