Sarah Murnaghan
10 yo F with cyctic fibrosis
 Denied lung transplant with adult lungs
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– Would be eligible for adult lung if 12
– 50% 5 year survival with CF
Federal Court ruled Sarah should be
placed on adult transplant list
 First transplant failed, received second
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Anthony Stokes
15 yo with heart failure, 6 mo prognosis
 Childrens Healthcare of Atlanta declined
to place him on heart transplant list due
to failure to comply with medications
 Poor grades, minor legal difficulties
 Civil rights groups taking up cause
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Herbert and Catherine Schaible
Charged with murder in death of 8
month old who died of pneumonia
 2 yo son died in 2009 of untreated
pneumonia, parents placed on
probation, required to seek medical care
 Members of First Century Gospel
Church, believe in divine healing
 If parents can choose abortion, can they
choose to withhold medical care?
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Ethics and Professionalism
34 year-old single woman, on public
assistance, comes to you for IVF
 Previous IVF resulted in six children, all
living with her
 What would you do?
 Why?
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Ethics and Professionalism
Richard L. Elliott, MD, PhD, FAPA
Professor and Director, Medical Ethics
Mercer University School of Medicine
Adjunct Professor
Mercer University School of Law
Ethics and Professionalism at MUSM
Faculty
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Richard L. Elliott, MD, PhD (Macon)
– Room 62, East Hall, MUSM
– Elliott_rl@mercer.edu
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Martin H. Greenberg, MD (Savannah)
R. Stephen Williams, MD, MHSA (Macon)
Others
Ethics and Professionalism at MUSM
Office of Professional Practice
Medical ethics
 Professionalism
 Legal regulation
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– Malpractice, EMTALA, HIPAA, . . .
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Health administration
– Payment systems, accreditation, reform
– Interest group
Ethics and Professionalism at MUSM
Curriculum
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Orientation
Community Medicine I
– Informed consent, confidentiality, professionalism
Community Medicine II
– Research ethics, abuse of trainees,
pharmaceutical industry malpractice
Clerkships
– Internal medicine, pediatrics, ob-gyn, family
medicine, surgery, EC
Senior papers and electives
Capstone
What to do?
A child in an
MVA is losing
blood rapidly,
mom refuses
permission for
transfusion based
religious beliefs
What to do?
An HIV-positive
man admits he is
sexually active,
states he cannot
tell his fiancee
his HIV status
What to do?
A patient comes
repeatedly to the
EC demanding
opiates for
headaches
Medical Ethics
Current Controversies
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Use of embryonic stem cells – is it OK to
“sacrifice” embryos to save lives of adults?
Transplantation – how do we establish
priorities for recipient lists
Futility of care – when can MDs “pull the plug”
over the wishes of patient and family?
When can we override wishes of parents and
treat children (e.g., JW)?
How do we handle performance enhancers?
A helpful resource?
A faculty member provides a list of the
answers to an upcoming test and tells
you to let everyone know on your
campus, but not to let the other campus
know about the list.
Is it cheating?
A first year student asks a second year
student for advice regarding his upcoming
MDE exam. She gives him a list of old
exam questions and review sheets that will
help you greatly. She states that you
should “keep it quiet” when around faculty,
because some have been disgruntled with
old questions floating around, but that
each class has done so in the past. She
encourages you to pass the materials on
to your friends.
Can’t we be friends?
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You are a woman third year student
who studied in the company of a group
of friends the first two years. During
your first clerkship one of the group
begins to make unwanted advances
and, despite your insistence this can go
no further, he persists and becomes
aggressive.
It’s tough to make predictions.
Especially about the future.
Who will be disciplined by medical boards?
Greatest risk if disciplined during
medical school
 Drugs and alcohol
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– Who is your AIMS representative?
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Reliability
– Preparation, on time
Volunteering
 Respect for colleagues
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Professionalism in non-clinical years
Be on time
 Dress appropriately
 Courtesy and respect for all
 Preparation
 Help your brothers and sisters
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– Academically
– Substances, recreation, etc
– Social media
Between your first and second years of medical
school, you do laboratory research at a hospital
near your home. After a couple of months of hard
work, you collate your data and write a draft paper
for the faculty advisor to revise before submitting it
for publication. After reviewing your draft and
making many comments, you see that they have
included the name of one of the second-year
students, although he didn’t have anything to do
with your work. Afraid of angering him, you don’t
say anything. However, a few weeks later, you
discover that your name has been added to a paper
the other student has written with you were not
involved with.
Financial Aid
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A third year student receives the FAFSA packet in
February of her second year, signing a form
acknowledging that she received it. The Office of
Financial Aid sends several reminder emails to the
student that she needs to fill out the application. In
the first week of her third year, her financial aid check
is not at the bursar’s office. The student calls the
Director of Financial Aid and yells at her saying that
no one gave her the packet, she didn’t get any emails
reminding her, and demands a check
I’m lonely
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You are interested in a competitive specialty
and you have heard that the best way to get
in is to have a lot of research publications. A
male faculty member has a reputation of
having many students in his lab and many of
them get published. One evening, he calls a
female student and tells her that his wife is
out of town, he is lonely, and he wants her to
come over to keep him company.