Transcript ETHICAL CROSSROADS ALONG THE WAY

ETHICAL CROSSROADS
ALONG THE WAY

STORIES ABOUT MEDICAL TRAINING
AND PSYCHIATRY
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John Maher MD FRCPC
Whitby Mental Health Centre, Canada
WHY TELL STORIES?
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“Insofar as ethics occurs in the context of
human relationships, our ability to discern
right from wrong and good from bad
depends to a significant extent on how open
we allow ourselves to be to others…
WHY TELL STORIES?
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By sharing and comparing stories we learn
to better appreciate where our lives and
experiences intersect with the lives and
experiences of others.
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Ethics takes place at this intersection…
WHY TELL STORIES?
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In a very real and important sense, the
ethical landscape of each clinical encounter
is subtly negotiated through shared
understanding. Through sharing we
cultivate empathy,and from empathy we
internalize the motivation to behave toward
others as we ought…
WHY TELL STORIES?
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Empathy is the impetus to respect, and
respect is the core of ethics.
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Narrative is the mechanism that brings it all
together.”
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Workman S, Hubert J, Byers R, Jaggi R, Jantz A;
CMAJ, May 9, 2006; 174(10), p. 1453
MALAISE:
The feelings that guide us
1) Clinical Malaise (head)
 2) Moral Malaise (head/heart)
 3) Interpersonal Malaise (heart)
 4) Freudian Malaise (heart of hearts)
 5) Spiritual Malaise (heart and soul)
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Medical School
 What
I knew before I got there…
 Philosophy
 Medical
Ethics
 Health Services
 Health Policy
Medical School
“Are you Christian?”
 “Medical Student” or “Student Doctor”?
 “Hello Dearie”
 “Do you drink a lot of alcohol?”
 My policy beliefs
 Go along to get along…
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Clerkship
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Exhaustion, stress, codes
 A fair call schedule
 “Jump on him!”
 Stat to surgery
 CARMS
Year 1 – Rotating Internship
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Black Day in July
 Different strokes for…
 Post-kidney transplant
 Pronouncing death
Year 1 – Rotating Internship
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A problem with blood pressure
 Abortion clinic
 “Butcher B.” and the truth
 A supervisor’s woes
YEARS 2 to 5 - RESIDENCY
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9 years in 5
 Growing autonomy
 Essential paternalism
 Certifying someone
 Saudi perspectives
YEARS 2 to 5 - RESIDENCY
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Attitudes towards BPD
 Serge was beat up
 Changing a report after a suicide
 A mercenary’s story
 Being Chief Resident
 FITRE
 Not invited back
IN PRACTICE
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Informal opinion:
“Do I need to see a doctor?”
 Pill exchange
 “I want my gun back”
 Alcohol and harm reduction
 Drug company money
IN PRACTICE
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Nurse accused of assault
 Inadequate response to suicide attempt
 “Dreams”, hit and run, assault
 Hit man & a disability application
 A colleague refusing consults
 ACT Team
AND THE STORY
CONTINUES…
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Where are the heroes of bioethics?
(Freedman)
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C.S. Lewis, The Great Divorce, and the real
heroes…
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Going on safari…