What is bioethics? Bioethics is the study of ethical practices within medical and biological research. While seemingly complicated and obscure, the ethics of these fields can get quite interesting- especially as technology advances, and especially when accounting for all of the strange and particular situations that occur in hospitals.
Doctors and researchers are professionally trained for their jobs, knowing how to help people in dire scenarios and establishing new ways to do so. They are not however, professionally trained to make critical decisions concerning ethics. This job is left to bioethicists. They can either work alongside lawyers and legislators to implement core policies that make our hospitals and labs run ethically, or they can work in hospitals handling the obscure cases that walk through the door when there is a lack of policy that applies to the specific scenario.
Because bioethicists work on varying things anywhere from daily policy on patient treatment to more bizarre questions such as the ethics of cloning, the field is best exemplified through specific examples.
What would you do as a doctor in the emergency room if an unidentified man came in suffering cardiac arrest and needed to be resuscitated? If the man was identified, doctors must look at his records prior to resuscitation to see if he has a DNR form. A DNR form is “an order not to attempt CPR in the event a patient suffers cardiac or respiratory arrest.” If a patient is unidentified, protocol would allow doctors to attempt CPR.
Due to the ethical complications of DNR forms, their use and terms are laid out extensively for patients and physicians. These protocols, however, cannot account for all scenarios.
Doctors in Miami, Florida faced an extraordinarily difficult situation when an unidentified, unconscious man was delivered to their emergency room. Without access to his records, a decision had to be made regarding resuscitation. While this may seem like an ordinary occurrence, this man happened to have “Do Not Resuscitate” tattooed across his chest, with an apparent signature below it.
Initially, doctors worked to have the man regain consciousness using reversible measures. However, these efforts did not bring the man back. They then had to decide on beginning CPR, despite the mans tattoo’d wishes. When students graduate medical school and become doctors, they swear to abide by an ethical code called the Hippocratic Oath. Following this oath, the doctors in Miami thought pursuing CPR best adhered to the principle of not choosing an irreversible path when faced with uncertainty.
Yet, the tattoo was a very blatant statement that could not be ignored. Instead of wasting time grappling with the issue themselves, the doctors decided to consult their hospitals team of bioethicists. While waiting for the ethics team to finish consulting, the doctors in the emergency room were able to place the man on medications to preserve his life.
Because this case was so fascinating, it has become a large topic of debate for bioethicists. And while we cannot know for sure what the team debated over- we can certainly look into our own ethical objections to this scenario.
A tattoo can be many things. It must be taken into consideration that it could have been a drunken mistake, a dare, or something that was done years prior that no longer reflects the individuals actual thoughts or beliefs. It is not uncommon to find people who regret tattoos, as they are in fact, permanent. However, it must also be considered that a tattoo, due to their permanent nature, is often well thought out and a true reflection of an individual. Because both scenarios are equally likely, the ethics of making a medical decision based off of a tattoo become shaky.
In this situation, the ethics team decided that this tattoo was most likely an effort for the mans wishes to be followed- and an extreme one at that. Because of this, the doctors did not attempt resucitation and a DNR form was written out of his best interests. The man died later that night without medical intervention. Once identified, doctors and the ethical team were relieved to find that the man actually did have a DNR form.
While a correct decision was made in this scenario, many questions still remain. Is a tattoo a legally binding document? Should it be? Would the same decision be made from a different team of bioethicists?
The case report finished by saying they were neither in support or opposition of end-of-life wishes in a tattoo form to be granted. Because legislation and procedures were not outlined previously on how to handle a case like this, the hospital used their resources available to them to attempt to make the best decision possible for this particular man. But ethics are complicated, especially in the medical field. Much more deliberation and research must be done before actual procedures are outlined on this matter.
Bioethics is still a relatively new addition to the medical field, and cases like this one stress the importance of having an ethics team present in hospitals. There are no easy answers when it comes to patient care, and the questions will only get more complicated.
Sources:
https://www.bioethics.msu.edu/what-is-bioethics
https://www.health.ny.gov/regulations/task_force/reports_publications/docs/do_not_resuscitate.pdf
https://www.nejm.org/doi/full/10.1056/NEJMc1713344?af=R&rss=currentIssue&#iid=f01
The Principle Of Not Choosing An Irreversible Path When Faced With Uncertainty