Clinical Ethicist Reacts to House M.D. DNR Episode
2024 ж. 15 Сәу.
9 043 Рет қаралды
Dr. House-and frankly this whole hospital-needs a clinical ethicist. In this video, I go through the DNR episode, where House overrides a patient's refusals a bunch of times. Somehow, he doesn't lose his license or get arrested.
Correction: I say in the video that they're in Massachusetts, where assisted dying isn't legal, but they're actually in New Jersey, where assisted dying is legal. To qualify for an assisted death in New Jersey, you have to be likely to die of natural causes within six months, so John Henry Giles still wouldn't qualify.
If you enjoy this episode, let me know what other shows you'd like me to discuss!
Dr. House, the most ethical physician there ever was!
Lord help us!
Probably the very most unethical, other than evil scientists. But the writers would give him the win all the time, of course.
Also modest and humble!
honestly the whole ethics thing is what make house md a better hospital drama that any other show.
It's definitely another layer!
If i had a doctor id have DR House as my personal doctor regardless of Ethics
Same here cos he’s the best.
I think the part about wanting to sign with his hand was more of a pride thing. If you want a really good ethics episode, try "Informed Consent" in Season Three. It covers not just what they do to the patient, but also some things the patient has done.
Thanks! I'll check it out.
Great video! 12:35 you say it's in Massachusetts, but the Princeton-Plainsboro hospital in the show is in New Jersey. Maybe it's the same law there.
Shoot! You're right. House trivia fail on my part. Assisted dying is legal in New Jersey, but it requires being likely to die within six months, so John Henry Giles still wouldn't qualify.
I only remember it being said 1 time but House doesn't want nurses working on his patients, just his doctors.
Ughhhh.
This was great! Please do more!
Thanks! Will do!
Can a DNR done under misled/mistaken circumstances be rendered invalid? "I dont want to be resuscitated because ALS over months/years will be horrible to endure" vs got the wrong medication an hour later
Ethically speaking, sure. Suppose at this point in the episode that the doctors knew for sure that Giles didn't have ALS and that the new treatment was simple, but they accidentally gave him medication that stopped his heart. If fGiles said that he was only requesting the DNR based on his belief that he was likely to die soon, and this turns out to be false, resuscitation could be justified. But House has nothing like that kind of evidence when he resuscitates him. A DNR order is a medical order made by the healthcare provider in charge, but patients can refuse interventions for whatever reason they want. The bar for valid refusal is lower than the bar for informed consent, so Giles could say, "I don't even want to go to the hospital", which is his right. His decision might be uninformed or unjustified, but that wouldn't give doctors the right to treat him against his will. I'm not sure what a lawyer would say about this kind of case. Maybe I can talk LegalEagle into a collaboration one day!
I never heard this kind of title or job exist😅😅😊
So on the DNR subject. If a doctor was somehow unaware of the DNR and just reacted to the situation and intabated the patient. Would the doctor still be legally liable?
It's extremely unlikely that this would happen in a hospital. The procedure is to call a code blue, at which point physicians and nurses from the unit would come to the room. They would all know that the patient is DNR. Some hospitals have other signs for staff, like a different coloured bracelet or a sign on the wall. It's possible that a patient could be wandering around the hospital and collapse, so someone nearby begins resuscitation without realizing the patient is DNR. My guess about the law in most places is that beginning resuscitation if you don't know the patient is DNR is legally fine (not legal advice though!). Mistakes are more common on long-term care homes and prisons. Here's a story about staff at a care home failing to resuscitate a resident because they thought she was DNR (it was actually her roommate). The family has sued: www.courant.com/2024/03/27/a-ct-woman-died-in-a-care-center-her-family-says-it-was-due-to-error-in-do-not-resuscitate-order/
@ValueJudgments thank you for that amazingly detailed explanation. I worked as a security guard in a hospital for 6 years and was always fascinated by the medical field. But unfortunately, most of my questions like this weren't taken seriously when I asked them. I often was given "that couldn't happen" or "that's a stupid question" with no explanation. So again, thank you for the detailed response explanation and article for reference.
@@smithysforge5309 That's a tough job. You're a legend for doing that work. I bet you have a lot of stories! I just found this case of basically what you were asking about. A nurse found a patient unresponsive, the code blue team arrived, there was confusion about his code status, so they began resuscitation and he was resuscitated before they confirmed he was DNR. He won $400,000 in a lawsuit. www.physiciansweekly.com/jury-awards-400000-in-wrongful-prolongation-of-life-lawsuit/#:~:text=The%20estate%20of%20Rodney%20Knoepfle,DNI%5D%20during%20a%202016%20hospitalization.
@ValueJudgments haha well thank you for saying that, and you're right. I've got quite a few stories, some good, some bad, some head scratchers and some that I still laugh about to this day. This article is a very interesting read. I can honestly say I've always struggled with the concept of lawsuits against doctors or hospitals in these types of situations. Seems there's there's both a fine and hard line when it comes to this. For example, if a guy is driving and gets into a horrible wreck and the EMS crew that shows up just reacts and resuscitated him. But he had a DNR then they could potentially be in danger of a lawsuit. Unfortunately, the legal field of medicine seems to be quite the mine field
This was interesting thanks.
Thanks for watching!
Most doctors now days just dont care anyways. Wile my dad was dying 2 of his doctors had to skip state due to malpractice. I remember days where doctors would throw everything at the wall to save a life...now its just a part of the ER team if they are having a good night.
Thank God for doctors like House.
I may end up in a horrible state or not But i will live, the price is only my life
In love with this video, please more!!
Dear Mr. Mathison, I'm interested that performing a rejected treatment is actually battery. I've read posts from women who yelled Stop! Stop! when an office procedure got too painful, but the "professional" kept on going. What's sad is that I doubt a lawyer would take such a case. A woman whose concerns were dismissed by a doctor is likely to get the same reaction from a lawyer. )-: However, I have a different ethical question for you. My elderly uncle's terminal health was well-known by him, his family and his doctors. His death was just a matter of time. Lifelong smoker, emphysema, heart failing, etc. But when he went in the hospital, he plainly told them he did NOT want them to sit back and let him die. He wanted to fight to the end, regardless of how painful it would be. A couple months later, he went to the hospital again. He was perky and sane that night with visitors. The next day he had to be put on a ventilator. No surprise, his damaged lungs were failing. But because he was "fighting the ventilator" they put him in a medical coma. And then the doctors badgered my born-again Christian aunt to "pull the plug" as if he had fallen into a brain damage vegetable-type coma from which he would never awaken. After a week, she gave in. The whole point of putting a ventilated person in a medical coma is so they *don't* breathe on their own, since their body us not cooperating with the ventilator. When the doctor "pulls the plug" ... of COURSE the patient doesn't breathe on his own, you have made sure that he can't. Unless they bring him out of the coma first they are not giving the patient's body a chance. shutting In case this sounds like an isolated case, it isn't. A few years later, another family member went into the ER. He was not elderly, he had no ongoing physical conditions. He just didn't seek medical care in time. It was his colon. He was in complete denial of how much trouble he was in. He still thought he had a choice about whether he would get a colostomy or choosing something else, and wasted another 24 hours in the hospital arguing. His organs started failing. They put him on a ventilator. Still cheerful, still talking. They had to put him in a medical coma due to "fighting the ventilator." And then they told his wife to pull the plug. Sound familiar? Yes, again, he WAS probably going to die. There was so much damage. He developed ARDS. Before this happened, my uncle suffered from lifelong major depression - coping with a colostomy would have been bad enough, coping with the other ongoing medical devices to keep him alive if he survived sepsis would have wiped him out. But he had no idea he was going to die when they put him under. And again, he wasn't in a brain-damage coma, he was in a medically induced coma. Pulling the plug didn't give his body a chance to start breathing. I am not paranoid about a big conspiracy. In Sweden, which became the international right-to-die destination, some citizens suggested that doctors were making convenient decisions for elderly or traumatically ill people who were "going to die anyway." I don't think that's true here. But I do think that the mental attitude towards right-to-die has slipped in the USA. It is the PERSON'S decision. The family can be asked, but if the person is not brain dead, doctors shouldn't be pushing this heart-wrenching decision on families as if it's okay. If the person still has a brain - wake them up and ask them.
I'm sorry to hear that your family has had so many health issues. There's an important medical question about why this might have happened in your family members' cases that a physician is better suited to answer. In the cases I've seen, doctors will only use a medically induced coma to prevent severe brain injury once the other options have failed. The decision happens really fast. "Fighting the ventilator" typically means extreme agitation: the patient suddenly sits upright, her skin starts turning blue, she's sweating and clearly distressed. It's a sign that something is seriously wrong. Since a coma is a last resort, if there's organ failure, reversing the coma either isn't possible-there has been too much brain damage-or too harmful for the patient. The decision about continuing or stopping ventilation is in part an ethical one. They need to be on the ventilator to get oxygen, which is why removing it causes them to die. Again, I'm not sure what happened to your family members, but the most common situation is that a patient is deteriorating so much that the ventilator is no longer benefiting him in a meaningful way. Because of the medical situation and other factors, like pain management, taking them out of the coma isn't possible. I absolutely agree that these are heart-wrenching decisions for a family to make. Even when people believe that removing the ventilator is the best option, making that decision for a loved one can be extremely difficult.
The interaction between House and Forman, discussing Forman going to work with Dr Hamilton is my favorite scene in the entire series. House beautifully describes who he is, what he does, and why he does it.
Funniest thing about this show. Doctors don't run cultures, they don't draw blood, and they damn sure don't do polysomnograms. lol I think the show is based in NJ, BTW. Not Mass.
And they wear masks! I have a correction in the info about the location. I screwed that up!
Pls do more
Thanks!
Wonder what your stance on Informed Consent, Medical Experimentation on Humans and Coercion is? A lot of that went down the past few years in Canada……
I know a guy who has 'DNR' tattooed on his left breast and always wondered if that would matter to EMTs or doctors. It's not a legal document obviously but it does show his wishes
I've had a couple cases like this. I'll make a video about it. Stay tuned!
12:37 The show is not based in Massachusetts. It's based in New Jersey.
Thanks. I have a correction in the description.
Hi Prof. Mathison: UofT student really enjoying your work on KZhead. Would you be interested in covering the Grey's Anatomy episode "Bad Blood" from the ninth season? Interesting but almost classic case of a Jehovah's witness needing a blood transfusion; would love a general discussion of religion conflicting with medical care.
Sure! Thanks for letting me know!
That patient isnt the victim he is just sick man who dont wont to get treatment!
House has offered to help kill at least 3 people.
The episode with actor Joel Gray was another. He was dying regardless, six months to live. DNR. But he had something new and House wanted to know what it was. House put something in his iv saying it would kill him, but actually he was giving him something to cause a coma. Then he ran tests etc until he found out what it was. WOKE THE PATIENT UP to tell him. And then did an assisted death. Joel Gray won an emmy award.
"They never have aby nurses in the show" is by far the best commentary of the show. Not a bad show, but absolutely an unrealistic one.
But they do have nurses.
Sorry, im with House on this one. He saved a life. Patient is an idiot.
this is misleading, you are not stating the 'ethics', you are stating the law. the law isnt always ethical, ethics and morality are different to the law.
All my points about what he should or shouldn't do are about ethics. Since the law and ethics overlap for DNRs, I include the legal points at no extra charge. Clinical ethicists tell people what the law says in cases where it's clear-cut, but you're right that the law and ethics sometimes come apart. In those cases, I'm clear that my recommendation differs from the law, so they should consult a lawyer and they have to decide what they want to prioritize. Cases like this are pretty rare, but it's somewhat more common for the law to be silent or ambiguous on an issue.
@@ValueJudgmentsheavy semantic use to avoid the reality. The same concept would fall under the good samaritan act in the case of a attempted suicide. Same moral dillema, but the legal red tape is on your side as opposed to against you. Don’t say they overlap when there are clear lines drawn
So because he's an ethicist he can't talk about law? So much for categorialism and transdisciplinarity.
@@musical_lolu4811 if you can't separate ethics from law than you're not much of a ethicist are you
So is Eric here Pro-choice?
True, but people hates bureaucrats and love little genius dictators who do not play by the rules!
It certainly makes for better television.
People like people who can see past rules and red tape and do the right thing regardless
This guy must’ve thought this was a biography. He must not realize that it’s fictional drama.
Is that why House won't return my requests for comment!?
@@ValueJudgments, oh, I get it… …you think a lot of viewers think it’s real.
@@JimCGamesit’s more of a analysis of fiction, ya know, a human past time since we first started telling stories. That being said, this man isn’t ethical, he’s just really good at following the legal guidelines. Ethics aren’t the same as laws.
@@milewesler9592, “…analysis of fiction…”? Is it? When you say this and that isn’t so? You’re imposing reality onto “fiction”. fiction /fĭk′shən/ noun The category of literature, drama, film, or other creative work whose content is imagined and is not necessarily based on fact. I watch programs all the time and see things that don’t coincide with reality, except when they want it to. For instance, all the millions and millions of retail outlets with cameras and yet crimes go on in these areas and police never have the inclination to look for such videos. Even when they occur inside these establishments, it’s the same thing. Or how about when on NCIS they storm into a building without first obtaining a warrant. They knew where they were going ahead of time, and yet they never sought a warrant. They come upon their destination, immediately arm themselves and start maneuvering around the building ready to rush inside and take down the villain. Yeah, we’re so set on all the details of fiction and these programs persist and nobody bats an eye. Why? Because it’s fiction!
@@milewesler9592, it’s an author’s work. If these people are so set on inserting every nuance of reality into fiction, I think they should go write their own screenplays. Fiction doesn’t always work if you go to that extreme because the author is trying to bring about specific scenarios to further the drama within it that can’t otherwise evolve upon such insistence.
I'll say this I know it's a TV show and all but if there was a lot more house dudes like him doctors like him in the world then there will be a lot more less people dying pretty 110% positive about that shit
House constantly gets extremely lucky after nearly killing his patients with his wild theories. The fact he often gets them right in the end is a narrative convenience so that all his team's effort and diagnosis are justified. A doctor who actually "heard hoof beats and thought zebras instead of horses" would and went about treatment as recklessly as he does would almost certainly kill many more patients.
@@CharlieQuartz it's a show...... And yeah he's teaching his collies how to work even though half of the time he ends up helping them or half of the time he already knows what's the symptom he just making them work.....good 👍