A Case-Based Discussion Supporting Ethics Education in Medical Schools
Keywords:Patient Self-Determination Act, Patient-centered healthcare, Advance directives, Incapacitated, unrepresented patients, Ethical awareness in healthcare providers, Ethics education in medical schools, Ethical literacy, Clinical ethics, Case-based discussion, Autonomy in medical decision-making, Capacity assessment, Vulnerability of homeless patients, Stigmatization of psychiatric illness, Ethics curriculum in medical education, Ethical dilemmas in patient care, Provider uncertainty, Patient autonomy, Standardized ethics education, Hands-on ethics training, Humanistic ethics in healthcare
Background: Ethics education in medical schools lacks uniformity, yielding uncertainty when providers are faced with ethically complex patients. Without streamlined ethics training, providers are less confident in their ability to provide ethically appropriate care for all patients, particularly for those most ethically vulnerable. This case report seeks to elucidate ethical concerns when treating an ethically complex patient. Subsequently, the need for early ethics education is substantiated.
The Case: A 58-year-old unhoused patient with no known medical history presented to the emergency department (ED) for evaluation of an infected foot wound. Imaging confirmed acute gas gangrene osteomyelitis. The patient refused the recommended below-the-knee amputation (BKA) but was amenable to intravenous antibiotic therapy. He was subsequently determined by psychiatry to lack decisional capacity and met the DSM-5 criteria for schizoaffective psychosis. Subsequently, the patient’s brother deferred decision-making to the patient, who he believed should make his own medical decisions. Following an ethics consultation, the brother’s decision, and by proxy the patient’s, was respected.
Conclusion: In this case, the patient’s autonomy was prioritized, despite his high level of ethical vulnerability. Ethically conscious treatment was provided despite the implicit stigmatization of homelessness and psychiatric illness. However, an ethics consultation was necessary for this to occur. Ultimately, this paper should serve as a call to action for standardization and prioritization of ethics education during and beyond medical training.
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