ETHICAL CROSSROADS ALONG THE WAY

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ETHICAL CROSSROADS ALONG THE WAY

• STORIES ABOUT MEDICAL TRAINING AND PSYCHIATRY
• John Maher MD FRCPC
• Whitby Mental Health Centre, Canada

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WHY TELL STORIES?

• 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

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WHY TELL STORIES?

• By sharing and comparing stories we learn to
  better appreciate where our lives and experiences
  intersect with the lives and experiences of
  others.
• Ethics takes place at this intersection

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WHY TELL STORIES?

• 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

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WHY TELL STORIES?

• Empathy is the impetus to respect, and respect is
  the core of ethics.
• Narrative is the mechanism that brings it all
  together.
• Workman S, Hubert J, Byers R, Jaggi R, Jantz A
• CMAJ, May 9, 2006 174(10), p. 1453

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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

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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

• Exhaustion, stress, codes
• A fair call schedule
• Jump on him!
• Stat to surgery
• CARMS

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Year 1 Rotating Internship

• Black Day in July
• Different strokes for
• Post-kidney transplant
• Pronouncing death

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Year 1 Rotating Internship

• A problem with blood pressure
• Abortion clinic
• Butcher B. and the truth
• A supervisors woes

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YEARS 2 to 5 - RESIDENCY

• 9 years in 5
• Growing autonomy
• Essential paternalism
• Certifying someone
• Saudi perspectives

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YEARS 2 to 5 - RESIDENCY

• Attitudes towards BPD
• Serge was beat up
• Changing a report after a suicide
• A mercenarys story
• Being Chief Resident
• FITRE
• Not invited back

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IN PRACTICE

• Informal opinion
• Do I need to see a doctor?
• Pill exchange
• I want my gun back
• Alcohol and harm reduction
• Drug company money

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IN PRACTICE

• 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

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AND THE STORY CONTINUES

• Where are the heroes of bioethics? (Freedman)
• C.S. Lewis, The Great Divorce, and the real
  heroes
• Going on safari