January 4, 2009

• Your Body is my canvas...

  Alright, so before I get into trying to start ethical debates with you folks, I figure it would only be fair to introduce you to the four basic principles of medical ethics (source linked):

  Autonomy: the patient has a rational decision making capacity and can decide what level of care they deem appropriate
  Nonmaleficience: primum non nocere (first, do no harm)
  Beneficience: after doing no harm, attempt to do the most good
  Justice: fair distribution/allocation of scarce resources

  Now all of these topics are extended posts in and of themselves, and the justice one is going to be important in the coming years under Obama's free healthcare for everyone plan...but lets take things one step at a time, shall we?

  The Article I will be covering this week is here

  Where to begin? Was the surgeon's action inappropriate? possibly. Should he have chosen a different place for his little surprise? probably. But were his actions unethical? I don't believe so.

  Lets look at the principles involved shall we?

  Right off the bat we can eliminate justice and beneficience, as leaving a temp tattoo on a woman has nothing at all to do with being fair, and little to do with helping the patient outside of supposedly providing a cheery surprise.

  So the concerns here are Autonomy and Nonmaleficience

  Autonomy, according to the Washington site means that in health care decisions the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act. This principle is the basis for the practice of "informed consent" in the physician/patient transaction

  In this case, the womans autonomy was clearly violated as she never indicated a willingness for a temporary tattoo, nor was she informed at any point by the surgeon that such might be included in any part of the procedure. In fact she was unconscious and unaware and had things turned out differently the surgeon could have given her a permanent tattoo or carved his initials instead of just applying a tiny rub on. Had she been told and accepted or declined, the surgeon could then have made his decision knowing the patients wishes.

  Just to be clear, I still personally think this is a ridiculous case and another example of a frivoulous lawsuit, but in principal the woman was correct.

  The other principle involved is nonmaleficience. According to the washington site, it requires of us that we not intentionally create a needless harm or injury to the patient, either through acts of commission or omission

  I am not personally a believer of the "mental anguish" claim made in so many lawsuits today, but again under the exact wording of the principle, the woman is in the right. There was no part of the operation that required a tattoo on her belly when the operation was on her back and while she was not physically injured, she was clearly distressed and or embarassed to learn of what had been done. The location of the tattoo, just below the panty line was highly inappropriate and doubtless contributed to the idea of harm she is claiming.

  So what would I have done differently? After all, apparently this doctor had no previous history of lawsuits against him per the article, and has been doing these little surprise tattoos for a while

  "Kirshner does not deny placing the tattoo - and has left washable marks on patients before to improve their spirits, "

  So was this woman just overreacting because of the location of the tattoo? Such would be my thought, but were I in the surgeons place, I would think very carefully in the future about where I place anything to improve the spirits of the patient...had he done it on an arm or somewhere less possibly indicated with a prurient intent, or had he told the woman that he occasionally leaves washable tattoos on patients and given her the opportunity to reject it, the problem may have been avoided.

  So while I personally feel this is a frivoulous complaint from an overreacting woman, a brieft analysis of the principles involved would unfortunately bear out her point.

  What are your thoughts? I will endeavor to find how the case ended for all of you
  

  • 3:39 pm
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