Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case. And next week, we'll reveal how you all made the call. And stay tuned, bioethicist Jacob M. Appel, MD, JD, will weigh in next week with an ethical framework to help you learn and prepare.
The following case is from Appel's 2019 book, :
Monty, a 50-year-old roofer who is positive for HIV, has been treated by Dr. Kildare for many years, but often skips his prescribed HIV medications for months at a time. One summer afternoon, Monty becomes short of breath while working and is rushed to the nearest hospital with a collapsed lung -- the result of a walking pneumonia that likely resulted from his untreated HIV/AIDS. Soon Monty loses consciousness and is placed on a ventilator; his prognosis for recovery is poor.
As Monty's condition deteriorates, Dr. Kildare contacts the patient's only immediate living relative, his sister, Crystal, to make decisions about Monty's medical care. In the past, Monty has told Dr. Kildare that he loves his sister very much but does not want her to know that he is HIV-positive or that he used to inject intravenous drugs, because such knowledge would upset her. By the time Crystal arrives at the hospital, Monty has already died. "I want to know what really killed my brother," Crystal says to Dr. Kildare. "For peace of mind. Healthy middle-aged men don't just drop dead of pneumonia. He didn't have HIV or AIDS, did he?" She demands to see Monty's medical records.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases: