During my medicine Sub-I, there was an interesting ethical case that was brought up during one of our conferences. The case was written by a third year medical student on his medicine rotation.
A patient had come in with AMS and the team wasn’t entirely sure what it was. Meningitis wasn’t a top priority on the list initially, so they put off doing the LP. By the second day, they decided an LP was indicated. Unfortunately, the LP was done without asking the patient or his family for consent. The patient did not have capacity to make medical decisions, but there was very easy access to family members who could have given consent. In addition, the procedure was non-emergent and consent could have been obtained without causing the patient excess harm.
After performing the LP, the resident realized that he had not asked for consent, so he told the medical student to call the family and ask for consent, but to make sure he didn’t tell them that the procedure was already done. At my school, medical students are not allowed to obtain consent without having a physician present. The medical student, being a good member of the team, called the family and asked for consent without telling them the procedure was done. Fortunately the family was agreeable and they said they approved. However, this brings me to my question of when should we stop being a team player? When they presented this case, I was conflicted in what I would do. As much as I would have wanted to tell the resident he needs to call them and tell the truth, I would have feared for myself in terms of the retribution that would come from this resident. I think my most likely response would have been to weasel my way out of the consent by telling the resident I am not allowed to obtain consent and the administration said I can get in trouble if I did. However, if the issue of me not being allowed to obtain consent wasn’t there, I’m not entirely sure what I would do… Anybody have any thoughts on the matter?
