Grey’s Anatomy Episode Opens Good Ethics Discussion

With April being “National Donate Life Month,” I was happy to see one of my favorite shows include organ donation and some of the complexities surrounding that issue. Recently on Grey’s Anatomy Miranda said, “Take away the story. Take away the good guys and the bad guys. It’s a child who needs an organ and a patient with one to give.”

This was not just any little innocent child, but a 15 year-old accessory to armed robbery and double-homicide. And the potential donor? A policeman and victim of the attempted robbery. But wait – there’s more . . . who must give permission for the donation? The mother of the policeman, whose other son, also a policeman, was killed in the robbery, as well.

Both doctors, the potential donor’s and the recipient’s discussed the best interests of their patients and how to proceed – request the mother’s permission or not? One says to the other, “Ethically, I’m looking out for the best interests of my patient and you are looking out for yours.” Hmmm . . . so many ethical issues here to discuss: doctors’ influence (due or undue); best interests considered from the doctor’s, not the patient’s, perspective; justice and access — shortage of organs and notion of worthiness of recipients; survivors making decisions on behalf of their lost loved ones who hadn’t previously expressed their wishes.

However, not addressed was the role of the hospital (the organization) in resolving these complicated issues. The organization’s role must begin much earlier than the actual incident. The hospital is obligated to safeguard the provision of quality care, ensuring that clinicians are able and willing to provide conflict-free, patient-oriented care based on shared decision making. This includes providing ethics training and encouraging clinicians to call for an ethics consultation when appropriate.  It takes a culture stressing consistent behavior and communicating standards and protocols to individuals in a personal manner.

I was really glad to see such a popular show in a healthcare setting nudging viewers to contemplate these varied ethical issues that many will inevitably face at one time or another. What do you think? Who has more accountability for these types of issues – the organization or the professional?