Contemplating ethics and morals

Hypothetical and rhetorical questions, food for thought…

When overseas, members of our team encountered a situation where a person greatly needed a taxi ride from the hospital to the train as he had very limited mobility.  Should they have given him money for a cab, and both set a precedent and an expectation from the staff for future hard cases (and they all are hard)?  What about in the states, where a blanket/pillow for a homeless client or bus coupons can greatly improve a client’s comfort/outcome or keeping an appointment?  Where does our responsibility as a healthcare provider end, and as a citizen begin (and end)?  Does the citizen part start once we clock out, or affect us at work as well?

When in a large public urban hospital, you may encounter those who are thought to be seeking pharmacotherapy for reasons other than intended through simulation of pain and you may be called upon to determine if it may truly be musculoskeletal in origin.  Besides being a great clinician with outstanding differential diagnosis skills, can you completely put aside the fact that they are likely not there for what you can do but for what an MD can provide?  How do you stay away from casting that stereotype on those it seems to fit?  How do you maintain professional demeanor when you encounter someone who says or does something you find offensive, insulting, etc?

The first questions drive at morals, the second at ethics and professionalism, I think.  Still mulling it over, but I think the morals issue is a case-by-case basis – not that morals themselves are case by case (Is it right to help, or is it wrong to turn a blind eye?  How do you help without enabling?), but more that you help in the best way you can or think you should (referral to appropriate resources, supplying a small need yourself, etc).  In class we talked about ethics and professionalism in the first year.  I think that we all have a certain level of professionalism and of interpersonal skills, but they are developed through testing, strengthening, and mentoring.  While I am doing well (I think) in regards to the moral and ethics questions, there is always room for improvement – this (and here) is a great place to be for these questions.

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