Having a Stroke: Ethical Issues in Medicine and Law

Abstract

Tom (not his real name; all names are changed) had a stroke. I learned a lot about this case and see various medical and legal realities that reflect possible ethical concerns. I present the case history below, and number the possible ethical issues involved.Tom's stroke occurred when he worked in the retail store of a large U.S. corporation and the person doing clean-up accidentally splashed toxic chemicals on him. Tom eventually had to be taken to the hospital where they failed to diagnose that he had a stroke (possible ethical issue #1). Later, they figured out that he had a stroke, but misdiagnosed the kind of stroke (possible ethical issue #2). Regarding 1 and 2, are these ethical issues when a hospital gets the diagnosis wrong? Should medical practitioners know better or should we conclude that anyone-including professionals-can make a mistake? Certainly, professionals cannot always be accurate. I almost laugh when people say things like, could the parole board let him out? after someone goes on to commit more crimes. The answer is that one cannot be close to 100 percent accurate in predicting which prisoner will or will not commit future crimes. However, there are minimal standards that any professional-such as hospital personnel-should attain, and sometimes the failure to attain these minimal standards is an issue of ethics, e.g., when due to neglect of something that is known or should be known. But hospitals and other agencies protect themselves by claiming to be operating according to their code of ethics (Hauptman & Hill, 1991; Konner, 1988; Wallace, 2010; van Meijl, 2000).Ethical issue #3 occurred when Dr. Dollar referred Tom to the rehabilitation center where Dr. Dollar has a financial interest and apparently gets money for referrals. Is that unethical? If the answer is no, what if Dr. Dollar refers people who do not need that service, but is motivated by the money he will make? Is that not clearly unethical? The rehab center had Tom doing exercises that caused horrible pain and yet another stroke. When Dr. Hasty heard about this, he was furious at Dr. Dollar and yelled at him, Why did you have him doing exercise? He had a stroke. He should not be exercising.Ethical issue #4 occurred when the hospital finally figured out what kind of stroke Tom had and rediagnosed him AND changed the earlier diagnoses to make it seem that they had it right all along. It seems to me to be clearly unethical and probably criminal. It makes me wonder, How often does this occur in hospitals and in medical practice and in other contexts?Ethical issue #5 was the inadequate treatment Tom received in the hospital, even after the correct diagnosis. In fact, they informed his wife that he would probably not live for more than a few days. Fortunately, his friend Jack visited Tom in the hospital. Jack was in medical school (though older than most of his fellow medical students) and knew about strokes. He looked at Tom's charts and other information about his treatment and concluded he was being mistreated. He contacted Dr. Hasty who said he would be glad to take over the treatment of Tom, but first Tom's wife would have to fire his current doctors. She did, Dr. Hasty took over, changed the type of treatment Tom received, and Tom survived.Consequences of the StrokeThe stroke had horrible consequences in Tom's life. He had to relearn how to walk, talk, swallow food, and much more. He is legally blind, although he has some sight. Strokes affect the brain and are harmful to anyone, although Tom seemed to have had the bad fortune of winding up with poor medical treatment, as opposed to Taylor (2009) who also had the bad fortune of having a stroke, but received top notch treatment since she worked at Harvard Medical School. Tom talked to an attorney who filed a lawsuit against the corporation Tom had worked for. He was seeking many millions of dollars. Later, other attorneys heard about the lawsuit and asked if they could be part of it. …