I am about half-way through a master’s degree in biomedical ethics and public health, and I have an abiding interest in how ethics issues are portrayed in media. One of television’s most popular programs is House, M.D. It features the misanthrope Dr. Gregory House, who is brilliant but who pays utterly no attention to social conventions or rules of human behavior in his zeal to solve the difficult medical cases that he sees each week. This includes the rules of medical ethics that all institutions have to live by. So each week House does what he thinks necessary in order to diagnose the condition; this may include breaking into a patient’s house, treating them against their will, bullying them into compliance or forcing his co-workers to do his dirty deeds.
Last night’s episode contained a number of issues that are illustrative, but in this case they do not actually involve House himself, but the people who work for him and who have been influenced by him whether they wish to admit it or not. To set the stage, let me note that House’s colleague Dr. Foreman has begun a new relation with House’s latest hire, Dr. Remy Hadley, better known by her nickname “Thirteen.” Recently, Thirteen was positively diagnosed with Huntington’s Chorea, which has not yet begun to manifest; however, she understands it is a death sentence and has begun acting badly as a result. With Foreman’s coaching and after facing death from a deranged patient, she has decided to live better. Thus, she accepts Foreman’s suggestion that she enter a trial of a new drug for her disease, which is being held at their hospital, and which Dr. Foreman is one of the doctors overseeing the trial. In the course of showing up for treatment, she has befriended a woman whose Huntington’s disease is much more advanced, though the constant reminder of what is to come troubles her. As a result, Foremen rescheduled the patient so that they did not have coincident visits.
Which sets the stage for yesterday’s developments. In the episode, Thirteen tells Foreman she cannot see him again. She does not wish, in her words, to bring him down with her as she worsens (the case they are seeing outside of the trial involves a man in constant pain and the effect it has on his family). When she returns for her own treatment in the trial, the patient who had been rescheduled is there again, but she is greatly improved. She is obviously getting the experimental drug and it is working. Thirteen therefore accuses Foreman of setting this up in attempt to get her to remain in the relation. Foreman points out that it is a double blind trial, he does not do the scheduling, and he could not know whether or not this patient is getting the active drug or placebo. Thirteen is mollified and even happy to hear this.
Finally, to the point. Thirteen is in treatment again, and Foreman is there helping to fix a small leak in her IV bottle. They agree to go out that night. When Foreman leaves the room, the nurse outside asks him how he can stand the smell. He notes that he does not smell anything at all. The nurse then states that, in that case the patient (Thirteen) must be getting the placebo because the active drug smells very bad. We see Thirteen sitting inside, alone, but smiling in the thought of a successful treatment and a date to come. And then we see House pull Foreman aside, and tell him that he looked over the treatment logs and saw that Foreman had indeed switched the scheduling and manipulated the other patient in order to maintain his new and growing relation with Thirteen. And now Foreman knows that the woman he is growing to love is getting the placebo. And he is involved with the trial.
So, what violations have occurred here? What is wrong in the picture I have painted? Please feel free to send comments in here if you would like. Next post I will provide some answers, but for now, have at it, please.