Tuesday, January 20, 2009

Bioethics on Television: The Case of House, M.D.

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.


Anonymous said...

From Ryu
This is such an interesting episode, as usual.
What I see in this is that there is the conflict between the relationship in terms of study of new drag and the relation as humans. While Foreman plays a role in the study and is suppoesd to treat her as a participant, there has been the growing feelings between them, whcih may affect the result of study. As a researcher, Foreman's actions such as intentional manipulation in rescheduling for partucular one among participants and personally asking her out are not recommended, due to the nature of double-blinded study design, and as a result, it seemingly creates Placebo on her. In contrast as a participant, she desearves to and should be respected for her autonomy and will, like wishing not want one to see her a result of treatment in bad behavior, wishing sucessful treatment and looking forward to date someone. In light of a patiant perspective and not decreasing the quality of the study, withdrawing her from the study without notifing her information which may intercept the effect of placebo and maintaing this treatment may benefit for both her and the study, rather than pulling Foreman from her, I think.

Anonymous said...

Thank you, Ryu. You raise one issue that we need to pay attention to, but there are others as well. What do our colleagues in our class think may be some of those other issues?

Anonymous said...

From Barbara
First, a code of professional ethics (above all, do no harm) has been violated when Foreman changed the appointment to console "Thirteen's" concerns about the progress of the disease. His intentions were selfishly motivated, violating character ethics. He also lied about his involvement to Thirteen, further violating virtue/character ethics. Perhaps his actions could be validated through the ethics of care or relationship-based accounts, except that he did not consider the obviously unintended negative consequence. His paternalistic approach--toward a colleague, nonetheless--completely violates her individual rights to interact with other patients, perhaps gaining insight to her demise, and interferes with her chances of receiving the treatment instead of the placebo. And that's just Foreman.

House, as usual, has no boundaries considering ethics or his actions--only his act utilitarian approach and huge ego, albeit ironically correct eventually. He has viewed records he shouldn't. He hasn't interfered--yet.

Finally, House and Foreman have to deal with the knowledge that their colleague (and potential girlfriend) is not getting treatment and may decline in health more rapidly. They also have to consider NOT interfering further with the study and moving her into the test group from the placebo group. We'll see how they conform to those ethical choices!

Anonymous said...

Correct you are, Barb. Thank you for your response.