Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case. And next week, we'll reveal how you all made the call. And stay tuned, bioethicist Jacob M. Appel, MD, JD, will weigh in next week with an ethical framework to help you learn and prepare.
The following case is from Appel's 2019 book, :
Carrie is a 25-year-old woman who lives with a violent male partner. She arrives at the emergency room of her local community hospital with a black eye and a broken wrist. After some coaxing, she tells the physician on duty that her partner is responsible for her injuries. The doctor documents this in the patient's electronic medical record (EMR).
Several hours later, once her wrist has been cast and she is ready for discharge, the patient summons the doctor back to her bedside. "Please don't put anything in my chart about my partner hurting me," she says. "He has friends who work at this hospital. If they find out what I told you, it will get back to him and he'll hurt me again."
The hospital's EMR system has an "override" feature intended to allow removal of inaccurate and potentially dangerous information (such as a wrong blood type) from a patient's chart. In theory, the doctor could use it to delete the woman's statement that her partner caused the injuries.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Force-Feed Prisoner on Hunger Strike?