Author: Mehak Bhatia
Many students want a career that is about making a difference. For most of us, having a career that is line with our personal values would be ideal. However, when it comes to researching and planning a career, we rarely think about what ethical scenarios we might face on a job and how our career satisfaction might be impacted by such issues. As a second year Health Sciences student contemplating a career in medicine, I am thinking ahead on these issues. Consider the following scenario:
It was late in the evening. After struggling to control her limbs that constantly and spontaneously moved in random directions, Steph’s mother finally stepped out of her bedroom and came downstairs in the living room. She sat across from her son and with a confused look on her face asked, “Where’s my nurse?” Uncomfortable and crunched in a corner toward the edge of the couch, she said, “Who are these two people, why won’t they sit somewhere else?” Steph’s family had not been to the hospital, nor had they had a nurse or a physician come to their place in a while. There was no one in the room except for her brother and mother. Steph’s mother was hallucinating.
A couple minutes after this, she had another attack of dyskinasia (highly uncoordinated movement of limbs) that continued to bother her throughout the night. Getting concerned that she might injure herself, Steph’s dad tried to hold her to control the movement. The force of the movements was such that it pushed her dad over to the wall across the room.
Although, Steph’s mother has Parkinson’s disease and experiences tremors (shaking of limbs) throughout most of the day, the forceful and random movements of her limbs and hallucinations are not among the most evident symptoms of Parkinson’s disease.
What was going on? After speaking to her mother’s neurologist, Steph’s brother and dad realized that hallucinations and dyskinasia were the side effects of a new drug that the neurologist prescribed for her mother. Her mother, who weighs about 90 pounds, could jerk her dad away, who weighs almost twice as much. Her brother could not sleep at nights because their mother would wake up in the middle of night saying that she “saw” things in her room that did not exist. All because of a pill.
Was the neurologist to blame for prescribing the drug to her? Parkinson’s disease is incurable. Therefore, it cannot be treated but the symptoms can be controlled. Unfortunately, as the disease progresses, it requires the patient to intake larger amounts of medications to control for symptoms. Also, with the progression of the disease, it takes longer and longer for the medicine to show its effect. Hence, researchers have come up with other medications that can be used as an adjunct, and help to speed up the absorption of the drug. The medication that was causing hallucinations was also helping the Parksinson’s symptoms. Therefore, to blame the neurologist for prescribing it to her would be a double edged sword.
This issue represents one of the darker sides of medicine. For incurable conditions such as Parkinson’s disease, physicians don’t have a choice other than prescribing and regulating amounts of different medications.
Would I as a physician encourage consuming a medication that, although controls negative symptoms, can cause side effects detrimental to health? Where would I draw the line when it comes to comparing the side effects with the therapeutic effects of a medication? How would I deal with the tension it creates in the patient’s family? How would I justify prescribing such a drug? If it is determined that the drug was in fact extremely harmful and should not have been prescribed to begin with, would I be courageous enough to accept my mistake? This issue gives rise to some really important questions that I must ponder upon before applying to medical school.