Welcome to Ethics Consult — an opportunity to discuss, (respectfully) debate, and learn together. We select an ethical dilemma from a real, but anonymized, patient care case. You vote on your decision in the case and next week we reveal how you all called. Bioethicist Jacob M. Appel, MD, JD, will also discuss an ethical framework to help you learn and prepare.
The following case is an adaptation of Appel’s book from 2019, Who says you’re dead? Medical and ethical dilemmas for the curious and concerned.
A middle-aged woman, Vivien, shows up for her first appointment with an oncologist, Rocky Bock, MD, to begin treatment for a rare cancer. She is accompanied by her sister, Jeanne, with whom she bears a striking resemblance. On evaluation, the physician finds several significant inconsistencies between the patient’s medical records and the findings of her physical examination. Most notably, previous doctors have documented that the patient lost her left index finger in a car accident, but Vivien appears to have all 10 of her digits intact.
Bock confronts Vivien about these inconsistencies, and she confesses that she is actually Jeanne and that the two sisters conspired to exchange identities because Jeanne has health insurance, while Vivien is an undocumented US resident and has no way of get insurance or pay for cancer treatments. The chemotherapy needed to treat her cancer costs more than $150,000, and the sisters can’t realistically raise that amount quickly. Vivien and Jeanne both beg the doctor to “overlook” his discovery. Bock sincerely believes that the treatments will save the woman’s life.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board of the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a Bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases:
Wrong to offer cheap, illegal version of drugs?
Cutting health insurance for risky activities?
Stop life assistance for a tax benefit?