An ethical case study

A couple, on vacation at an exotic beach, woke up one morning to find “red pinprick marks” on the butt of the woman. Soon thereafter, the husband developed the same marks. They got cursory treatment while on vacation but after the marks had not gone away after ten days, when the couple returned home they went to the hospital. The doctors found that the couple were each “infested by worms” and found an working combination of medications to relieve them of said infestation. The doctors, recognizing such a rare/interesting condition could be written up for the scientific community so that other doctors encountering the symptoms have something to go on, sought to obtain permission from the couple to publish a short case study in a prominent medical journal. The couple is informed that such medical journals are often read by journalists from larger news organizations and that there is a chance, though a remote one, that their case could be seen more widely. The couple gave permission to use their story.

Within days, photos of their infested regions end up in the tabloids. The couple fears recognition, asks the journal to remove the article, and the journal retracts the story and photos.


Questions to ponder

Is there at least one single action done by anyone that crosses the border into unethical behavior? In what way do you consider it unethical? If that person or entity had acted in a more ethically sound manner, what affect might it have had on the ultimate outcomes of the situation? From such an assessment and its extension, given the choices available to the person or entity, to what extent does a “more ethical” decision in this choice-making behavior affect the outcomes of the situation? Is there a choice among those that you believe would lead to the best of all possible worlds? If so, where does it lie on the moral grayness scale? Are you comfortable making that choice?

How much demographic information should we present about patients? Where lies the balance – in your opinion – between the twin duties of disclosure and discretion for the physician?

Is this an unfortunate example of the coarsening of our discourse? Is it yet another manifestation of the stigma of disease?

Does this story strike you? Why?

Try to put yourself in the place of one or both of the couple. Imagine wanting to go to an exotic beach location for your vacation, accidentally sitting in dog droppings somewhere on said beach, getting a nasty rash that turns out to be worms digging into the flesh of your butt, the symptoms progressing to respiratory malfunction, working with physicians who look at you with at least more than mild curiosity, getting treated, getting written about, signing a disclosure form, seeing your photos on newsstands. How has your perspective in life changed after such a walk?

Would you allow your photos to be remain published?