Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, .
During a robbery, a shopkeeper, Silas, is shot by an armed assailant. After he is wounded, Silas returns fire and hits the attacker in the thigh. The shopkeeper dies before he can describe the perpetrator to the police, mumbling only, "I shot him in the leg. I shot him in the leg."
The police suspect a known criminal named Wesley, who showed up in the emergency room of a city hospital 2 hours after the robbery with a bullet wound in his leg. The police would like to compare that bullet to the rounds remaining in Silas's handgun. However, when Wesley realizes that the bullet may be used as evidence against him, he refuses to consent to surgery to remove it. The doctors believe that without the bullet removed, Wesley may suffer from some chronic pain and possibly a limp, but with proper wound care, he is unlikely to die or experience other long-term consequences. No other direct evidence ties Wesley to the crime other than the bullet wound.
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 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.
And check out some of our past Ethics Consult cases:
Forcibly Medicate Psychiatric Patient?
Approve a Horn Implantation in Patient's Skull?
Is Doctor Liable for Withholding Patient's Diagnosis From Family?