David Oliver: Moral distress in hospital doctorsBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1333 (Published 27 March 2018) Cite this as: BMJ 2018;360:k1333
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Moral distress in doctors might best be highlighted by looking at the role of the police doctor whete thete are very definite tensions between the role and ethics of the doctor, the commercial priorities of the employer and the police whose primary focus is upon gathering evidence and secirong a conviction.
There are several examples where a doctor's ethical standards will be tested against these competing interests which are worthy of consideration.
Take a recent case of a middle-aged woman who had been raped. She had been encouraged to report the matter to the police who persuaded her to undergo an intimate examination for DNA evidence. When seeking consent, the woman burst into tears and reported that she hadn't understood that the examination was voluntary and claimed that the police had bullied her into having the examination. The police were furious that the examination did not proceed and complained to the company whoch fired the doctor.
Another example was the woman who had been raped by her husband with whom she had had consensual sex the previous evening and with whom she shared a bed naked. The police were advised that an intimate examination for DNA would have no probitive value as the laboratory could not distinguish between "consensual", "non-consensual " and "environmental" DNA. They insisted that the examination should proceed against medical advice. When seeking informed consent does the doctor explain that the examination will not prove rape? This doctor felt that consent should be informed. The police complained and the doctor was fired.
What is an ethical doctor supposed to do when, in custody, the detainee politely refuses to discuss his private medical problems with the custody sgt., or the doctor. He has capacity to refuse and states that he feels his medical problems are private between him and his GP. The custody sgt. is then heard to threaten the detainee that if he ever wishes to be released from his cell, he will go and be examined by the doctor. This doctor refused on the grounds that consent had been coerced. The police complained to the company and the doctor was fired.
One has to ask if it is possible to conduct medical practice ethically when the prevailing standards, ethics and moral values are so widely divergent.
Competing interests: No competing interests