Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true 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, :
"Fozzie" is the brutal dictator of a wealthy nation that enjoys a long-standing military alliance with the United States. He develops a rare leukemia resistant to approved treatments. However, a trial is about to begin for a promising experimental new therapeutic agent that may treat this variant of the disease. Fozzie secures an emergency visa and arranges with the hospital to participate in the study, which holds out the only realistic chance of saving his life.
Steven Strange, MD, chief of oncology at the hospital, had initially agreed to allow Fozzie to receive the experimental treatment. Yet on the same day Fozzie arrives, before the treatment begins, Strange learns that Fozzie's government is responsible for the deaths of thousands of innocent civilians and has been implicated in sexual violence, torture, and even cannibalism. He is troubled by the possibility that successful treatment could allow Fozzie to continue to rule when Fozzie's people have no access to basic medical care or the most fundamental human rights.
"Lots of people die of leukemia in his country," Strange is told. "None of them are allowed to come to the United States for experimental treatments."
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:
Can I Fire 'Extremely Unpleasant' Dialysis Patient?