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, .
A retired psychiatrist, Rick Eckleburg, MD, recalls treating one of the major party nominees for U.S. president (now in his late 50s) when the psychiatrist was in training and the politician was in his early 20s. Eckleburg vividly remembers the case because the politician's father was a prominent elected official and the patient had attempted suicide. It was the patient's second suicide attempt, and he was diagnosed with manic depression (now better known as bipolar disorder).
To Eckleburg's surprise, the candidate releases his "entire" medical record to the public as part of his campaign, and there is no mention of any suicide attempts, mental illness, or the psychiatric medications generally prescribed to prevent patients with bipolar disorder from relapsing.
Needless to say, Eckleburg is concerned that the future leader of the free world may have a serious untreated psychiatric illness, or that he is a liar. At the same time, he is reluctant to break the candidate's medical confidentiality, especially as he has not seen him in 30 years.
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: