Ethics Case Studies in Biodesign

Case 3 - Conscientious Student

Mr. Conscientious, a student in Biodesign with a Ph.D. in Mechanical Engineering, is in the operating room, with the patient’s agreement, to observe a cardiovascular surgical procedure repairing a popliteal artery aneurysm. The CV surgeon has asked him to scrub so Mr. C. can better observe the operation from a position next to the CV surgeon at the operating table and has shown him how to scrub, gown and glove properly. The assisting surgeon is called from the ward by his first year resident and requested to leave the operating room to deal with an emergency. The assisting surgeon asks the CV surgeon if Mr. C. can move to the opposite side of the table to hold a retractor and then use scissors to cut the knots being tied by the CV surgeon. Mr. C. catches an exchange of "looks" between the CV surgeon and the scrub nurse and he is uncomfortable. The CV surgeon asks Mr. C. if he will hold the retractor and use the scissors.

• Should Mr. C. accept the surgeon’s invitation to hold the retractor?
• Should Mr. C. accept the surgeon’s invitation to use the scissors?
• If this were an operation in the chest cavity, would that make a difference in your judgments about the questions above?

Discussion points:

• Has the patient given consent for the student to be involved with her treatment as opposed to observing the treatment? ["Touching" a patient without their consent in a medical context is a "battery" on their person.]
• The general consent signed for surgery by patients usually agrees to the members of the medical team providing care. Is the student a member of the medical team?
• If the student does not help the surgeon, is the patient in jeopardy because of inadequate hands at the table? Is that a danger to the patient that mitigates the situation?
• Will the student create a situation of unhappiness or anger in the CV surgeon by refusing to help that might negatively effect the other students or the program sponsoring the student?