This ethical dilemma is a case where duty conflicts with ethics and moral values. In this scenario, a doctor discovers a heart murmur in a pilot who is a month away from retirement. She struggles in deciding whether withholding this information is justifiable. As lives are at stake and medical professionals are bound by the rules of HIPAA, the choice between risking one’s career or the wellbeing of others is difficult. When analyzing the situation through the eyes of medieval philosophers St. Augustine and St. Aquinas, we find that the principles of “good and evil”, “wrong and right,” and “ought/should be vs. what is” take prevalence in ethical decision making.
According to Ruggerio, “The basic rule of morality is to do good and to avoid evil” (Ruggerio,2018). While people are mostly born with the intention of doing “good” they are sometimes moved to do “wrong”. “Evil” can be characterized as doing things that can cause people harm, with the intention to do so. While “wrong”, can be characterized as being deceitful and being the opposite of “good”. Parallel to this, is the idea of “what should be”, and “what is”. Just because a situation is certain way does not mean that one should not intervene or attempt to improve it. As political thinker Edmund Burke contends, “The only thing necessary for the triumph of evil is for good men to do nothing” (Burke, E., & wiseoldsayings, 2017).
Ethics of the medieval era evolved to be a combination of human reasoning and obedience to the will of God. Philosopher St. Augustine theorized that, “although we feel free to make choices in life, our true nature as human beings includes a persistent disregard for what is good” (Page, 2019). On this premise, our only hope for salvation comes from the forgiveness of God. St. Aquinas, on the other hand, taught that people are rational thinkers. He believed that humans have the capability and the reasoning to distinguish between good and evil. He considered this awareness, or conscience, to be a gift from God. Furthermore Aquinas theorized that as long as the intentions behind our choices were good, those who were faithful would be forgiven.
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When applying the theories of these philosophers to the dilemma at hand, we can surmise how they might proceed in the doctor’s position. Augustine’s notions would have one believe that ultimately, the good or right decision warrants having faith that God’s will would be done. Although there are particular circumstances in which a HIPAA covered entity may disclose patient health information to law enforcement, it can be argued that a heart murmur may not be a justifiable reason. Per the policy, it is only tenable if the information will, “ prevent or lessen a serious and imminent threat to the health or safety of an individual or the public” (U.S. Department of Health and Human Services, 2017). According to Harvard Medical School, “About 10% of adults with normal hearts have a harmless murmur, known as an innocent or functional murmur” (Harvard Health Publishing, & Bhatt, D. L., 2015). Murmurs alone are not considered deadly or dangerous in most circumstances. Augustine would suggest the doctor to inform the patient of their concern and give them all the necessary information, as that is her duty. However, the rest should be left in God’s hands to see that his will is performed.
Believing that man should follow the promptings of their God-given conscience, Aquinas would probably disagree with Augustine’s solution. Instead, Aquinas would empower the doctor to believe that she has the capability and the reasoning to determine whether to report the information or not, and would ask that she look at the bigger picture and consider what is at stake. Although not fatal, some symptoms of heart murmurs include: chest pain, shortness of breath, swelling in the feet, legs, or abdomen, and dizziness or fainting (Bamrah, V. S., 2017, February). The manifestation of any one of these symptoms may be enough to distract the pilot, affect the quality of his skills, or hinder his decision making. The doctor should acknowledge this and consider their moral obligation to, as a doctor, practice justice and nonmaleficence in regard to all affected. To do no harm should be the end goal with every physician’s decision; meaning that health care providers must, “consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient” (Saint Joseph’s University, 2017). With this, we can deduce that Aquinas would support the doctor’s decision of reporting this information to the appropriate staff of the airline company.
Based on the ethical theories presented, and the applied ideas of “good and evil”, “wrong and right,” and “ought/should be vs. what is”, in good conscience the intention of withholding information cannot be justified. As the manifestation of symptoms regarding the patient’s condition are enough to jeopardize the pilot’s abilities and the safety of all those in the aircraft, this information should not be withheld. In alignment with the theories of St. Aquinas, the intention of protecting the wellbeing of all involved would grant the doctor a clear conscience and the forgiveness of God. Although an incredibly difficult and potentially career ending decision for both professionals, it is ultimately what is morally correct; and deemed by Aquinas as ethically good.
Bamrah, V. S. (2017, February 14). 5 Vital Answers You Should Know About Heart Murmurs. Retrieved from https://www.aurorahealthcare.org/patients-visitors/blog/5-vital -answers-you-should-know-heart-murmurs
Burke, E., & wiseoldsayings. (2017). Good And Evil Sayings and Good And Evil Quotes: Wise Old Sayings. Retrieved from http://www.wiseoldsayings.com /good-and- evil-quotes/p age-1/
Harvard Health Publishing, & Bhatt, D. L. (2015, May). Ask the doctor: What can cause a heart
murmur in an adult? Retrieved from https://www.health.harvard.edu/heart-health/ask- The-doctor-what-can-cause-a-heart-murmur-in-an-adult
Page, K. (2019). Week 2 Discussion: Human Nature: the Good, the Bad, and the Ugly [Discussion Introduction Notes]. Retrieved from Chamberlain College of Nursing.
Ruggiero, V. R. (2012). Thinking critically about ethical issues (8th ed.). New York: Mc-Graw Hill.
Saint Joseph’s University. (2017, February 24). How the Four Principles of Health Care Ethics Improve Patient Care. Retrieved from https://online.sju.edu/graduate/masters-health-a dministration/resources/articles/four-principles-of-health-care-ethics-improve-
U.S. Department of Health and Human Services. (2017). Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for Law Enforcement. Retrieved from https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special
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