Medical Ethics

Medical Ethics












Medical Ethics

Medical ethics has evolved significantly over the past three decades given the growth of patient knowledge and increased focus on ethical and moral conduct among healthcare professionals. In essence, medical ethics is a vast discipline despite its application being limited to medical or healthcare settings. It involves a variety of scholastic approaches such as sociology, theology, philosophy and history. They all play a significant role towards contribution of theoretical frameworks and practices for ethical conduct within healthcare settings. Medical ethics is made up of a variety of values that revolve around four principles namely respect for autonomy, non-malfeasance, beneficence, justice, respect for persons, honesty and truth. In The House of God, Dr. Roy makes an un-informed and unethical decision as a medical profession, which results in jeopardizing the provision of care to the patients in the hospital and the overall reputation of the hospital and its medical staff.

Ethics and moral duties are essential in the field of healthcare given that they provide the difference between the provision of quality care to patients and inappropriate care that has the potential of jeopardizing the lives of patients. The House of God provides an insight into the world of medical practitioners who have little regard for medical ethics. The book provides an insight into the conduct of practitioners in the early 1970s in the United States. This is different from the current conduct among medical practitioners, despite the values towards ethical conduct among medical practitioners being constant (Shem, 1978). In essence, medical ethics has diversified rather than remaining constant given that society has become more enlightened than the past. This is mainly because of growth of technology that provides ready access to information.

The novel focuses on the conduct of the protagonist by the name Dr. Roy Basch who is highly intelligent but naïve working as an intern at the House of God hospital after graduating from the Best Medical School. He lacks the appropriate skills to meet the numerous responsibilities in the hospital given that he is not provided with adequate orientation and guidance from his experienced seniors who are tasked with initiating him into the operations of the hospital. The first year at the medical institution is marked by interactions with an intelligent and iconoclastic resident doctor named Fat Man (Shem, 1978). Fat Man is responsible for initiating him into the medical world by telling him that the means of surviving in the institution is through breaking the official rules. Such would ensure that he achieves his goals and objectives towards providing quality care to his patients while at the same time ensuring that he maintains his sanity.

Fat Man has 13 rules that he presents to the interns. One notable rule is that a majority of the medical procedures, medications and other diagnostics procedures usually result in greater harm rather than assisting the patients. The teaching is defined as “GOMERS” which means ‘Get Out Of My Room’ (Shem, 1978).

The rules are as follows:

  1. “Gomers do not die.” (Shem, 1978).
  2. “Gomers go to ground” (Shem, 1978).
  3. “At a cardiac arrest, the first procedure is to take your own pulse.” (Shem, 1978).
  4. “The patient is the one with the disease.” (Shem, 1978).
  5. “Placement comes first.” (Shem, 1978).
  6. “There is no body cavity that cannot be reached with a #14g needle and a good strong arm.”
  7. “Age + bun = lasix dose.” (Shem, 1978).
  8. “They can always hurt you more.”
  9. “The only good admission is a dead admission.”
  10. “If you don’t take a temperature, you can’t find a fever.” (Shem, 1978).
  11. “Show me a bms (best medical student, a student at the best medical school) who only triples my work and I will kiss his feet.” (Shem, 1978).
  12. “If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.” (Shem, 1978).
  13. “The delivery of good medical care is to do as much nothing as possible.”

Dr. Roy adheres to these set of rules, which results in his identification as the best intern in the institution together with his team. Such is achieved at the expense of adherence to the categorical rules and conventions laid out for the medical practitioners by the hospital administration. The novel takes a different turn when the interns have to adhere to an intern rotation, which means that Roy has to leave Fat Man’s supervision to be supervised by another doctor named Jo. Under Jo’s supervision, he manages to retain a good reputation as an excellent intern. Roy gradually becomes affected by the emotional and physical demands of the work in the hospital (Shem, 1978).

In essence, the novel displays the plight of intern doctors in terms of the poor working conditions, the physical and emotional demands that they have to fulfill as doctors. Such strains in the workplace influence changes in Roy’s personality and outlook. He starts experiencing temperamental outbursts in the workplace, engages in adulterous affairs with different social service workers and nurses that result in a strained relationship with his girlfriend Berry. Such conditions illustrate the perfect experiences of medical practitioners and interns in the modern healthcares settings. The differences between the hospital setting in the novel and medical settings in the modern society are mainly on the technological advancements that have played a significant role in provision of care to patients. The novel concludes with Roy and Berry seeking psychiatric help (Shem, 1978).

A number of ethical issuers are evident in the novel that can be related to the modern healthcare institutions. They range from adulterous relationships with co-workers among the healthcare professionals, lack of adherence to the set out rules and conventions in the hospital and lack of considerations for the wellbeing of the patients. From the novel, it becomes evident that the medical practitioners such as Fat Man and Roy have a little regard for ethical and moral conduct in the hospital. This is largely influenced by the poor working conditions and challenges present in the hospital towards meeting the needs of all the patients.

The two individuals, Fat Man and Roy, seem to throw care to the wind as they have little regard for ethical conduct. Ethical conduct in the healthcare settings constitutes a major contribution towards the overall wellbeing of the patients. Normative ethical principles provide that providing patients with compassionate care is essential towards understanding the needs and expectations of a patient from treatment procedures.

This is essential towards creation of an environment that is vital for effective treatment and healing process of patients. In addition, the value of Beneficence is considered as one of the primary ethical considerations towards provision of care to patients. It demands that the interests of the patients are first. Thus, the actions of a medical practitioner should reflect the best interests of the patient. Roy and Fat Man, and possible other interns in the team, do not adhere to such a value. They are solely driven by the need to preserve their sanity at the expense of adherence to set out rules and conventions in provision of care to patients.

The value of non-malfeasance is another value that is seemingly ignored by the medical practitioners in the novel. First do no harm should have been a guiding principle for the doctors. They put their patients at risk of death or contracting nosocomial infections in the hospital due to disregard for rules in the hospital. Adherence to other self-induced rules such as the GOMERS puts the lives of all patients and hospital staff at risk. In addition among the thirteen rules established by the Fat Man was, “the delivery of good medical care is to do too much nothing as possible.” (Shem, 1978). This illustrates the presence of medical practitioners who have little regard for the best interests of the patients. They subvert the basic tenets of medical ethics towards ensuring that compassionate and appropriate care is provided to patients (Henningfeld, 2011).

On the other hand, it is evident that ethics and moral conduct among the medical practitioners plays a minimal role towards provision of quality care to the patients. In essence, ethical values in medical ethics provide solutions towards addressing conflicts and challenges in the work place in terms of decision-making. Roy’s team and Fat Man have exceptional skills towards addressing the needs of the patients.

They both share a view that the medical procedures and treatments are ineffective and only result in excessive damage to the wellbeing of the patients. Roy results to lies when intern rotation takes place as a means of covering up his inadequacies. The practitioners are only provided with ethical guidelines that have minimal contributions towards their contributions to the wellbeing of the patients in the hospital. Edmund Pellegrino, a scholar in the field of medical ethics provides that beneficence is the only principle in medical ethics as it summarizes all ethical conduct in healthcare settings (Henningfeld, 2011).

Other values that are relevant towards provision of quality patient care with respect to medical ethics include reciprocal benefits dignity, humanness, stewardship, gratitude, trust, and service. They can all be termed as part of beneficence given that they all ensure that the provision of care by medical practitioners is done with respect to the best interests of the patient. Trust and honesty are essential in the workplace towards appropriate provision of service to clients or patients in this context. Roy and Jo formed a relationship that was based on lack of honesty and trust, which resulted in Roy doing nothing. Moreover, given that, Roy was part of a team; his unethical influences would have moved other interns towards adoption of a similar attitude in providing care to patients (Shem, 1978).

Furthermore, Roy risks jeopardizing the careers of ethical doctors such as Jo with his laid back attitude towards execution of duties and responsibilities delegated by Jo. The author signals the need for flexibility in terms of ethical conduct among healthcare practitioners in providing care to patients. This provides them with the freedom to deliberate with the patient on the best strategies that would best suit their individual needs. In addition, while regulation of healthcare provision is paramount, the overregulation of conduct of healthcare providers results in rigid and ineffective rules and ethical conventions that do not contribute to the health of patients. This is highlighted by the selection of Roy and his team as the most effective team in providing services to the patients in the hospital. This is achieved despite their utter lack of consideration of the wellbeing of the patients (Henningfeld, 2011).

In conclusion, the novel highlights the presence of unethical conduct in modern healthcare settings despite the setting of the novel in the 1970s. Unethical conduct and practitioner malpractices are a common occurrence in modern healthcare settings (Henningfeld, 2011). The author aimed to communicate the fact that the poor working conditions, emotional and physical demands in healthcare institutions are to blame for the unethical practices and approaches adopted by practitioners towards providing patients with care. In addition, the practitioners seem to adopt unethical conduct as a means of dealing with the challenges and insatiable demands of the workplace.





















Henningfeld, D. A. (2011). Medical ethics. Detroit, Mich: Greenhaven Press.

Shem, S. (1978). The house of God: A novel. New York: R. Marek Publishers.

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