Moral Musings with Dr Melanie Baker
By Emily Wu
A
uckland based doctor Melanie Baker explains how medical ethics, despite not frequently involving dramatic life or death decisions, is a day to day challenge facing general medical practitioners in New Zealand.
Alongside questions of “is it an allergy or eczema?” GPs face a constant stream of dilemmas that necessarily require moral judgements.
Dr Baker and her husband (who is also a GP) co-own a GP clinic in central Auckland, New Zealand’s largest city. The family run business attracts patients from a diverse range of cultural backgrounds, particularly Asian immigrants who seek a doctor who can speak to them in Chinese (Dr Baker’s husband is from Taiwan). An important implication of this…show more content… Adopting a rather deliberative approach to patient interaction she holds a reasoned discussion with the patient about the long term harm that may come to them through unnecessarily use of antibiotics and the different health related values that needs to be considered. Perhaps adopting some elements of a paternalistic approach, Dr Baker then encourages them, through a discussion on values (short vs long term health) and facts (the science), to let the cold/infection run its natural course. To ensure that the patient does not leave the practice feeling mistreated and uncared for, she assures them that if the condition worsens then a reassessment would be appropriate and they should not hesitate to call her. Dr Baker did admit that in certain situations, where the patient was so distressed and upset by their condition, she was more inclined to succumb to their wishes and prescribe antibiotics even if it had little more than a placebo…show more content… Dr Baker identified her primary duty as being to the patient, not the insurance system. In addition to patient well-being however, Dr Baker also sees the decision as compatible with the purpose of the system rules even if it is made slightly outside of them. The purpose of the ACC scheme is workforce rehabilitation (although it’s reach is wider) and the underlying justification for it is that when the medical costs are shouldered by the community, the economy will not suffer every time there is an injury. Dr Baker reasons that an injured person, unable to work and unable to afford the necessary medical treatment, is an immense cost to the economy and this results in community wide harm. It would seem that Dr Baker is again influenced by utilitarian ethics as her decisions are largely swayed by what she considers to be beneficial for the community at large.
Concluding Remarks:
Consultations in a general practice are commonly adorned with difficult decisions that require the doctor to balance competing moral values.
Because there are some situations that arise frequently (such as the two discussed in this article), GPs have the opportunity to develop decision making processes that can be applied to many cases. While this may reflect a positive handling of dilemmas in the past, there is certainly a danger that the doctor