Bioethics on TV: What is being portrayed?

(Image credit: ABC/Eric McCandless)

It is likely no surprise to regular viewers of the television medical dramas “Grey’s Anatomy” and “House, M.D.” that bioethical issues and the conflict they create are frequent components of the storylines. These programs aim to entertain, and the drama inherent in contentious bioethical issues seems a natural fit. Furthermore, these programs aim for realism, frequently employing physicians as consultants to check their medical facts. This combination of realism and frequency raises concern that these medical dramas have the potential to affect viewers’ beliefs and perceptions of bioethics. In fact, previous studies have demonstrated this phenomenon in other areas, including organ transplantation and obesity.

With that background, I, along with Dr. Ruth Faden and Dr. Jeremy Sugarman at the Johns Hopkins Berman Institute of Bioethics, aimed to systematically describe the bioethical and professionalism content of one season each of the widely watched medical dramas. While we would have liked to include “E.R.,” it wasn’t available on DVD for the same time frame. In addition, “Nip/Tuck” and “Scrubs” were excluded because of their dissimilarity to the shows analyzed. Our goal was simply to document the bioethical and professionalism content of these two programs as a starting point for a discussion about their possible impact on the perceptions and beliefs of the general public, as well as their utility as a tool in the education of medical and nursing students.

Perhaps unsurprisingly, we found that both “Grey’s Anatomy” and “House, M.D.” are rife with depictions of bioethical issues and egregious deviations from the norms of professionalism. We identified 179 depictions of bioethical issues, which we separated into 11 categories, of which the top three were consent, ethically questionable departures from standard practice, and death and dying. We also identified a total of 396 deviations from normal professional interactions, classifying those into categories of “respect,” “sexual misconduct,” “integrity and responsibility,” and “caring and compassion.” Most of the professionalism incidents were negative, which is less striking when one considers the fact that these programs are more akin to soap operas than documentaries. Importantly, we did not try to evaluate the possible impact, whether positive, negative, or neither, on viewers of these programs. Rather, we hope that our study will provide the groundwork for other studies assessing exactly that.

I’d personally like to encourage any interested readers to take a look at the full text of our article, “Bioethics and professionalism in popular television medical dramas,” which is available in the April issue of the Journal of Medical Ethics. In addition, more information about the wide variety of ethical issues investigated by the Johns Hopkins Berman Institute of Bioethics can be found at our website, http://www.bioethicsinstitute.org. Finally, more information about media and health can be found at the Kaiser Family Foundation website.

Thanks for letting us share our work with the thoughtful readers of the Women’s Bioethics Blog!

-Matt Czarny

Bioethicists Weigh In On the Healthcare Reform Vote (updated)

As the readers of this blog know, both myself and several of our bloggers have posted about universal health care coverage many, many times as an ethical and moral imperative. In the last year, my hopes (along with many other bioethicists, I'm sure ) of attaining universal coverage have gone up, down and sideways, like a roller-coaster ride, exhilarating and frightening, with emotions ranging from inspiration to resignation.   Now that the US House of Representative has finally passed a health reform bill, I've requested several bioethicists (and friends of the WBP) to share their thoughts on the ethical implications of the passage of this bill:

Art Caplan of UPenn:  "The passage of this bill, flaws and all, represents the elimination of the single greatest failure in American health care -- a lack of universal insurance coverage.  With this legislation in place America can finally say after decades of failure that it has honored its responsibility to create equal opportunity for every citizen."

Tom Murray, President and CEO of the Hastings Center:

 "I liked Nancy Pelosi’s comment that being female will no longer be considered a preexisting condition.

As I tried to say in my essay in the Connecting American Values to Health Reform collection, and reiterated in my Perspective in the New England Journal of Medicine, any serious and responsible health reform had to include universal participation along with means for insuring that we could be good stewards of our finite health care resources.

The “universal participation” piece was not fully accomplished, but very significant progress was made. Already today, however, news reports say that it will be under attack in several states. We will have to see whether it survives.

Perhaps the least appreciated aspect of the legislation is the set of strategies to make stewardship a reality (most commentators lump it under “cost containment”). Ezra Klein offers a very useful, brief summary here." 



Ruth Faden, Executive Director of Johns Hopkins Berman Institute of Bioethics and Philip Franklin Wagley Professor in Biomedical Ethics  says:  "This historic legislation for the first time enshrines a national commitment to guarantee that all of us in this country have meaningful access to appropriate medical care.  As a consequence, our society is now more just.  Our people have a greater prospect of securing for themselves and their families not only more health, but also more of everything that is essential to human well-being, including personal security, respect and self determination."

Hilde Lindemann, Professor of Philosophy and Immediate Past President of the ASBH says: 

"Can one be happy and angry at the same time? The passage of the health care reform package is cause for rejoicing: it helps the poor and dispossessed—a disproportionate number of whom are women and children--gain access to health care. But it was achieved at the cost of both parties’ affirming in very loud tones that if a woman is pregnant unwillingly, she has recourse to abortion only if she can pay for it privately. That so much of the rhetoric surrounding reform was given over to underscoring what has been the case since the Hyde Amendment was passed many years ago, leaves me furiously frustrated."

I am waiting for several other bioethicists to respond to my inquiries, and will post them upon receipt.

As for my own feelings and thoughts, I think Nancy Giles of CBS Sunday Morning said it best:

"So I'm a progressive, and I don't consider this bill, or Dennis Kucinich (D-Ohio), or anyone who supports this legislation to be "selling out" because it doesn't go far enough. The bottom line is 30 million more people will get health care coverage, and that will save lives now. Voting "yes" gets a foot in the door.

Change takes serious effort, but progress happens. The fight for women's rights didn't end when we got the right to vote in 1920; the Lily Ledbetter Fair Pay Act signed just last year was another move toward true gender equality. Civil rights didn't end with the Emancipation Proclamation or the Voting Rights Act of 1964.

HR 4872 is a crucial first step, and can be amended and improved, but doing nothing is not an option. Health care should be a basic human right. And no one should be uninsured, or underinsured, or go broke paying their medical bills in the richest country in the world."  

Amen to that. 

[Cross-posted on IEET's blog]