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

"Sweet Nothing in My Ear"

Tonight at 9pm, Hallmark is airing the original movie "Sweet Nothing in My Ear". Before you decide to lynch me, hear me out: the movie is about a married couple, one hearing and one Deaf, who have to decide whether or not their deaf child should receive a cochlear implant. Director Joseph Sargent has a history of working with Deaf actors and making movies that are considered accurate and respectful towards the Deaf point of view, and the cast is full of both Deaf and hearing actors, including Marlee Matlin in her first full ASL-only role since "Children of a Lesser God."

At its heart, this story is one of medical debate: is hearing the norm? Is a lack of hearing a handicap that needs to be fixed? Or is it just a part of life, a condition to be accepted and dealt with and moved on from?

I know this is a subject that gets a lot of commentary around here, which is why I'm mentioning the movie being on this evening. Given I'm in the finals crunch, I probably won't have time to watch and/or comment on the movie for a few days, but did assume others here would likely be interested - both in the subject matter, and how ethical dilemmas are played out on television.
-Kelly Hills

Bioethics & Television - Private Practice

It's too bad there's not a way to easily track the increase in call volume at fertility clinics. I'd give a lot to see what the call activity looked like this morning, after folks saw last night's episode ("In Which Dell Finds His Fight") of ABC's spin-off of Grey's Anatomy, Private Practice.

One of the two medical story lines followed in this episode centered on a couple who wanted to conceive, but the husband was diagnosed with azoospermia. The couple rapidly - as in, immediately after receiving the diagnosis - rule out adoption and decide that, since the wife is currently ovulating, they will try for sperm donation immediately.

Let's pause for a moment to consider the likelihood of a private practice based ob/gyn/fertility specialist and fetal surgeon/genetics specialist (we could really stop that sentence right there, but...) going from delivering a diagnosis of infertility to, within minutes, agreeing to allow the couple to select a sperm donor for insemination that day. I admit, this isn't my area of specialty, but I would think that this might be a process that takes time. Certainly more than the span of a few minutes.

However, that in and of itself, while rapidly paced and smoothed over for dramatic license, wasn't terribly egregious. It's the next part, where they opted not for sperm donation, but advanced sperm removal and IVF, that took the show beyond dramatic license and into the realm of "creating headaches for fertility clinics nationwide."

The two doctors explain to the couple that they can do a procedure called microsurgical retrieval of epididymal sperm, or MESA, and then extract the currently ovulating ovum from the wife, and use intracytoplasmic sperm injection (ICSI) to create a viable fetus, which was then immediately placed back into the uterus. The picture above is from this scene; you'll see that the patients were there and talking to the doctors as they performed this several stage complicated procedure all by themselves.

One of the things being talked about is just how real all this medicine was, and from what I saw and know (please correct what I get wrong), the procedures are all actually sound. It's the speed, the setting, and the overall depiction of the entire process that I find problematic. It's one thing to accelerate, for dramatic license, multiple office visits to discuss sperm donation and the details that would make, frankly, for boring television. No one wants to watch people sitting around talking, and it seems that the general knowledge level is such that no one expects to walk in to a fertility specialist office for a first visit, and walk out a hour later with sperm floating in their uterus.

MESA and ICSI are much more obscure, new, and not known procedures. By depicting them as joint events that can be simultaneously with single egg extraction during ovulation, and as something that takes no longer than an office visit instead of a several day if not weeklong or so process, gives an awful lot of false information that specialists then have to work at undoing. It's no longer a matter of educating a patient on a procedure, it's about undoing the subtle information bias that they might not even realize they hold.

Is it irresponsible for a show to compress and simplify a complicated procedure or concept so that it fits into the time allowed for the story? Maybe not, we expect dramatic license when we watch fictional television. The problem is just the degree of license - when you're going out of your way to establish authenticity with realistic imagery and dialogue, and strive for medical accuracy, it seems that putting a limit on just how far you stretch reality has to come in to play, as well.
-Kelly