Doctors must kill the skunk, says bioethicist

When Toronto neurosurgeon and bioethicist Mark Bernstein encountered a wounded skunk in the middle of the road on his drive to work, he considered his options.

I figured I had four: 1) I could stop and pick it up and drive to an all-hours veterinary clinic (I knew the whereabouts of one due to a recent illness in one of my two Labradors); 2) I could keep driving and forget about it; 3) I could call 911 or information to get a number for the humane society (assuming they have an after-hours number); and 4) I could try to somehow put the poor thing out of its misery.

You can probably guess where this story is going.

I put the car in drive and slowly drove over the poor beast in my heavy Toyota four-runner truck. I felt the front wheel roll over the animal and a second later the back wheel. I stopped a few yards away and stared back for a good five seconds and it remained motionless. I was satisfied I had done the job but for good measure, I repeated the process twice more. I then proceeded down to work, driving slower than usual, deep in thought and feeling a little nauseated, but convinced I had done the right and kind thing.

In his article "Curbside Ethics" (PDF, pp 3-4) for the Joint Centre for Bioethics newsletter this month, Dr Bernstein explains why his decision is the only one an ethical physician can make. The dying skunk on the road isn't just a skunk -- it's a metaphor for the entire field of medical ethics.

Sometimes in life we have to do unpleasant things, but must take comfort in knowing we felt it was the right thing. Exercising “tough love” with a child with major problems such as drug abuse would be one example. Another would be kicking a child out of the house when you feel they have overstayed their welcome and their life is not going forward because of their desire to stay in the protection of their parents’ womb. A further example would be a doctor reporting to a family an error performed in the course of well-intentioned caring for a patient. Another would be breaking the heart of a 29-year old woman, wife, and mother by having to inform her that the brain tumour you have just removed is highly malignant. Maybe these aren’t exactly analogous, but you get the idea. Sometimes you need to do something difficult, then go forward knowing you did your best under the circumstances. There are countless examples in our everyday lives. We can go though life hoping that we never encounter such ethical real-life dilemmas, but we’re kidding ourselves if we believe we will be that lucky.

Would you have killed the skunk? It's an important question -- one that physicians would be well advised to consider.

There's the easy solution: ignore the skunk (i.e. dismiss the noncompliant patient; rush through the diabetic comorbidities cases; let patients stay on narcotic painkillers as long as they claim to 'need' them; or any other manner of unpleasant tasks).

And then there's the hard one: kill the skunk.

Physicians must be prepared, says Dr Bernstein, to crush the skunk repeatedly beneath the tires of trucks.


Photo: MontanaPictures.net

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