Markkula Center of Applied Ethics

The Role of Friends in a Medical Emergency

Response to the Case of Madisyn Whitfield
By Richelle Neal

Since Maddy's friends have noted her deteriorating condition and transported her to the emergency room, they do have an ethical obligation to notify others in her life. First and foremost Maddy's parents have a right to know about her worsening condition. I also do not understand why the physicians and hospital staff do not seem to understand Maddy's financial circumstances and the influence this may have on her decision about potential treatment. And why is Maddy ashamed of her lack of ability to pay for her expensive medical bills? She has an extreme case. Maddy is clearly a hard-working young adult, being in graduate school and working part time. She is unable to control the outside factors in her life, such as her dad losing his job, lack of health insurance, and even that she suffers from Crohn's disease. The one thing Maddy might be able to manage is the severity of the symptoms, but even that seems to be taken out of her control when she is no longer able to afford her medication.

It is clear that Maddy is unable to take care of herself - demonstrated by her quick relapses, dropping out of school, developing kidney stones, and leaving the hospital "against medical advice." Maddy appears to be either prideful or afraid of being a burden to her family. By trying to avoid causing stress for her family members, she has instead diverted the stress onto herself, which is not good for her condition. Since she is not making good decisions, her friends should step in again and notify the physicians, hospital, and Maddy's family.

In The Man With the Iron Tattoo, Doctors John Castaldo and Lawrence Levitt share stories that have changed and shaped their lives and practice. One of them writes about a peer who took his own life. The author knew something was different and not right with his friend, but he failed to ask a simple question like how he was doing or if he needed any help. The doctor has regretted that failure ever since. A simple intervention might have saved his friend's life.

The same is true for Maddy's friends. They do have an obligation, especially since they have already assessed the situation as severe enough to bring Maddy to the ER. Whether Maddy wants them to or not, the friends should notify the family, physicians, and hospital staff. These additional resources and loved ones at the very least will provide extra comfort, and perhaps be able to work out a payment plan or loan for the medical costs associated with her disease.

Richelle Neal was a 2008-09 Health Care Ethics Intern at the Markkula Center for Applied Ethics.

July 2009

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