Ethics Consultation: Letting Lookalike Sisters Commit Well-Intended Insurance Fraud?

Welcome to Ethics Consult – an opportunity to discuss, (respectfully) debate and learn together. We select an ethical dilemma from a real, but anonymized case of patient care. You vote on your decision in the case, and next week we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also step in with an ethical framework to help you learn and prepare.

The following case is adapted from the 2019 Appeal Book, Who said you’re dead? Medical and ethical dilemmas for the curious and the worried.

A middle-aged woman, Vivien, comes in for her first appointment with an oncologist, Rocky Bock, MD, to begin treatment for a rare form of cancer. She is accompanied by her sister, Jeanne, with whom she bears a striking resemblance. During the assessment, the physician notes several major inconsistencies between the patient’s medical records and the results of her physical examination. Most notably, former doctors have documented that the patient lost her left index finger in a car accident, but Vivien appears to have all 10 fingers intact.

Bock confronts Vivien about these inconsistencies, and she confesses that she is actually Jeanne and that the two sisters conspired to swap identities because Jeanne has health insurance while Vivien is an undocumented resident of the United States and has no way to get insurance or pay for the cancer. treatments. The chemotherapy needed to treat her cancer costs more than $150,000, and the sisters cannot realistically raise that amount of money quickly. Both Vivien and Jeanne beg the doctor to “disregard” his discovery. Bock sincerely believes that the treatments will save the woman’s life.

Jacob M. Appel, MD, JD, is director of psychiatric ethics education and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and an MS in Bioethics from Albany Medical College.

Check out some of our previous ethical consultation cases:

Is it wrong to offer a cheap and pirated version of the drug?

Cut health insurance for risky activities?

Stop Life Support for tax relief?

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