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Morally Grey Anatomy: The Ethics of Medical TV

By Ore Fawole 

“I’m always looking for a new TV show to watch, do you have any recommendations?”

“Well, you want to be a doctor, so what about Grey’s-”

“No.”

This is the way most people are introduced to my distaste for the long-running television program Grey’s Anatomy. As a pre-medical student interested in film and media, I have avoided this TV show for years. I have tried to fall in love with it, but Seattle Grace Mercy West Hospital loses me somewhere in season two. 

“Why not? I feel like it should be right up your alley?” 

If you ask my roommates why I do not like the show, they will cite my history of being “a pretentious film major who can’t enjoy anything unless it is worthy of an Oscar.” While I am (embarrassingly) pretentious, I have no problem with bad TV. However, the nineteen-season show is far too long, every character you grow to care about will die a tragic death, and Meredith Grey might be the most annoying heroine ever to grace America’s TV screens. Her begging Derek Shepherd to “pick me, choose me, love me” haunts me far more than any horror film ever could. However, my biggest complaint is not about the series’ length or the characters’ decisions. Every time I finish an episode, I wonder, “How do these people still have jobs?” Everyone, and I mean everyone, should have lost their jobs due to violations of every ethical standard known to medicine. Although it may seem like a frivolous complaint from someone who reads far too deeply into their media, with 8.5 million weekly viewers, the implications of the show’s depictions of medical ethics are far more significant than some may imagine. So, how morally grey is our medical TV?

As medicine continues to grow more complex, so do our expectations of our healthcare providers. To keep patients as safe as possible, providers abide by set standards of bioethics. The four pillars of bioethics are beneficence, nonmaleficence, justice, and autonomy. Beneficence is a provider’s obligation to act in a way that benefits the patient and their health, such as a doctor checking in with their patient. Nonmaleficence is the pillar that ensures that providers cannot do anything that will harm the patient. This would include a physician deciding to use a less painful treatment when available. The ethical pillar of justice enshrines patients’ right to fair and unbiased treatment, which includes treating all patients the same, regardless of gender, race, or socioeconomic status. Autonomy represents a patient’s right to make their own uninhibited decisions about their medical care. This pillar is what gives patients the right to clear consent before surgery. Providers are held to these pillars by hospital ethics committees and the boards issuing their licenses. Hospital ethics committees vary widely from system to system, but all consider and advise on ethical dilemmas and must report any violations. 

Despite popularizing the genre far beyond what most would ever expect, Grey’s Anatomy was far from the first medical TV show to air. In 1961, NBC aired Dr. Kildare, featuring our titular young physician’s journey through medicine. Starting in 1955, the American Medical Association (AMA) had complete control over the depiction of medicine with the Physician Advisory Committee on Television vetting every script that would be put to screen. However, due to the popularity of M*A*S*H in the early 1970s, a show that violated a lot more than just medical ethics, the AMA was ousted in favor of more entertaining stories. In a now unregulated space, shows like Doogie Howser, M.D., ER, and Scrubs could flourish before the modern age, while our current era of medical television features shows like The Good Doctor, The Resident, and New Amsterdam. Still, few have reached the notoriety of Chicago Med, House M.D., and Grey’s Anatomy, which draw in millions of viewers weekly. Studies show that of people who consume weekly TV, 49.6% of them watch medical dramas. This TV genre is a cultural phenomenon that has taken our screens by storm. 

In a study featuring 50 episodes from House and Grey’s Anatomy, researchers found 179 instances of bioethical issues. Most issues regard physicians failing to gain explicit patient consent; some breaches are more significant than others. For example, in a notable episode of House, “The Tyrant” (season six’s fourth episode), watched live by almost 14 million people, an African dictator comes to the hospital searching for a cure for his illness. Aware of his terrible deeds, Dr. Robert Chase fakes a blood test which results in the patient receiving an incorrect treatment, in turn killing the patient. Despite all of the doctors expressing their distaste for the tyrant occupying their hospital, only Chase abandons his moral code. Although this results in tension between him and those around him, Chase keeps his job and his license.

During the course of a three-episode arc that culminates in the season two finale, Dr. Izzie Stevens of Grey’s Anatomy violates multiple ethical pillars, one of which is justice. With a combined viewership of a whopping 67.6 million people, this is one of the most viewed Grey’s arcs ever. When the man she has fallen in love with, Denny, realizes his heart condition has worsened, Dr. Stevens manufactures an error by cutting his LVAD wire, which moves him up the donor list. In lying about the status of this patient to prioritize his health over others, Dr. Stevens is violating the other patients’ right to justice. At risk of losing her license, she decides to quit before she can face the consequences of her actions, but she is reinstated a few months after the incident.

“Choices,” the ninth episode of the first season of Chicago Med, highlights Dr. Halstead violating autonomy. Although a terminally ill patient had a clear do-not-resuscitate order, he pressured the patient’s husband to allow him to perform CPR. A lawsuit is filed, but it is dropped by the end of the season. While it proves a gripping scene, this action would be grounds for terminating one’s medical license immediately, but Dr. Halstead continues to see patients. Little to no consequences for violating ethics is a common thread running through medical TV. 

This example of a provider blatantly violating a patient’s right to autonomy, and the following lack of consequences, is one of Dr. Cynthia McCarthy’s picks to illustrate violations of medical ethics on TV. Dr. McCarthy is a healthcare ethicist here at the University of Pittsburgh who holds a doctorate in Healthcare Ethics and a Master’s in Philosophy. Her unique field of study offers dynamic insight into the depiction of bioethics on TV. As stated by Dr. McCarthy, the problem with Dr. Halstead’s violation of ethics is that, “They show something that is ethically wrong, but there is no conclusion to the story of what should have happened.” The writers may illustrate that the physician was making poor decisions, but viewers are left to wonder what the right decision would have been. With the fast-paced nature of television, this storyline is abandoned for whatever is next for our cast of characters. 

But then again, that’s just what they are, right? Storylines? Why does it matter if a fictional doctor violates a fictional patient’s rights? Cultivation theory states that the media you consume begins to shape how you view the world. With millions of people tuning in to watch every week, the scale of this issue is unlike most that we have seen before. In TV shows like House, where doctors kiss nine-year-old patients, real patients may feel comfortable developing inappropriate relationships with their providers. Additionally, watching doctors consistently ignore patients’ wishes may deter those who are already wary of doctors. Most people would not want to be seen by a Dr. House, who is a bully in a white coat, a Dr. Chase, who has used his job to kill people, a Dr. Stevens, who will put your life in jeopardy for her fiancé, or a Dr. Halstead, who does not care about patients’ boundaries. This is where some would expect pleas for screenwriters to go back to the days when the AMA reigned over TV, but that would create a problem of its own; medical TV shows that follow procedures to the letter would not be nearly as entertaining as the drama we see on TV today. Dr. McCarthy states that in order to keep the drama and educate the public, “There could be an opportunity for them to do a team consult at the end to say this is what happened, this is what we should have done, this is what’s ethically appropriate.” There is no need to entirely scrap the plot of a doctor switching out a patient’s medication, as long as there are proper consequences and discussions afterward. This approach allows your TV show to be compelling but also ethically accurate. 

People are always going to watch (or, in my case, recommend) Grey’s Anatomy, no matter what you say or do. However, Dr. McCarthy has posited steps to stop the cultivation of inaccurate ideas before it starts. She states that bringing on ethicists on the screenwriting team can improve depictions drastically. Additionally, she recognizes our roles as viewers: “It is important for viewers to realize that this is not reality, and that some things are sensationalized, so constantly reminding viewers that it is not always accurate would be a good public statement.” This is much easier said than done, something Dr. McCarthy also acknowledged: “When you’re watching a zombie apocalypse show, you know that’s not reality, but when you’re watching somebody die in a hospital, that is something, at some level, we can all relate to, so it is much harder to separate that as something that is not real.” Medical dramas will remain a fixture on our screens for the foreseeable future, but allotting more effort to depict ethics will help ensure that the only grey thing is anatomy.