Please read the scenerio and answer the following questions.

MIKE, THE BUS DRIVER

You are a physician in New York City. A new patient, Mike, has come to you on his own for a physical examination. During the course of the exam you identify a serious heart condition that could lead to a heart attack. The ailment is real but the prognosis is uncertain. Many factors play into how Mike will be affected. He could have a heart attack tomorrow or it could be a long way down the road of life. You explain this to Mike and in the course of the discussion you learn that he is a bus driver with 35 years on the job. You factor this into your diagnosis and you then recommend that Mike stop driving the bus because of the inherent danger to Mike and his passengers. Mike becomes somewhat indignant and goes on to explain that driving the bus is all that he knows. You then suggest that Mike seek a transfer within the bus company, perhaps to the repair yard or to the dispatcher's office. Mike explains that the repair yard is hot and dusty in summer and that winters are brutally cold and uncomfortable. The dispatcher's office is too noisy and the work is boring. Mike goes on to tell the doctor that driving is his life. He even knows most of his passengers by first and last name.

You make several more attempts to reason with Mike, whereupon Mike puts on his shirt and as he leaves the office he reminds you that he has come to you of his own accord and is paying for the exam out of pocket. Mike demands that you remain silent regarding your findings. He reminds you of doctor-patient confidentiality and leaves your office with a veiled threat of legal action if you were to breach that contract.

You are left standing alone in your exam room wondering what to do next.

1. What are the ethical issues?

2. Who are the possible stakeholders?

3. What are two alternative solutions?

4. What are the ethics of each alternative? For example, if you analyze an alternative using the utilitarian approach you will be looking at the results and what promotes the greatest good for the greatest number of stakeholders. Analyze your alternatives using more than one ethical framework.

5. Are there any practical constraints?

6. What plan do you recommend the doctor follow?