Informed Consent (House episode)
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| House episode | |
| "Informed Consent" | |
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| Episode no. | HOU-303 |
|---|---|
| Airdate | September 19, 2006 |
| Writer(s) | David Foster |
| Director(s) | Laura Innes |
| Guest star(s) | Joel Grey as Ezra Powell Leighton Meester as Ali William Charlton as Mark Stephanie Venditto as Nurse Brenda Previn |
| All House episodes | |
Informed Consent is the third episode of the third season of House and the forty-ninth episode overall.
Contents |
[edit] Plot Overview
Dr. House's ketamine treatment has worn off and House is back to using his cane and doesn't want to talk about it. House has to diagnose Ezra Powell, a 71-year-old renowned pioneer in the field of medical research who collapsed while studying rats. House puts Ezra through diagnostic rigors, but the team is unable to come up with a conclusive diagnosis, and Ezra's health continues to deteriorate. Becoming increasingly debilitated, Ezra ultimately demands that the team stop the litany of medical tests and help him end his life by injecting him with a large amount of morphine. House strikes a deal with him and asks for one day to do tests on him.
The moral dilemma of whether to assist in his suicide and abide by Ezra's wishes, or to ignore what their patient wants drives the team in very different directions. The team members have divergent opinions on the morality of helping Ezra die. Cameron despises the idea of interfering with what Dr. Powell wants to do. Both Foreman and Cameron are opposed watching House put Ezra to sleep, but Chase seems to have little problem. Wilson says that House has done it before "plenty of times" and House insists "two patients that I knew were terminal." In an example of Chase's ongoing character development, among the four, Chase is the most religious.
When House fails to diagnose Ezra in one day, House agrees to give him the morphine dose. Instead of killing him, House puts Ezra in a coma, so that he can do his diagnosis in peace. Cameron wishes not to partake in any more of House's plans until House directs Cameron to an article in an old medical magazine to better understand Ezra and his beliefs, which Cameron could not disagree with more than anything. However, during a colonoscopy, Ezra's lung gives out and House is forced to intervene and notices that Ezra's has lost reflex capabilities in his right arm. In order to proceed with additional diagnostic procedures, House wakes Ezra from his coma and finds that Ezra has also lost sensation in his abdomen and right leg. House asks Cameron to obtain a skin sample for other possible diseases he may have. Cameron and Ezra engage in conversation where Ezra reveals that things such as "informed consent" interfere with research and thus he does not let it stand in the way. Cameron slices a piece of skin off using his perspective as her solution, upon which Ezra thanks her for doing what she believes is right.
As always, random episode happenings coincidentally help House come upon the final diagnosis, in this case, Amyloidosis. Chase also finds that it is of sub-type AA and therefore is a terminal illness. During the end scenes, Ezra is seen crying in his hospital bed. The following morning, Cuddy comes into House's office to let him know that Ezra passed away at 2:30 am, although declared stable at 2:00 am. House denies any knowledge of it and asks Cuddy if she would want to know even if he did. House then goes to Cameron, who is seen dressed in black, crying at the hospital chapel, suggesting that Cameron aided in the passing away of Ezra by euthanizing him.
[edit] Diagnosis
Amyloidosis, sub-type AA, an invariably fatal form of the disease: House's Idea - Congo Red test results affirmed diagnosis.
[edit] Medical Terms
Amyloidosis: Chase's Idea - Never considered or tested.
Kawasaki's Disease: Chase's Idea - Test results declined theory.
Lymphoma: Foreman's Idea - Test results declined theory.
Sarcoidosis: Chase's Idea - Test results declined theory.
[edit] Clinic Patients
- Mark: A middle-aged man who suffers loss of appetite and headaches. Diagnosis is a rhinovirus (common cold). He has an attractive daughter who has an obvious crush on House, and tells him she only has to "wait six months, 'til I'm eighteen."
[edit] Arc Advancement
[edit] Happenings
House claims you cannot help someone live and help them die simultaneously; in this case, you cannot give someone only palliative care without knowing whether you could save them. House often overrides patient's intent to end treatment or refuse resuscitation, and wars with Dr. Powell over ending diagnostics for this case. He also pushes Cameron toward her own ethical confusion, directing her towards Dr. Powell's work.
Cameron stands against House when he feigns euthanasia (he instead knocks Powell into a coma), but after they diagnose Powell's terminal condition she does it herself, torn between the official moratorium on assisted suicide and allowing him the inevitable without the painful, prolonged asphyxiation he would suffer dying naturally. House tested her, referring her to documentation on several experiments Powell performed which conflict with Cameron's ethics, and indeed, all accepted ethics in modern medicine. The patient himself commends her for going against his wishes when she takes a skin biopsy without his permission, saying ethics (specifically informed consent) get in the way of medical treatment and advances. Earlier in the series, Cameron herself agonizes over the illusion of informed consent when dealing with parents or next-of-kin who lack medical training, saying they cannot possibly understand situations through a 10 minute briefing with doctors.
Chase stays in the room when the three fellows think House's impending (although staged) euthanasia attempt legitimate, while Foreman leaves silently and Cameron, following him, vows she cannot be a part of it. Chase's religious background likely affects the decision, as well as his position in the plot line as the team member who most trusts House.
The patient congratulates House on diagnosing him, despite House disobeying his wishes in the process. He forgives the team for pushing him and going against him, just as he expects forgiveness for his own large-scale experiments on unwilling or ignorant subjects.
[edit] Characters
[edit] Self References
- TB or Not TB: The wall clock in the MRI procedure room has the words Stoia Tucker on it. This is the name of the pharmaceutical company that provides anti-tuberculosis medications that Dr. Sebastian Charles uses to treat TB patients in Africa.
[edit] Trivia
[edit] The Show
[edit] Behind the Scenes
- Wilson jokes that House has a "one patient-a-week quota," referring to House's weekly timeslot and how House mainly treats a single patient in each show.
[edit] Allusions and References
- The Wizard of Oz: When talking to Ezra, Dr. House peers under the bedsheet and says, "Pay no attention to the man behind the curtain." While this could easily be misunderstood as merely a reference to The Wizard of Oz, it is in fact an allusion to Joel Grey's role as The Wizard in the Broadway musical Wicked, based on a novel that tells the story of The Wizard of Oz from the Wicked Witch of the West's perspective.
- Pulp Fiction: Early in the episode, House remarks that "the little vermin seized the day, so to speak, and went medieval on his ass." The line "I'm gunna get medieval on your ass!" was spoken by crime boss Marcellus Wallace in the film Pulp Fiction.
- The Merchant of Venice: After the scene where Chase diagnoses the patient to have Kawasaki's Disease, House says "Just give me a pound of flesh" to Cameron referring to the Merchant of Venice where Shylock is request a pound of flesh from Antonio when he forfeits the loan.
[edit] Memorable Moments
- This is the first episode of the third season where a patient dies under House's care. It is implied Cameron euthanized him.
[edit] Quotes
"Take this four times a day. And stay off airplanes. They're flying cesspools."
"Somehow I just can't imagine you taking a Jell-O shot."
"I try to kill him, you're mad. I don't kill him, you're mad."
"I'm a cripple, remember? Accommodations must be made."
[edit] Music
"Prelude Suite # 1 in G Major" by Johann Sebastian Bach, performed by Yo-Yo Ma: Ezra collapses while studying rats.
"Into Dust" by Mazzy Star: Ezra is mysteriously dead only thirty minutes after being declared stable. Cameron cries in the chapel. House puts a comforting hand on her shoulder, and says that he is proud of her.
