Earlier this year the Supreme Court of the State of New York issued an opinion that reminded me of an old joke.

A young law student asks his father, an attorney in practice for decades, to give him some expectation of what he will learn in the upcoming course on ethics. His father offers an illustrative example. You and a classmate pass the bar and go into practice together. A lady comes in to see you about a minor adjustment to her will. She returns the next day to receive her papers and hands you a crisp, new $100 bill in payment for this little bit of work. As she is leaving the office you discover that she actually gave you two brand new $100 bills stuck together. Now you have an ethical dilemma. Do you tell your partner about the extra $100 you made?

A man sought treatment for alcoholism in a hospital emergency department. He then changed his mind and decided to leave. He was apparently quite intoxicated (and the record included a “very high” blood alcohol level). He left, wandered onto a highway, was struck by a vehicle, and was left quadriplegic as a result of his injuries. He sued, claiming he should not have been permitted to leave the emergency department.

The Court said the defendants (physician and hospital) had neither the authority nor the duty (under New York law) to detain the patient.

This decision has been hailed by some of my colleagues as a victory for common sense and for the principle that there is such a thing as personal responsibility. And I must admit to being pleased that the doctor and the hospital were not held legally responsible for this tragedy. Further, I can easily imagine circumstances under which medical personnel could not possibly be responsible. For example, if the patient seemed cooperative and fully desirous of treatment for his addiction and then slipped out of the building undetected, it would be quite unreasonable to hold them to account for subsequent events.

Nevertheless, this case offers an excellent example of how ethical and legal analysis can lead to quite different conclusions.

Often when we’re trying to figure out the right thing to do, we can frame the question as an ethical dilemma. Sometimes that means there are competing interests that must be weighed against each other. Sometimes, as in a case such as this, there are principles of biomedical ethics in conflict, and we must decide which takes precedence.