Is it permissible to let this child go home without dialysis if he and his mother are refusing it?
Category Archives: Case Study
Autonomy vs. Protection: The Ethical Dilemma of Involuntary Treatment in a High-Risk Patient
Should the medical team allow the request of a patient’s mother, acting as his surrogate, to approve involuntary hospitalization and the off-label use of antibiotic treatment where the benefit appears unclear?
A Lady with Few Directives
QUESTION: How should we make decisions about resuscitation status for this confused woman with no designated surrogate?
STORY: Nellie is a 97-year-old woman who was living alone in her own home until she was admitted to the hospital four days ago with weakness, decreased mobility, and confusion. She was found to have pneumonia, sepsis, renal insufficiency, and dry gangrene of one toe. She has responded surprisingly well to treatment, but remains frail, somewhat confused, and is at risk of further complications. Dr. Roberts, who has not previously known the patient, has attempted to have conversations with Nellie about her wishes regarding resuscitation, intubation, and other end-of-life care, but she has given inconsistent responses. He believes that CPR with chest compressions is unlikely to work if Nellie’s heart should stop because of her very frail ribs—however, he is not absolutely certain.
Religious Decision-Making in a Teenager
Question: May we accept this adolescent Jehovah’s Witness refusal of blood transfusion?
In this case, the physician needs to ascertain whether or not a teenager’s statement of religious faith should be allowed to direct her life-sustaining medical treatment.
Keywords: Jehovah’s Witness, Mature Minor Doctrine, Blood Transfusion Refusal, Decision-Making Capacity, Adolescent Autonomy, Pediatric Ethics, Medical Jurisprudence
A Clash of Medical Cultures
Question: Should we go to court to prevent this Samoan man’s family from taking him home against medical advice? Tuiasosopo is a 39-year-old Samoan agricultural worker who was admitted 7 weeks ago after two weeks of headaches and intermittent nausea and vomiting and blindness for 24 hours.
Daring to Discontinue Life-Sustaining Treatment
Question: Is it ethically permissible for this young man to stop his ventilator so he will die? David is a 34-year-old man who has been on a ventilator for 9 years. He was re-admitted to the hospital two weeks ago for treatment of recurrent pneumonia and has improved. He asked yesterday if his ventilator could be stopped.
Proposed Surgery During an International Pandemic
Question: Is it ever appropriate to perform a surgical procedure if it is not medically necessary?
Story:
Nathaniel is presently an active 21-month-old infant. Overall, he has done exceedingly well since birth and has required no hospitalizations or surgeries. After the first several months of life, he began to develop increasing difficulty with nasal symptoms and sleeping difficulties, and ultimately developed perforated eardrums after having had several episodes of otitis media and treatment with appropriate antibiotics. There seemed, however, to be no problem with the infant’s hearing. Nathaniel’s father also had problems with his ears as a child, and ultimately required a tympanostomy tube placement.
Daring to Discharge
Question: “My patient is refusing some appropriate medical care and services. How do I transition her to the next level of care?”
Story: Margine is a seventy-three-year-old woman with a history of breast cancer, which was known to have spread to her bones and thus be incurable when she received treatment five years ago. This resulted in a fracture of her left hip last year, requiring short-term nursing home placement. She has been living at home. She began intermittent vomiting a few weeks ago, and an outpatient upper gastrointestinal series showed gastritis and a mass outside the stomach, suspicious for malignancy. She refused CT scanning at that time, saying she was “too sick.”