A Lady with Few Directives

Posted on March 31, 2023April 24, 2026 by Robert D. Orr, MD, CM and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

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

Posted on December 15, 2021April 22, 2026 by Robert D. Orr, MD, CM and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

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

Posted on December 15, 2021January 29, 2026 by Robert D. Orr, MD, CM and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

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

Posted on March 30, 2021January 29, 2026 by Robert D. Orr, MD, CM and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

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

Posted on November 30, 2020April 22, 2026 by Ferdinand D. Yates, Jr, MD, MA (Bioethics)

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.