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. He was found to have cryptococcal meningitis[2] and has been treated with 2 standard antibiotics for this uncommon infection (amphotericin intravenously and flucytosine by mouth). He initially had gradual improvement, demonstrated by repeatedly testing of his spinal fluid and considerable improvement in his mental status. He was nearing the end of his 6-week course of treatment when 1 week ago he suffered a stroke. This precipitated vomiting which precluded retention of his flucytosine for several days. He has subsequently had a worsening of the spinal fluid test, and his mental status is again severely depressed. Immunosuppression[3] is suspected, but no source has been found.

Proposed Surgery During an International Pandemic


Is it ever appropriate to perform a surgical procedure if it is not medically necessary?


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.