Ethical Guides for Sedation and Pain Management of Patients with Advanced Illness

Posted on December 31, 2023May 5, 2026 by David E. Smith, MD, MA and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

This column presents a problematic medical-surgical case that may pose a medical-ethical dilemma for patients, families, and healthcare professionals. As this case is based on a real medical situation, identifying features and facts have been altered to preserve anonymity and to conform with professional medical standards. In this case, the physician and family give serious consideration to the types of pain control that are available to the patient.

The Lesser of Two Evils

Posted on December 31, 2023May 5, 2026 by Robert E. Cranston, MD, MA, FAAN and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

This column presents a problematic medical-surgical case that may pose a medical-ethical dilemma for patients, families, and healthcare professionals. As this case is based on a real medical situation, identifying features and facts have been altered to preserve anonymity and to conform with professional medical standards. In this case, the family members struggle to identify an ethical and God-honoring course of action following a terrible assault.

Aggressive Interventions for an Infant with Thanatophoric Dysplasia

Posted on December 1, 2022April 22, 2026 by Sara S. Manetta, MD, Peter D. Murray, MD, MSM, HEC-C and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

Question: What medical and surgical treatments should be offered to an infant with a birth diagnosis that portends a lifetime of chronic problematic therapeutic needs?
History: Chelsea is a 7-week-old girl with thanatophoric dysplasia (TD) who has had a long and tumultuous hospital course since birth. Her diagnosis was discovered on prenatal ultrasounds, and her parents met with pediatric subspecialists, including both neonatology and pediatric palliative care. They received counseling on Chelsea’s diagnosis, its severe lung pathology, and poor survival rates. They discussed possible management and anticipated challenges, including the possibility that Chelsea would not respond to such interventions. The team and the parents focused on the “moment-by-moment” information gathering and decision-making in the delivery room, only briefly touching on the inevitable long-term support needs if Chelsea survived. Despite the counseling the parents received, they felt as if a trial of resuscitation was in Chelsea’s best interests after birth.

Personal Choices and Future Medical Need

Posted on August 31, 2022April 18, 2026 by Robert D. Orr, MD, CM and Ferdinand D. Yates, Jr, MD, MA (Bioethics)

Question: Should this man with alcoholism be considered for liver transplantation?
Story: Everett is a 62-year-old business executive with a 40-year history of constant moderate alcohol use. He has no history of violence, blackouts, or legal or work problems because of his drinking. It is reported that his wife has also been a problem drinker all during this time, and his two adult daughters are moderate to heavy drinkers. Rather suddenly nine months ago, he suffered liver decompensation. He was stabilized (reluctantly), stopped drinking, and was referred to our liver transplant program.