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.
Category Archives: Clinical Ethics Dilemma
The Lesser of Two Evils
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
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
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.
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.”