Ethical Decision-Making Issues

Chapter 18 Ethical Decision-Making Issues




Clinical Case Problem 1: Withholding Information from an Aging Patient


An 89-year-old woman lives with her daughter and family. At times, the living arrangement has been difficult. Recently, the daughter was concerned because her mom was not eating. You have been the primary care physician for the mother and the family for approximately 10   years. The concerned daughter brings her mom to see you. After seeing you, the mother is hospitalized. In the hospital, the mother is started on IV fluids and nutrition. Even though she complains about the hospitalization, the mother is basically compliant with treatment. You order several tests, and the results are not good. The daughter is concerned that her mother will not be able to emotionally manage the difficult report, which includes an intestinal malignant neoplasm and the recommendation of intestinal surgery. With or without surgery, life expectancy is probably only a matter of 6 to 8   months. The mother is asking about the test results, but the daughter says, “Doctor, don’t tell my mother what is going on. She has a hard enough time with things as it is.”



Select the best answer to the following questions




1. Who is the decision maker for mother?


a. mom: “What do the tests show?”

b. daughter: “Don’t tell mom.”

c. doctor: “I know what is best.”

d. call risk management

e. nursing staff: they are with the mother all the time

2. What ethical principles are most relevant to this case?


a. justice and fidelity

b. beneficence and noncompliance

c. autonomy and beneficence

d. nonmaleficence and justice

e. all of the above

In determining whether someone has the capacity for medical decision making, the physician often says, “The patient is oriented ×    3.”



3. What does this mean?


a. place, employment, time

b. place, time, person

c. time, place, decision

d. family, age, place

e. family, person, time


Clinical Case Problem 2: Decision Making and the Confused Patient


Assume the previous case as it is presented but with the following difference: As a physician, you have determined that the mother is somewhat confused by the environment and what is going on. The daughter agrees with you, and she says she just wants her mom to be comfortable. The mother still asks to know what the test results show, and the daughter says not to tell the mother the bad news.



4. Who is the decision-maker for mother?


a. mom: “What do the tests show?”

b. daughter: “Don’t tell mom.”

c. doctor: “I know what is best.”

d. call risk management

e. refer the decision to another physician

5. The historical model of medical decision making was called paternalism and was characterized by


a. patient passivity

b. lengthy discussions between physician and patient about potential treatments

c. authoritative language and veiled orders like “you should …” or “it is necessary that …”

d. graduated participation by patients so that ultimately their self- knowledge leads the decisions

e. a and c

f. b and d

6. Barriers to increased patient participation include all of the following except


a. age of the patient

b. ethnic origin

c. health care workers’ refusal to delegate power

d. decreased consumption of health care provider time secondary to the patient’s taking some of the decision making

e. health illiteracy

f. severity of disease


Clinical Case Problem 3: When Siblings Disagree


Continue to assume the original case but with the following difference: Rather than being confused, the mother is delirious and in and out of conscious awareness.


Because you have treated the mother and family for 10 years, you have in the mother’s medical record three documents. First, there is a do-not-resuscitate order in the event that the situation becomes critical. Second, there is an advance directive stating that the mother does not want anything “heroic” for her care. She wants only to be comfortable. Third, there is a Power of Attorney for Health Care Decisions that the mother has executed, naming the daughter as surrogate in case of her incapacity. There is a brother present who insists that the mother be told everything. He says, “She always taught us to tell the truth. Lying is just plain wrong, and she would never agree to that.”



7. Who it the decision-maker for mother?


a. mom: “What do the tests show?”

b. daughter: “Don’t tell mom.”

c. doctor: “I know what is best.”

d. call risk management

e. refer the decision to another physician

8. Which is true about a Durable Power of Attorney for Health Care?


a. it allows the surrogate to make medical decisions about what the surrogate thinks is best in this situation

b. it can be overruled by the attending physician

c. it mandates that the surrogate make decisions for the patient based on what the patient would decide if he or she had the capacity for decision making

d. it is a democratic process, and family members, by majority vote, can overrule the decisions of the appointed surrogate

e. because the Power of Attorney is a voluntary process, the immediate next of kin always has veto authority over any medical decision that is made


Clinical Case Problem 4: When Technology and Religion Conflict


A 16-year-old boy is brought to the emergency department with a lacerated leg from a lawnmower accident. The father tied a tourniquet around the leg, but the boy has lost a lot of blood. On entering the emergency department, the parents identify themselves as Jehovah’s Witnesses and say they do not want the boy to receive any blood. However, they do want the boy’s life to be saved. The doctors assess the situation and quickly tell the parents that the boy needs blood immediately or he will die. The boy, who is conscious, says, “Give me the blood. I do not want to die. It’s a stupid rule any way.” The parents overrule the boy and say it is not his decision.



9. It is a life-or-death decision. What do you do?


a. tell the parents that they are wrong and that you know what is best for the boy

b. inform the parents that in your opinion, the Jehovah’s Witnesses are incorrect in their views of not accepting blood

c. view the decision as a medical emergency, give the boy blood, and then address the difficult issues with the parents at a later time

d. knowing he will die, you refuse to give the boy blood, realizing that to do so against the parents’ instructions will be battery against a minor child

e. tell the parents to take the boy to another hospital


Clinical Case Problem 5: Unmarried, Pregnant, 18-Year-Old Woman


You work in an area with a large adolescent population. An 18-year-old woman comes to you because she has had sexual intercourse for the first time, and she has missed her last period. She is distraught and concerned that she may be pregnant. You are emotionally touched by her story. In addition, you are an advocate for unwed mothers to complete their pregnancy. When the pregnancy test result comes back, it is positive. When you inform the young woman of the test results, she immediately says she wants an abortion. Through further conversation, you learn that the father of the baby does not know about the pregnancy, and she has no intention of telling him. She says it was all a mistake, and she does not want to ever see him again. She insists on an abortion. However, because of your pro-life views, you personally and morally oppose abortion.



10. What should you do?


a. explain to the patient your opposition to abortion and that you will not help in doing what you believe is morally wrong

b. inform the patient that all you can do is help her through her pregnancy, and she can either keep the child or put the child up for adoption

c. tell her to find another doctor who is pro-choice

d. discuss her health options with her, namely, carry the baby to term and keep it, carry the baby to term and place it for adoption, or have a therapeutic abortion. You also strongly advise her to seek professional counseling during this time

e. none of the above

11. The 2002 law stating that any fetus born alive must receive appropriate care is called what?


a. No Child Left Behind Act

b. Born Alive Infants Protection Act

c. Fetal Birth Viability Act

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Ethical Decision-Making Issues

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