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.”





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.”





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.


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

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