Chp 8 Medical Ethical Cases

Chp 8 Medical Ethical Cases

RED means the case is exactly the kind I WON’T put on a Scantron test.

Patient: Herbert Orr, 75, Male• Symptoms: leg pain, shortness of breath, frequent

mental impairment, and mild left-sided weakness. His past history includes coronary artery bypass surgery, with complications requiring five months of hospitalization (two months of dialysis and a lengthy stay in the ICU). The patient says he wants to "die and go to God." His wife prefers that he continue dialysis and live, no matter how impaired he is.

• Diagnosis: pulmonary embolus, with a strong possibility of stroke in the future, and renal failure

• Treatment(s) proposed: dialysis

Patient: Herbert Orr, 75, Male

• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Fail• Conclusion Extraordinary

Patient: George, 27, Male • Symptoms: George has had fever, headache,

diarrhea, constipation, and rash for a month. His wife has been diagnosed with the same illness, but in her case it is too late, it is terminal. She has been sent to die at an island asylum for Typhus cases. Though George's sickness could be cured with antibiotics, he wants to go to the island asylum and die there with his wife.

• Diagnosis: Typhoid fever• Treatment(s) proposed: antibiotics

Patient: George, 27, Male

• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Pass• Conclusion Ordinary

Patient: Alcibiades Moreno, 37, male• Symptoms: He fell 47 stories off a window

washer platform. He's severely busted up: broken bones, crushed organs, severe blood loss, in a coma.

• Diagnosis: massive trauma• Treatment(s) proposed: He needs immediate

lifesaving surgery. His recovery will be long and include many surgeries, blood transfusions and organ transplants.

Patient: Alcibiades Moreno, 37, male


Patient: George Sherill, 69, Male • Symptoms: has a history of alcoholism,

depression and mania; has had a stroke and two heart attacks; his kidney function is declining and his lungs are deteriorating

• Diagnosis: bipolar, alcoholic, heart disease, kidney disease, lung disease

• Treatment(s) proposed: intubation (tube inserted in his windpipe to drain lung fluid)

Patient: George Sherill, 69, Male


Patient: Aziza (Somali immigrant), 22, Female

• Symptoms: Coughing up blood. She has refused any treatment because she says she wants to die.

• Diagnosis: pulmonary tuberculosis that had spread past her lungs, and she has depression.

• Treatment(s) proposed: Standard drug therapy (pills taken orally) would cure the tuberculosis. The hospital offers the pills free of charge. If she waits any longer than her disease will become incurable.

Patient: Aziza (Somali immigrant), 22, Female


Patient: Daniel Hauser, 13, male• Symptoms: cancerous tumors• Diagnosis: Hodgkin’s lymphoma• Treatment(s) proposed: Chemotherapy offers a

90% cure rate, but without chemotherapy the patient has only a 5% chance of survival. The patient's family has chosen alternative treatments due to their religious convictions. A judge ruled that the family must get medical treatment for their son.

Patient: Daniel Hauser, 13, male


Patient: Herbert Herb III, 57, male

• Symptoms: short temper, trouble speaking, dementia, loss of muscle control on his left side

• Diagnosis: stroke• Treatment(s) proposed: blood thinners to

dissolve the clot and prevent future clots

Patient: Herbert Herb III, 57, male


Patient: Ed, 67, male • Symptoms: mental disability, hearing impairment, high

blood pressure, diabetes, vision impairment. He also has a defective esophagus, and he often inhales his food and drink when trying to swallow. He sometimes develops aspirate pneumonia.

• Diagnosis: aspirate pneumonia• Treatment(s) proposed: antibiotics to treat the

pneumonia. The doctor also wants to put him (temporarily) on a feeding tube and a ventilator, to allow his lungs to heal. Ed doesn’t want a ventilator, but Ed is not competent. Bert, Ed's brother, invokes Ed's medical durable power of attorney, and must decide whether to accept or reject the treatment plan.

Patient: Ed, 67, male

• This case is ambiguous. If the pneumonia is not-so-bad and infrequent, then…


Patient: Baby Jane Doe, newborn, female

• Symptoms: rocker-bottom feet, heart murmur, enlarged heart, congenital heart defect, esophageal defect

• Diagnosis: Trisomy 18 Syndrome• Treatment(s) proposed: during the early

development of the child, provide fluids, electrolytes, and oxygen; remove carbon dioxide from blood; after this phase, the child may live for several years with moderate care

Patient: Baby Jane Doe, newborn, female

OEM: for the “incubation phase” procedures• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Pass• Conclusion OrdinaryNutrition/Hydration: obligatory

Patient: Madisyn Whitfield, 25, Female

• Symptoms: back pain, chills, and fatigue• Diagnosis: Crohn’s disease and kidney stones• Treatment(s) Proposed: feeding tube,

percutaneous nephrolithotomy (surgical removal of stones)


OEM:• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Pass• Conclusion OrdinaryNutrition/Hydration: obligatory

Patient: Krista Stryland, 32, Female

• Symptoms: obesity, lack of exercise, diet, depression

• Diagnosis: insufficient metabolism, obesity• Treatment(s) proposed: liposuction (which

will require lengthy recovery)

Patient: Krista Stryland, 32, Female

• We kicked this case around and considered various possibilities.

• Really, the medical facts are insufficient. Liposuction is just one of many possible treatments.

Patient: Nancy Cruzan, 32, Female

• Symptoms: displays motor reflexes but no indication of cognitive function, cannot breathe on her own

• Diagnosis: persistent vegetative state, in which she can live for years

• Treatment(s) proposed: ventilator, and provide nutrition by feeding tube

Patient: Nancy Cruzan, 32, Female

OEM: for the ventilator• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Fail• Conclusion ExtraordinaryNutrition/Hydration: obligatory if the ventilator

is KEPT ON, optional if it is taken OFF.

Patient: Monica, 36, Female• Symptoms: loss of muscle control and eventual

suffocation due to loss of control over respiratory muscles• Diagnosis: motor neurone disease (motor nerves fail, and

the patient cannot control her movements; the mind is virtually unaffected). People with MND usually die of suffocation within 4 years of the onset of the disease. Monica's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours.

• Treatment(s) proposed: She asks her doctor to give her morphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death because it lowers respiration.

Patient: Monica, 36, FemalePDE: for the morphine (DI: pain control)• Criterion #1 Pass (II: breathing suppressed)• Criterion #2 Pass• Criterion #3 Pass• Conclusion Good to doOEM: • Criterion #1 Pass, however the real benefit is pain management• Criterion #2 Pass• Criterion #3 PassConclusion Pass but still optional. Pain management here is

optional because it does not offer an increase of health…it’s a different kind of “real benefit.”

Patient: Terri Schiavo, 41, Female• Symptoms: Suffered a full cardiac arrest,

followed by coma• Diagnosis: Coma, persistent vegetative state• Treatment(s) proposed: Physical therapy;

experimental therapy; remove feeding tube so that she dies

Patient: Terri Schiavo, 41, Female• Nutrition/Hydration: obligatory

• Note: she’s NOT DYING of anything. Depriving her of food and water IN ORDER to kill her is HOMICIDE.

Patient: Piña Colada, 78, Female• Symptoms: jaundice, abdominal pain, history of

alcoholism• Diagnosis: cirrhosis of the liver• Treatment(s) proposed: liver transplant; note

that the patient does not have health insurance to cover this expensive procedure, and she also lives in a remote area, meaning she would have to travel a great distance to undergo the transplant


OEM:• Criterion #1 Pass• Criterion #2 Fail• Criterion #3 Fail• Conclusion Extraordinary

Patient: Dax Cowart, 25, male• Symptoms: Burned over 65% of his body from a freak

accident, with irreparable damage to his eyes, ears and hands. Dax has attempted suicide many times and repeatedly attempted to refuse treatment. He has been treated against his will because it was not clear that he was competent. Now that he is able to communicate better, he is expressing his refusal of treatment, and he is clearly competent.

• Diagnosis: extensive burns• Treatment(s) proposed: Large doses of narcotics for minimal

pain relief, regular baths in a chlorinated water to fight infection, and numerous bandages covering his body, replaced daily. Long-term recovery will require many surgeries to repair his skin.

Patient: Dax Cowart, 25, male


Patient: Walter White, 50, Male• Symptoms: cough, shortness of breath, chest pain,

coughing up blood, blurred vision, headaches, seizures, and symptoms of stroke

• Diagnosis: small-cell lung cancer • Treatment(s) proposed: Chemotherapy leading to

surgical removal of the cancer. Note that the patient’s insurance company will only cover a small portion of the vast expense of treatment. On the one hand, Walter does not want to plunge his family into debt. On the other hand, Walther does not want to leave his children without a father. Walther never smoked but is a chemist, and has been in contact with many dangerous chemicals during his career.

Patient: Walter White, 50, Male


Patient: Karen Ann Quinlan, 21, Female• Symptoms: Patient became unconscious after

arriving home from a party. She had consumed diazepam, dextropropoxyphene and alcohol. She collapsed. Twice she stopped breathing for 15 minutes or more. Her brain damage is profound and permanent. After a few months, her parents want to remove the ventilator.

• Diagnosis: she needs a ventilator to breathe for her; also, persistent vegetative state

• Treatment(s) proposed: ventilator

Patient: Karen Ann Quinlan, 21, Female

OEM: for the ventilator• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Fail• Conclusion ExtraordinaryNutrition/Hydration: obligatory if the ventilator

is KEPT ON, optional if it is taken OFF.

Patient: Vera Lynn, 78, Female• Symptoms: confusion, poor judgment, mood

swings, unable to retain information, frequently falls, recently had a four month hospital stay for pneumonia, and has had prior strokes. Her confusion makes her difficult to care for, and she is often dehydrated.

• Diagnosis: severe dementia, diabetes with impaired vision, poor kidney function

• Treatment(s) proposed: IV fluids

Patient: Vera Lynn, 78, Female• The medical facts are a little ambiguous, but

we interpreted the kidney function to be poor, but still working and not declining. If the kidneys were failing, the analysis would be different.

• Nutrition/Hydration: obligatory

Patient: Jayden Aldona Gonzalez, 20 months, male

Symptoms: vomiting, head pain, unsteadinessDiagnosis: aggressive brain tumorTreatment(s) proposed: transported to

Children’s Hospital of Philadelphia for surgery to remove the tumor

Patient: Jayden Aldona Gonzalez, 20 months, male

OEM:• Criterion #1 Pass• Criterion #2 Pass• Criterion #3 Pass• Conclusion Ordinary

Patient: Chris Sands, 24, MaleSymptoms: Hiccups as often as every two seconds a day

and cannot stop. Because of this, he has been limited in his ability to be a back-up singer in his band, “Ebullient.”

Diagnosis: The doctors aren’t sure, but suspect he has an acid reflux condition caused by a damaged valve in his stomach.

Treatment(s) proposed: Keyhole surgery to grab part of Chris’s stomach and wrap it around the valve to tighten it.

Patient: Chris Sands, 24, Male

OEM:• Criterion #1 Fail• Criterion #2 Pass• Criterion #3 Pass• Conclusion ExtraordinaryIf, however, the doctors became sure of the

diagnosis, the analysis might be different.

Patient: Malcolm, 64, maleSymptoms: shortness of breath; a tumor is compressing

his airways to both lungs. Aggressive treatment of the tumor has failed. The tumor has not shrunk. He was put on a ventilator to assist breathing. The doctors judge that his condition cannot be improved. He becomes incompetent. His wife wants to do everything possible to extend Malcolm’s life. The hospital is bearing the majority of the cost of his care.

Diagnosis: Incurable, terminal cancer of the esophagusTreatment(s) proposed: Ventilator

Patient: Malcolm, 64, maleOEM: for the ventilator• Criterion #1 Pass (assists breathing)• Criterion #2 Pass• Criterion #3 Fail• Conclusion Extraordinary

Patient: Lauren Richardson, 23, Female• Symptoms: a heroin overdose caused her to fall

unconscious and stop breathing. Lack of oxygen severely damaged her brain. She is in a coma. She is provided nutrition and hydration artificially. She has no health insurance.

• Diagnosis: Anoxic brain injury, persistent vegetative state

• Treatment(s) proposed: Removing nutrition and hydration

Patient: Lauren Richardson, 23, Female

• Nutrition/Hydration: Obligatory

• NOT an OEM CASE!!!

Patients: Rital and Ritag Gaboura,11 months, (both) Female

• Symptoms: Conjoined twins. Ritag’s heart is failing. Untreated, both will die.

• Diagnosis: Vertical Craniopagus, which means they are conjoined at the top of the skull and live at a 180 degree angle to one another. Heart failure (Ritag).

• Treatment(s) proposed: Surgical separation. The operation will be very long and risky, but both may be saved.

Patients: Rital and Ritag Gaboura,11 months, (both) Female

• We analyze this as two sick people who may be saved by a long, difficult, risky surgery:– Pass, Pass, Fail, Extraordinary

• What makes this case simple but still very hard to analyze is the fact that both will die without the surgery, and both might live with the surgery. Still, the surgery is radical and involves profound physical burden, so it’s optional.

Patient: Milagros Cerron, 9 months, female• Symptoms: She is born with a rare defect, born with several

organs only partially formed or missing. Because her legs are conjoined, she has the appearance of a “mermaid.”

• Diagnosis: sirenomelia• Treatment(s) proposed: Since this defect is very rare, and is

usually fatal within two days of birth, there is very little medical technology and experience treating it. First, the doctors will insert silicone bags between her legs to expand the tissue in her legs and abdomen. Then they will perform surgery to separate her legs. She has all the bones and structures of normal legs, and she might walk one day. However, her internal organs cannot not grow properly because of her deformity. She has only one functioning kidney. She is in constant danger of infection, and she may at best live a few years. The cost of her care is covered by the city of Lima, Peru.

Patient: Milagros Cerron, 9 months, female

• This case looks complicated but it’s really pretty simple.

• Criterion #1 Pass (offers survival and improved function)

• Criterion #2 Fail because the doctors have limited technology and experience with this procedure. They’re inventing the procedure (RARE).

• Criterion #3 Fail because the surgery is radical and physically demanding, and because the city of Lima, Peru is opting freely to pay for it

• Conclusion Extraordinary

Patient: Billy Thompson, 9, Male• Symptoms: Ear infections, pneumonia, asthma,

neck pain, headaches• Diagnosis: Tourette’s syndrome, insomnia; during

an examination, the doctor discovered a neck injury

• Treatment(s) proposed: neck surgery. Repairing the injury should reduce the Tourette’s tics, decrease the neck pain and headaches.

Patient: Billy Thompson, 9, Male


Patient: Gretchen, 25, Female

• Symptoms: perfectly healthy; wants breast implants to advance her modeling career

• Diagnosis: none• Treatment(s) proposed: silicon implants to

augment breasts


OEM:• Criterion #1 Fail• Criterion #2 Pass• Criterion #3 Pass• Conclusion Extraordinary, in the sense that

she has no obligation to accept the procedure…but I argue that she has an obligation NOT TO GET the procedure

Patient: Gretchen, 26, Female• Symptoms: Blurred vision, trouble retaining

information, memory loss, body tingles and dizziness, muscle and joint pain, extreme anxiety and depression, skin rashes, tremors, and extreme fatigue

• Diagnosis: complications arising from silicon breast implants

• Treatment(s) proposed: remove the silicon implants; treat any infections discovered during surgery



Patient: Dick Cheney, 69, Male• Symptoms: Suffered five heart attacks since 37

years old, chest pains• Diagnosis: Progressive congestive heart failure• Treatment(s) proposed: Implantation of a left

ventricular heart assistance device (pump that takes over some of the heart’s work), until a transplant can be performed.

Patient: Dick Cheney, 69, Male


Patient: Gandalf, about 4000 years, male• Symptoms: Patient started smoking a pipe when he

was young. Now he has a cough, fatigue, and failing respiration. He has battled lung cancer for years with chemotherapy and radiation.

• Diagnosis: terminal lung cancer• Proposed treatment(s): Chemotherapy and radiation

can no longer help him. The doctor estimates that he will die of cancer in six days. Ever dignified, he requests that his IV hydration and his feeding tube be removed, so he can be more comfortable. The doctor says that dehydration can kill him in four days, and starvation in eight days.

Patient: Gandalf, about 4000 years, male

• Hydration: obligatory• Nutrition: optional

• Cancer will kill him AFTER dehydration would but BEFORE starvation would.

Patient: Mary, 19, female• Symptoms: high levels of anxiety and rapid

mood swings• Diagnosis: bipolar disorder• Treatment(s) proposed: a prescription

medication (lithium bicarbonate) taken twice daily will reduce the severity of her depressive and manic episodes; however, the pills have side effects including headaches and sometimes nausea

Patient: Mary, 19, female


Patient: Brittney Lee, 24, Female

• Symptoms: abdominal pain• Diagnosis: abdominal aortic aneurysm, a weakening

in the wall of the thoracic aorta which causes it to stretch and bulge

• Treatment(s) proposed: surgery to repair the aorta (without which she will die). The scar left by the surgery will definitely end her career as a provocative dancer. She is paid to be an objectified stage decoration for touring performers such as Kenya East and 37 Cent.

Patient: Brittney Lee, 24, Female


• Note: her motive for claiming “emotional burden” is disordered…that’s one job she OUGHT to lose!

Patient: Ms. Bones, 18, female• Symptoms: low energy, anxiety, fertility cycle

stopped, muscle atrophy, aching joints; patient wants to fit into a size zero dress for prom

• Diagnosis: malnutrition• Treatment(s) proposed: increase caloric

intake, counseling; involuntary commitment if necessary

Patient: Ms. Bones, 18, female• Nutrition/Hydration: obligatory

• She wants to starve herself for vanity’s sake. Duh. Go eat something.

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Chp 8 Medical Ethical Cases