Medical Ethic More Then 100cases

8/12/2019 Medical Ethic More Then 100cases

1/30

1. A 25- year old mother refused immunization for her 2-month old son. The socialworker spoke to the mother. (Important for Board eamination!"et step in mana#ement$ immunization should %e #i&en for the %enefit of the child.

2. A '-year old mother refused sur#ery for suspected appendicitis for her )-year olddau#hter. The social worker spoke to the mother. (Important for Board eamination!"et step in mana#ement$ sur#ical remo&al of the appendi should %e preformed for the%enefit of the child.'. A 1)-year old %oy was dia#nosed with osteosarcoma of the ri#ht thi#h. The sur#eonrecommended amputation. The %oy refuses amputation. *e is doin# &ery well otherwise.*e is aware that death is certain without sur#ery. (Important!"et step in mana#ement$ amputation should "+T %e preformed.Adolescent patients or adults who are competent in makin# decisions ha&e an a%soluteri#ht to determine what shall %e done with their own %odies. *owe&er, most pediatricpatients are not competent to make their own decisions. lease remem%er, children (15

years or older! are usually a%le to #i&e a #enuinely informed consent. Thereforephysicians may respond to their reuest, ecept in a case of irre&ersi%le sterilization.

/. A 10-year old #irl is a eho&ahs 3itness. 4he refuses a lifesa&in# %lood transfusion.4he is aware of the conseuences. 4he spoke to the social worker. (Important!"et step in mana#ement$ %lood transfusion should "+T %e #i&en %ecause she iscompetent to make the decision.

5. A 5-year old #irl is a eho&ahs 3itness. 4he reuires emer#ency %lood transfusion.*er mother refuses %lood transfusion. A social worker alon# with two physicians spoketo the mother. (Important!

"et step in mana#ement$ %lood transfusion should %e #i&en %ecause the patient is notcompetent. other cannot refuse her dau#hters treatment.

). A 2-year old %oy was %rou#ht to the 67 %y his parents for an in8ury. hysicians madethe dia#nosis of child a%use. There are three other children li&in# in the same household.Both parents confess to child a%use %ut reuest the physician to keep it confidential.4ocial worker was in&ol&ed. (Important!"et step in mana#ement$ the case should %e reported to 9hild 3elfare A#ency (93A!.All children should %e remo&ed from the parents.

0. A 15-year old %oy with 4T: (seually transmitted disease! came to see aphysician. *e asked the physician not to tell his parents. (;67< I+7TA"T!"et step in mana#ement$ the physician should treat the patient and notify theappropriate health authority, %ut should not tell his parents.

=. A 1)-year old %oy wants to use a condom. *e comes to the clinic for free samples. *ereuested the physician, howe&er, not to tell his parents. (Important!"et step in mana#ement$ condom should %e #i&en and physician should not tell hisparents.


2/30

>. A '-year old male patient is recently dia#nosed with *I;. *e li&es with his wife andtwo other children %ut is promiscuous. *e reuested the physician not to tell his wife. *elost his 8o% recently. 4ocial worker spoke to the patient. (;ery Important!

"et step in mana#ement$ physician should notify the appropriate authority (e.#.department of health! for the safety of other specific persons who are en#a#ed in unsafeseual practices. The physician howe&er, should ask the patient to di&ul#e the dia#nosisto his wife and other seual partners.

??? 1. A &ery small premature infant was %orn in the deli&ery room %y "4;: (normalspontaneous &a#inal deli&ery!. The attendin# physician decided not to resuscitate thenew%orn. hysician spoke to the mother. other started to cry. "ew%orn epired after 'minutes. Is the physician lia%le for the new%orns death@Answer$ "+. lease remem%er, no physician in the 4A has e&er %een found lia%le forwithholdin# or withdrawin# any life sustainin# treatment from any patient for any reason.

11. A physician picked up a car accident &ictim from the street and %rou#ht him to the 67in his car. *e did not want to wait for an am%ulance %ecause the patients condition wascritical. hysical eamination in the 67 re&eals uadriple#ia. Is the physician lia%le forthis conseuence@ (;ery Important!

Answer$


3/30

15. A 15-year old homoseual %oy is %rou#ht %y his parents to a physician. *is parentsdo not accept their sons seual orientation. The %oy refuses to chan#e. (Important!"et step in mana#ement$ physician should tell his parent that homoseual acti&ity isconsidered as spamternati&e life style. arents should talk to his son %ut should not forcehim to chan#e his homoseual acti&ities.

1). A 1)-year old #irl %ecomes pre#nant. *er mother wanted her to a%ort this pre#nancy.The #irl wanted to continue her pre#nancy despite difficulties. *er %oyfriend is a hi#hschool drop out. (Important!"et step in mana#ement$ physician should ad&ise to continue this pre#nancy %ecausethe #irl is competent to make this decision.

10. A 15-year old #irl recently %ecomes pre#nant. 4he went to a doctor for a%ortion. 4hetold the doctor not to tell her parents a%out this pre#nancy. (Important!"et step in mana#ement$ a%ortion should %e done and parents should not %e notified.lease remem%er, strict reuirements for parental consent may deter many adolescents

from seekin# health care.

1=. 9an a physician pro&ide sterile needles for intra&enous dru# a%users@ (Important!Answer$ . A 2)-year old pre#nant woman went for antenatal check up. 4ono#ram re&ealed a 20-week old fetus with erythro%lastosis fetalis. :octor recommended intrauterine fetal %loodtransfusion. 4he refused the procedure. 4ocial worker discussed the case with the mother.(Important!"et step in mana#ement$ doctor should recei&e a court to do the procedure which willhelp the fetal condition.

2. A 2-year old man tells his doctor that he is #oin# to kill #irlfriend. 4he li&es in theuni&ersity dormitory. :octor called the uni&ersity and alerted them a%out the threat.*owe&er, uni&ersity security people did not protect her. 4he was killed %y her %oyfriend.3ho should %e responsi%le for this killin#@ (Important!Answer$ the 2-year old man is responsi%le. :octor did the ri#ht thin# %y notifyin# theuni&ersity or the police. The uni&ersity is also responsi%le %ecause they did not take anypre&enti&e measures.

6&en mothers wont ha&e ri#hts on their fetuses

21. A 2-year old pre#nant woman refuses cesarean section for complete placenta pre&ia.Cetus is full-term and healthy. 4ocial worker spoke to mother. (Important!"et step in mana#ement$ doctor can #o to court to #et permission for cesarean sectionfor the %enefit of the fetus.

22. A '-year old woman in#ested alcohol and illicit dru#s (e.#., cocaine, crack! whichare harmful to the fetus. 3hat should a physician do@ (Important!


4/30

Answer$ the physician should %e careful in reportin# this case %ecause the pre#nantwoman may not come %ack for prenatal care, which is important for %oth the mother andthe fetus. *owe&er, if the %a%ys urine toicolo#y test is positi&e for illicit dru#s, caseshould %e reported to 93A (child welfare a#ency!. 93A su##ests separate custody forthe child.

2'. A physician wants to study a #roup of children a#in# from 1-12 year old. hysician#ot the consent from the parents. *owe&er, he didnt discuss the study with the children.A child refused to participate. 4hould the physician force the child to participate@(Important!Answer$ no, %ecause a child can refuse to participate in a research study.

2/. A /-year old schizophrenic patient needs hernia repair. 4ur#eon discussed theprocedure with the patient who understood the procedure. 9an the patient #i&e consent@

(Important!Answer$ yes. If a psychiatric patient understands the procedure, he or she can #i&e theconsent.

25. A )5-year old schizophrenic patient needs coronary an#io#raphy %ecause ofsuspected myocardial infarction. 9ardiolo#ists eplained the procedure to the patient whodid not understand the procedure. 3ho can #i&e the consent on %ehalf of the patient@(Important!Answer$ the patients relati&e can #i&e the consent. If no%ody is a&aila%le to #i&e theconsent, court order should %e o%tained. If a psychiatric patient does not understand theprocedure, he or she cannot #i&e the consent.

2). A 25-year old woman de&eloped postpartum psychosis. The new%orn de&elopedcyanosis due to con#enital heart disease. The new%orn needs cardiac sur#ery. 4ur#eondiscussed the procedure with the mother. 4he understood the procedure. 9an she #i&e theconsent@ (Important!Answer$ yes, %ecause she understood the procedure.

20. A new%orn is dia#nosed with either trisomy 1= or 1' with T6 (tracheoesopha#eal!fistula which reuires sure#ery. other reuest sur#eon to repair the T6-fistula. 3hatshould a sur#eon do@ (Important!Answer$ sur#eon should refuse to do the reparati&e sur#ery %ecause these conditions(trisomy 1= or 1'! are non&ia%le. If the patient sur&i&es, sur#eon can put a #astrostomyfeedin# tu%e for nutrition. *owe&er, please remem%er that a patient with trisomy 21(:own syndrome! with T6 fistula should %e operated on.

2=. A /5-year old terminally ill patient wanted to die. *e has pancreatic cancer and has%een sufferin# from constant pain. *e asked the physician to #i&e him some medicationwhich can epedite his death. 3hat should a physician do@ (;ery Important!


5/30

Answer$ physician cannot #i&e any medication which will epedite the death. *owe&er,physician can prescri%e medication to minimize the pain. The dose should %e appropriate.hysician-assisted suicide is ille#al e&erywhere (ecept in the state of +re#on!.2>. A /0-year old man came to a doctor for chronic low %ack pain and dysuria. Thedia#nosis of metastatic prostate cancer was made after appropriate in&esti#ation. 4hould

the doctor tell the %ad news to the patient@ (Important!Answer$ yes physician must tell the truth to the patient.

'. A sur#eon wanted to perform cholecystectomy on a patient. The sur#eon is not surewhether the patient has decision-makin# capacity. 3hat is the net appropriate step@(Important!Answer$ consultation with a psychiatrist or neurolo#ist may %e helpful. 4ometimes it isnecessary to discuss the case with hospital attorneys, ethic committees, or ethicconsultants. In a difficult case, the ultimate 8ud#e of a patients competency is a court.

Do to court only in the end

'1. A /5-year old widow was admitted to an I9 (intensi&e care unit! with rupturedintracranial aneurysm. 4he is comatose and is placed on a mechanical &entilator. 4he hasa 2-year old son who did not keep any relation with his mother. *owe&er, he came tosee his mother. *is mother made a written proy ad&ance directi&e which indicates thather 5-year old female nei#h%or should make the su%stitute decision. 3ho is the ri#htperson to make the su%stitute decision in this situation@ (Important!Answer$ 5-year old nei#h%or should make the su%stitute decision. lease remem%er, themost appropriate person to make the su%stitute decision is someone desi#nated %y thepatient while still competent, either orally or throu#h a written proy ad&ance directi&e.+ther su%stitute decision makers, in their usual order of priority, include a spouse, adultchild, parent, %rother or sister, relati&e, or concerned friend. Cor a patient who has noother decision maker a&aila%le, a pu%lic official may ser&e as a decision maker.

'2. The ri#ht of patients to refuse medical inter&ention$ patients can refuse dialysis,cardiopulmonary resuscitation, mechanical &entilation, and artificial nutrition andhydration, e&en if such a decision results in the patients death. A patients decision towithdraw (discontinue! or to withheld (not to initiate! life-sustainin# treatment is notconsidered suicide and physician participation is not considered physician-assistedsuicide. hysicians do not ha&e any le#al risk.

''. 9an a medical student introduce himself or herself as a doctor to the patient@(Important!Answer$ no. a patient can refuse a medical student from performin# any procedure.*owe&er, medical students are allowed to perform a procedure under appropriatesuper&ision If the patient a#rees to that.

'/. 4hould a %us dri&er hide history of epilepsy from his employer@ (Important!Answer$ no. *e has reuested his physician not to mention his epilepsy to the employer%ecause this would result in the loss of his 8o%. The physician is o%li#ated not only to his


6/30

patient %ut to the community. The patient should notify his employer and try to find anon-dri&in# 8o% in the company. If the patient disa#rees, physician may notify theappropriate authority for the safety of the patient and the community.

'5. A 5-year old male is dia#nosed with stomach cancer. *e reuested the physician not

to tell his wife. The followin# day, the wife calls to inuire a%out her hus%andsdia#nosis. (Important!Answer$ the physician should not di&ul#e the hus%ands dia#nosis. *owe&er, thephysician should encoura#e the patient to re&eal his dia#nosis to his wife.

'). A 2>-year old man is dia#nosed with presymptomatic *untin#tons disease. Thisdisease is an autosomal dominant (5E chance of ha&in# the disease in each pre#nancy!.*e reuested his physician not to tell the dia#nosis to his wife. The wife wants to ha&echildren. (Important!Answer$ physician should ask the patient to seek #enetic counselin# and to ur#e him todiscuss the matter with his wife. 4ince there is a risk of harm to the future children,

physician can di&ul#e the dia#nosis to protect the future children.

'0. A 1=-year old man is dia#nosed to ha&e suspected %acterial menin#itis. *e refusestherapy and returns to the colle#e dormitory. 3hat should a physician do in thissituation@ (;ery Important!Answer$ physician should report to the colle#e authority and recommend that thesuspected indi&idual should %e isolated durin# the course of his illness.

'=. A '>-year old nurse is dia#nosed with hepatitis B anti#en-positi&e. 4he is workin# ina dialysis unit. 4he told her doctor. *owe&er, she did not tell the hospital authority%ecause she is afraid to lose her 8o%. (;ery Important!Answer$ physician should ask the nurse to di&ul#e her medical condition to the hospitalauthority. If she refuses, physician should notify the hospital authority for the protectionof patients.

'>. A 2-year old man with se&ere head in8ury was admitted to a small hospital. Thepatient needs neurosur#ical inter&ention which is a&aila%le in a near%y uni&ersityhospital. *ospital refused to accept a patient who has no medical insurance.Answer$ uni&ersity hospital must accept the patient.

/. A '-year old man needs a second prosthetic &al&e. *e is a dru# addict. 4ur#eon doesnot want to perform sur#ery %ecause the patient does not take care of himself. Is this theri#ht decision@ (Important!Answer$ no. 4ur#ery should %e performed if it is medically indicated.

/1. A new%orn male is dia#nosed with anencephaly. *is 1-year old si%lin# needs akidney. *is parents reuested the physician to remo&e the kidney from the anencephalicchild and to transplant that kidney in the 1-year old si%lin#. 3hat should a physician do@Answer$ sur#eon should perform the kidney transplant.


7/30

/2. A 5-year old man is in a persistent &e#etati&e state. hysician decided todiscontinue nutrition and hydration for that patient. Is this the ri#ht decision@Answer$ yes. This is an accepta%le practice in most states. Cew states reuire cleare&idence that the patient would ha&e chosen this course./'. A medical student reuested his attendin# to perform a pel&ic eamination on a

patient who is anaesthetized for appendectomy. Is this ethically accepta%le@Answer$ no. The patient did not #i&e consent to perform a pel&ic eamination.//. A 2-year old woman slashed her wrists and wanted to die. 4he was unconscious andwas %rou#ht to the 67. 3hat should a physician do@ (Important!Answer$ physician should take care of the patient. sychiatric consultation and socialworker e&aluation are indicated. A suicide attempt is &ery often a cry for help./5. A >-year old man was dia#nosed with ha&in# Alzheimers disease 1 years a#o. It isdifficult to feed him. *e cannot reco#nize his family mem%ers. *e de&eloped recurrentaspiration pneumonia. 3hat should a physician do@Answer$ physician should discuss this with the family and should respect their decision./). A 1-day-old infant was dia#nosed with hypoplastic left heart syndrome. The patient

is sta%ilized with the use of prosta#landin. hysician discussed this case in detail with theparents. 3hat should the parents decide in this situation@Answer$ the parents can choose a sta#ed sur#ical repair of the heart, a final hearttransplantation if the or#an is a&aila%le, or allow the infant to die./0. A 55-year old woman with se&ere de&elopmental disa%ility recently is dia#nosedwith %reast cancer. *er mental a#e is estimated at a 2-year old le&el. *er family mem%ersdo not want any more inter&ention. 3hat should physician do@Answer$ physician should discuss this case with the hospital ethics committee mem%ers.The usual consensus is not to do anythin# %ecause of her se&ere mental disa%ility./=. A />-year old woman with cer&ical cancer has a history of noncompliance. 4he hadsur#ery a month a#o. 4he missed se&eral appointments. 9an a physician force her forchemotherapy@ (Important!Answer$ no. hysician can talk to her re#ardin# the importance of chemotherapy.*owe&er, the patient must make the final decision./>. An internist has %een mana#in# a dia%etic patient for the last 1 years. The patientscondition is pro#ressi&ely #ettin# worse. The patient is also not happy with thephysicians mana#ement. 3hat should a physician do in this situation@Answer$ physician should find another physician (e.#., endocrinolo#ist! who mi#ht %emore successful with the patient in this particular circumstance.5. An internist recently refused to see a patient who he has %een seein# for the last 5years. Internist stated that the patient was rude to him. The patient went to see anotherphysician who reuested the patients medical record. 3hat should the internist do in thissituation@Answer$ internist should pro&ide the medical records of the patient to the new physician.51. An internist refused to see a complicated hypertensi&e patient who he has seen forthe last 1 years. Internist did not #i&e any notice to that patient. The patient was an#rywith the physician. The patient was recently admitted to a hospital with the dia#nosis ofstroke. Is the internist responsi%le for the patients condition@Answer$ yes. The le#al char#e of a%andonment can arise when the physician without#i&in# timely notice, ceases to pro&ide care for a patient who is still in need of medical


8/30

attention. Internist is not o%li#ated to find him another physician. *owe&er, patientshould ha&e sufficient time to arran#e for another physician.52. A physician went to &acation for 2 weeks. *e did not find another physician to co&erhim. *e is &ery sincere. +ne of his patients with hypertension de&eloped se&ereheadache. The patient has an appointment with the doctor as soon as he comes %ack from

&acation. The patient did not look for another physician and decided to wait. The patientsuddenly collapses and was dia#nosed to ha&e intracranial hemorrha#e. Is the physicianresponsi%le for this patient@ (Important!Answer$ yes. The physician has a le#al o%li#ation to arran#e for co&era#e %y anotherphysician.5'. An ophthalmolo#ist performed a cataract sur#ery on a patient who went home afterthe operation. In the e&enin#, the patient started &omitin# and complained of se&ereheadache. The ophthalmolo#ist refused to accept that the symptoms were due topostoperati&e complications. The patient wanted to see the doctor immediately %ut herefused to see that patient. The patient went to the nearest 67 and was dia#nosed to ha&edislocation of the lens and partial retinal detachment. Is the physician responsi%le for the

patients condition@Answer$ yes ophthalmolo#ist failed to 8ud#e the patients condition seriously enou#h towarrant attention.5/. A 0-year old 9hinese man is dia#nosed to ha&e se&ere osteoarthritis. *e told hisdoctor that he is usin# 9hinese her%al medicine. *e is feelin# %etter. *owe&er, he hadtwo episodes of dizzy spells since he started that her%al product. 3hat should a doctorsu##est to this patient@ (Important!Answer$ the doctor should su##est to discontinue the her%al product which may %ecausin# the dizzy spells.55. A '5-year old woman is dia#nosed to ha&e chronic throat infection. 4he is frustratedwith the con&entional medicine. 4he told her doctor that she is usin# spamternati&ehomeopathic medicine. 4he is feelin# much %etter and she has no other complications.3hat should a doctor su##est to this patient@Answer$ the patient can continue spamternati&e homeopathic medicine. Alternati&emedicine therapy is accepted in the society and is also used alon# with con&entionaltherapy.5). A /5 year old woman is dia#nosed to ha&e TI (urinary tract infection!. 4he told herdoctor that she could not afford to purchase anti%iotics. *owe&er, she is usin# her%almedicine that is cheaper. 4he is complainin# of fe&er and dysuria. 3hat should a doctorsu##est to this patient@ (Important!Answer$ the patient should discontinue the her%al medicine immediately and should startanti%iotics as soon as possi%le.50. A 1'-year old %oy with suspected menin#itis refuses therapy. *is parents alsosupport that decision %ecause they are supposed to #o on &acation the followin# day.3hat should a physician do in this situation@ (Important!Answer$ the patient should %e admitted and treated in the hospital. If they refuse, le#alaction should %e taken.5=. A 2-year old #irl is admitted with the dia#nosis of intestinal o%struction. *er motherhas a psychiatric pro%lem. *er mother is not capa%le of #i&in# the consent. *er fatherdied one year a#o. 3hat should a sur#eon do in this situation@


9/30

Answer$ le#al steps may %e taken to pro&ide a surro#ate decision-maker.5>. A )0-year old widow has %een usin# hypnotics for the last 5 years. 4he is addicted.*er doctor wants to withdraw her from her present medication %y trial on place%os. Is thephysician makin# a ri#ht decision@ (Important!Answer$ no. The physician cannot use place%os %ecause his decision is decepti&e. The

pro%lem of addiction should %e discussed directly with the patient. The use of decepti&eplace%o is indicated in the followin# conditions$(a! the patient insists on a prescriptionF(%! the patient wishes to %e treatedF(c! the alternati&e to place%o is either continue illness or the use of a dru# with knowtoicityF(d! hi#h response rates to place%o ( e.#., postoperati&e pain, mild mental depression!.). A 5-year old man is dia#nosed to ha&e multiple sclerosis. In the mornin#, thesur#eon asked the man his opinion on the sur#ical procedure and he a#reed. In thee&enin#, the man refused to #i&e consent for the same sur#ical procedure. *e is alsodisoriented to place and time. Is the patient capa%le of makin# the decision@

Answer$ no the patient has impaired capacity.)1. A 55-year old woman with dia%etes is dia#nosed to ha&e #an#rene on %oth feet. 4hewas %rou#ht to the hospital. 4he told the doctor the she is feelin# fine and she has nomedical pro%lems. 9an she #i&e consent for the amputation of %oth le#s@Answer$ no. The appointment of a surro#ate should %e sou#ht to #et the consent for thesur#ery.)2. A 10-year old %oy came to a sur#eon for %ilateral &asectomy. *e is the father of onechild and does not want to ha&e any more children. *e does not want to tell his #irlfriendand parents. *e li&es with his parents. 3hat should a sur#eon do in this situation@(Important!Answer$ sur#eon should not perform %ilateral &asectomy and should offer him lessradical alternati&es. lease remem%er, a mature minor may not comprehend theimplications of this procedure.)'. A 1)-year old #irl came to a doctor for %ilateral tu%al li#ations. 4he is a mother ofone child and does not want to ha&e any more children. 4he does not want to tell her%oyfriend and parents. 4he li&es with her parents. 3hat should a doctor do in thissituation@ (Important!Answer$ o%#yn doctor should not perform %ilateral tu%al li#ation and should offer herless radical alternati&es.)/. A 1)-year old %oy wants to donate one of his kidneys to his friend who is sufferin#from 647: (end sta#e renal disease!. The %oys parents did not a#ree with his decision.3hat should a physician do in this situation@ (Important!Answer$ the physician cannot accept his kidney. *owe&er, he can donate one of hiskidneys if his parents a#ree.)5. A 15-year old %oy wants to participate in a research study. *e told his parents whodid not a#ree. *e li&es with his parents. 9an this %oy participate in the research study@Answer$ no the %oy needs consent from his parents to participate in a research study.)). A 10-year old %oy li&es independently. *e is married and has one child. *e wants toparticipate in a research study. :oes he need his parents permission@ (Important!


10/30

Answer$ no. *e is an emancipated minor who li&es independently from his parentsphysically and financially.)0. A 0-year old man is dia#nosed with terminal esopha#eal cancer and reuires aninsertion of a #astrostomy tu%e. *e has si#ned a :"7 (:o "ot 7esuscitate! order a%out amonth a#o. 4hould the preeistin# :"7 order stand or %e suspended durin# the sur#ical

procedure@ (;ery Important!Answer$ attendin# physician, sur#eons, and the patient or surro#ate should discuss thematter and either affirm or suspend the order in anticipation of sur#ery. If a patient iscompetent and wishes a preeistin# :"7 order to stand, resuscitation should not %eperformed in the e&ent of an intrasur#ical arrest.)=. An infant, %orn at ' weeks #estation, appears to %e 4DA (small for #estational a#e!with multiple malformations. Amniocentesis study was not performed. Infant needsresuscitation at %irth. 3hat should a physician do in this situation@ (Important!Answer$ physician must resuscitate the patient in the deli&ery room %ecause thedia#nosis is uncertain.)>. A )-year old man is dia#nosed with terminally ill colon cancer and needs

resuscitation. *e did not si#n a :"7 order. The physician has decided to perform a slowcode on his own. Is this the ri#ht decision@ (Important!Answer$ no. lease remem%er, a performance of slow code or show code is notaccepta%le to the patient. This decision %y the doctor represents the failure to come to atimely and clear decision a%out the patients resuscitation status.0. A 2-year old man is dia#nosed with suspected %acteremia and menin#itis. *erefuses anti%iotic therapy. *e collapses and reuires resuscitation. 3hat should aphysician do in this situation@Answer$ the physician should resuscitate the patient despite the patients refusal toanti%iotic therapy.01. A 5-year old woman is dia#nosed with se&ere aortic stenosis. 4he collapsed in adoctors office and is reuired resuscitation. 4he is waitin# for &al&e replacement sur#ery.3hat should a physician so in this situation@Answer$ this condition is called physiolo#ical futility. In se&ere aortic stenosis, &i#orousresuscitation is hi#hly unlikely to restore adeuate cardiac output. Therefore, thephysician mi#ht reasona%ly refrain from resuscitation.02. A 1/-year old %oy is dia#nosed with terminally ill cancer. *e is not respondin# tochemotherapy. *is parents want to continue the treatment. *owe&er, the %oy does notwant to continue his sufferin#. The physician told the parents that chemotherapy will not%e helpful. 3hat is the appropriate decision at this point@ (Important!Answer$ the %oys decision should %e respected %ecause the treatment is futile.0'. A surro#ate pre#nant mother made a surro#acy contract with a couple in which shewill #i&e the %a%y to the couple. 4he de&eloped complications in the first trimester andwanted to a%ort. Is she allowed to do that@ (Important!Answer$ yes. If her life or health %ecomes threatened from continuin# the pre#nancy, sheshould retain her ri#ht to a%ortion.0/. A physician %ecame seually in&ol&ed with a current patient who initiated orconsented to the contact. Is it ethical for a physician to %ecome seually in&ol&ed@Answer$ no. 4eual in&ol&ement %etween physicians and former patients raises concern.The physician should discuss with a colle#e or other professional %efore %ecomin#


11/30

seually in&ol&ed with a former patient . The physician should terminate thephysician-patient relationship %efore initiatin# a romantic or seual relationship with apatient.05. A physician decided to take care of his own family mem%ers and relati&es. *e is a&ery smart physician. Is this a ri#ht decision@

Answer$ no. The physician should encoura#e all friends and family mem%ers to ha&etheir own personal physician.0). A male patient wants to ha&e a copy of his medical records. 3hat should a physiciando in this situation@Answer$ the physician should retain the ori#inal of the chart. Information should only %ereleased with the written permission of the patient or the patients le#ally authorizedrepresentati&e ( e.#., attorney!.00. A '-year old female wants to ha&e an a%ortion. *er physician o%8ects to a%ortion onmoral, reli#ious, or ethical #rounds. 3hat should a physician do in this situation@(Important!Answer$ physician should not offer ad&ice to the patient.

0=. A physician sees patients at a reduced fee. *e spends &ery little time with eachpatient. Is the physician doin# the ri#ht thin#@Answer$ no. The physician is not pro&idin# optimal care.0>. A surro#ate pre#nant mother si#ned a surro#acy contract with a couple. ale partner#a&e sperms which were artificially inseminated to the surro#ate mother. 4urro#atemother has a #enetic relation to the child. 4he wants to &oid the contract after the %a%y is%orn. Is she allowed to %reach the contract@ (Important!Answer$ yes. 4urro#ate contracts, while permissi%le, should #rant the %irth mother theri#ht to &oid the contract within a reasona%le period of time after the %irth of the child.=. A surro#ate pre#nant mother si#ned a surro#acy contract with a couple. Both maleand female parents #a&e sperm and o&ums respecti&ely. The surro#ate mother wants to&oid the contract and she has no #enetic relation. Is she allowed to %reach the contract@(Important!Answer$ no. Denetic parents ha&e eclusi&e custody and parental ri#hts.=1. A surro#ate pre#nant mother si#ned a surro#acy contract with a couple. The couple#ot di&orced. ale partner #a&e sperms and the female partner #a&e o&ums. They do notwant to continue the surro#ate pre#nancy. 3hat should %e the decision at this point@(Important!Answer$ the couple is #enetically related to the fetus. They ha&e the ri#ht not to continuewith this pre#nancy.=2. A surro#ate pre#nant mother si#ned a surro#acy contract with a couple. The couple#ot di&orced. ale partner #a&e sperms %ut the female partner could not #i&e o&ums.They do not want to continue the surro#ate pre#nancy. 3hat should %e the decision atthis point@ (Important!Answer$ female partner has no ri#ht to terminate this pre#nancy %ecause she has no#enetic relation. 4urro#ate mother has #enetic relation and she has the ri#ht to continuethis pre#nancy e&en if the male partner disa#rees.='. A '-year old #irl is dia#nosed with %lood cancer. 4he has %een waitin# for anum%ilical cord transfusion. *er mother deli&ered a new%orn %a%y #irl. m%ilical cord


12/30


13/30


14/30

1. The patients confidentiality should %e maintained ecept in the followin#situations$hysicians should o&erride third parties in case of domestic &iolence, child a%use, elderlya%use, #unshot wounds, syphilis, and tu%erculosis. They should report these cases toappropriate #o&ernmental authorities.

11. A physician is eperiencin# a &ery difficult ethical issue re#ardin# a complicatedcase. *e is confused. 3hat should %e the net step@Answer$ he should discuss the matter with other faculty mem%ers in his health care team,collea#ues, or hospital ethics committee.12. 3hat is the final plan of action in an ethical issue@Answer$ Both patient and physician should a#ree re#ardin# final mana#ement. Thepatient should %e well-informed a%out the medical condition. The physician should %esympathetic and knowled#ea%le re#ardin# the rele&ant medical condition.1'. :"7 (do not resuscitate! order. This is appropriate if the patient or surro#ate si#nedthat order or if 97 (cardiopulmonary resuscitation! would %e futile. hysicians shouldwrite :"7 orders and the reason for them in the chart. lease remem%er, GslowG or

GshowG codes are not accepta%le. Coods and fluids are considered therapies that should %estopped. (Important!1/. (A!Brain death (adult!$ (Important!(i! :efinition %y the residents 9ommittee$:eath is an irre&ersi%le cessation of circulation and respiratory functions or irre&ersi%lecessation of all functions of the entire %rain and %rain stem.(ii! The criteria of %rain death %y the staff of assachusetts Deneral *ospital and the*ar&ard 9ommittee$:eath occurs when there is a%sence of all si#ns of recepti&ity, responsi&ity, and all%rainstem reflees, and the 66D is isoelectric. 4ometimes meta%olic disorders andintoications may mimic the a%o&e findin#s.(iii! The #uidelines of %rain death$(a! The dia#nosis should %e made also %y another physician and confirmed %y clinicalfindin#s and 66D.(%! The family should %e notified. They should not make the decision a%outdiscontinuin# medical treatment ecept in a situation where the patient has directed thefamily to make the decision.(c! The physician should discuss with another physician %efore remo&in# supporti&emeasures (e.#., &entilators!.(d! Camily mem%ers may reuest or#an donation, and in many states physicians mayreuest the family to make an or#an donation.(B! Brain death (children!$(i! :efinition$ same as in adults.(ii! 9riteria$ similar in children and adults, %ut the period of o%ser&ation is lon#er inchildren.9hildren 1wk-2mo of a#e$ two separate eaminations /= hours apart9hildren 2mo-1yr of a#e$ two separate eaminations 2/ hours apart9hildren more than 1 yr of a#e$ two separate eaminations 12 hours apart4pontaneous mo&ements must %e a%sent, with the eception of spinal cord reflewithdrawal and myocolnus.


15/30


16/30

(c! 9yanotic heart disease at %irth$ immediate medical mana#ement, which is followed%y sur#ical repair as it is reuired routinely.(d! 9osmetic sur#ical condition (e.#., rhinophyma or %i# nose!$ there is no ur#ency torepair the underlyin# condition, %ut it can %e done as it is performed re#ularly.(e! "eural tu%e defects (e.#., menin#omyelocele!$ sur#ical repair is recommended as it is

done re#ularly.lease remem%er, a patients mana#ement should %e discussed with hisHher parents andthe decision made with the %est interest of the patient in mind.1>. A healthy male patient with :own 4yndrome li&es independently. *e went to adoctor for facial cosmetic sur#ery. 9an he make his own decision@ (Important!Answer$ yes. The patient can make his decision if he understands the procedure and theconseuences. *e li&es independently which indicates that he is capa%le of makin# hisown decision.11. A patient went to the doctor due to throat pain. The doctor asked the patient whather pro%lem was. The patient said that she woke up at si oclock in the mornin#, went tothe %athroom, ate %reakfast, and went to drop her children at school. 4he then came %ack

home, stared cookin# and continues to talk a%out irrele&ant thin#s. 3hat should thedoctor do to stop the patient from ram%lin#@ (Important!Answer$ the doctor should ask the patient to tell him what pro%lems she has related onlyto her throat.111. A patient went to a doctor for a%dominal pain %ut remained uiet throu#hout the&isit. *e did not tell the doctor enou#h a%out his symptoms. 3hat should the doctor do@(Important!Answer$ the doctor must ask the patient detailed uestions a%out his a%dominal pain. It isthe doctors o%li#ation to find out as much as he can a%out the patient. 3ithout enou#hinformation, the doctor will not %e a%le to make an accurate dia#nosis.112. A patient walked into his doctors office with acute a%dominal pain. *e has %eensufferin# from ulcerati&e colitis. The patient is noncompliant and did not &isit for the pastsi months. 3hat should the doctor do in this situation@ (;ery Important!Answer$ The doctor should find out more a%out the patients a%dominal pain %eforemakin# any other decision. The doctor should always %e responsi%le with the patients.11'. A terminally ill pancreatic cancer patient with multiple metastasis is admitted to thehospital. *e is in critical condition. The patient wants to know his pro#nosis. 3hatshould the doctor say@Answer$ the doctor should tell the patient politely that he will discuss his condition withhim and his family. The doctor should ne&er specify the lon#e&ity of the patient. Thedoctor should tell the truth e&en when the patient is a child. The doctor should not hideany medical information from the patient.11/. A patient is recently dia#nosed with cancer. *e is ner&ous %ut is ea#er to knowa%out his medical dia#nosis. 3hat should the doctors reply %e@ (Important!Answer$ the doctor should #ently tell the patient his condition.115. A patient is recently dia#nosed with cancer. re&iously, he had an episode of aner&ous %reakdown after hearin# a family death and had to %e admitted to a hospital. *elo&es his family mem%ers and tends to %e &ery open with them on all issues. *ow shouldthe doctor tell the patient a%out his current state@ (Important!


17/30


18/30

125. A male physician is eaminin# an adolescent or adult female patient. 3hat should aphysician do in this situation@ (Important!Answer$ a chaperone should %e present durin# the physical eamination. The same rulesapply when a physician is eaminin# a patient who appears to %e seducti&e. (Important!12). A female physician is eaminin# an adolescent or adult male patient. 3hat should a

physician do in this situation@ (Important!Answer$ a chaperone should not %e present durin# the physical eam.120. A suspected *I; patient epired in a car accident. *e si#ned for or#an donations.3hat should a physician do in this situation@Answer$ his *I; status is not certain. The or#ans can %e preser&ed until the *I; status isconfirmed. If the test for *I; is positi&e, or#ans should %e discarded.12=. A patient who epired in a car accident si#ned in his license foe or#an donations.*is license has epired. *e always wanted to donate his or#ans. 3hat should a physiciando in this situation@ (Important!Answer$ physican cannot accept or#ans %ecause the si#ned consent has epired.12>. A male physician seually harassed a female patient durin# the physical

eamination. The patient complained to a nurse. 3hat should the nurse do in thissituation@Answer$ the nurse should tell the patient to make an official report to the hospitalauthority or to an appropriate a#ency.1'. A chronic male smoker comes to the physician for his heart pro%lems. Thephysician wanted his patient to uit smokin#. 3hat should the physician ad&ise in thissituation@Answer$ the physician should ask the patient to uit smokin# immediately %ecausepatients are usually more responsi&e when they are ill. The physician should assist thesmoker to mo&e one step closer to uittin#.1'1. A terminally ill patient did not si#n a :"7 (do not resuscitate! order, howe&er, hesi#ned a :"I (do not intu%ate! order. 3hat should the physician do in this situation@Answer$ the physician should follow his orders i.e., the patient should %e resuscitated %utshould not %e intu%ated, despite se&ere hypoic condition of the patient.1'2. A terminally ill patient si#ned a :"7 order, howe&er, he did not si#n a :"I (do notintu%ate! order. *e wants to %e intu%ated %ut not resuscitated. 3hat should a physician doin this situation@Answer$ the physician should follow his orders i.e., the patient should %e intu%ated %utshould not %e resuscitated.1''. An adolescent car accident &ictim was %rou#ht to the 67 in an unconscious state.The patient needs immediate sur#ical inter&entions. The sur#eon was una%le to contactany family mem%er to o%tain consent. 3hat should a sur#eon do in this situation@(Important!Answer$ the sur#eon should do the procedure without waitin# to o%tain a consent for the%enefit of the patient.1'/. An o%#yn doctor is recently dia#nosed with *I; infection. *e is recei&in#medication for *I;. *is physical and mental conditions are normal. 4hould he tell hispatients or fellow physicians a%out his *I; status@Answer$ no, howe&er, the doctor should take appropriate precautions for infectioncontrol. *e does not ha&e to tell his fellow physicians a%out his *I; status includin# the


19/30

physicians who are referrin# patients to him. The doctor is allowed to see patients if hetakes appropriate precautions. *owe&er, he should notify the hospital authority.1'5. A physician is scared of seein# an *I; patient with an open wound. 9an aphysician refuse to see a patient@Answer$ yes, howe&er, a physicians refusal to see a patient is unethical %ut is le#al.

1'). An elderly semicomatose patient may reuire sur#ical inter&ention. *is familymem%ers are confused a%out the sur#ery. They asked the sur#eon for his opinion. 3hatshould the sur#eons response %e@Answer$ the sur#eon can #i&e his opinion and act as a moral surro#ate for the %enefit ofthe patient. (;ery Important!1'0. A 12-year old %oy is dia#nosed with a terminal illness (e.#., mali#nancy!. *e askedthe doctor a%out his pro#nosis. *is parents reuested the doctor not to tell him the %adnews. 3hat should the doctor do in this situation@ (;ery Important!Answer$ the doctor should tell the truth politely and compassionately to the patient.1'=. A 55-year old woman is recently dia#nosed with ri#ht %reast cancer. The doctortold the patient that she will reuire sur#ery for remo&al of the ri#ht %reast. 4he started to

cry. 3hat should a doctor do in this situation@Answer$ first, the doctor should #i&e her some tissue paper for wipin# her tears. Then,the doctor should %e sympathetic to her and console her. *e mi#ht tell her that similarreactions are usually epected from other patients with %reast cancer. lease do notmention that she will %e fine with a %reast implant or without a ri#ht %reast %ecause she isalready 55-years old.1'>. A mother is carryin# a 5 #ram premature fetus which de&elops acute fetaldistress. The physician wanted to perform a cesarean section. other refused cesareansection. 3hat should the doctor do in this situation@Answer$ the physician should arran#e a %edside conference with the mother alon# withother physicians, social worker, and administrator to discuss the matter.

1/.


20/30

d. call the police

e. ask the father yourself if there has %een any a%use

f. speak to the wife pri&ately a%out possi%le episodes of a%use

#. eplain to the parents that net time this happens you will ha&e to call child protecti&e

ser&ices

h. report the family to child protecti&e ser&ices

i. #i&e the parents referral to a family therapist they can see with the child the foll week

Answer$ *. report the family to child protecti&e ser&ices. 7eportin# of child a%use ismandatory e&en %ased on suspicion alone. The physician is le#ally protected e&en if itturns out to %e no a%use as lon# as the report was made honestly and without malice.


21/30

(CA!. The patient has %ecome di&orced and refuses to #i&e you consent to inform hisewife

who now has custody of their children. *e threatens to sue u if u re&eal elements of

his medical care to his e-wife.

3hat should u do@

a.respect the patients ri#ht to confidentiality.

%.transfer the patientLs care to another physician

c.ask the health dept to inform the e-wife

d.seek a court order to inform the e-wife

e.inform the e-wife of the risk to the children.

f.inform the e-wifeFs doctor

Ans$e. inform the e-wife of the risk to the children

The patients ri#ht to confidentiality ends when it comes into conflict with the safety of

other people. The children ha&e a ri#ht to know whether their li&es will %e cut short %y

the disease.The most important element is to %e#in screenin# at 12 yrs with

si#moidoscopy e&ery year. In addition the mother has a ri#ht to know whether herchildren will %e come ill K how to plan that. As a part of di&orce ,the stipulation that eachparent must inform the other parent of health care issues for the children as they arise is astandard part of the a#reement. The ri#ht to one personLs pri&acy is not as important asthe ri#ht to another persons safety. this is an esta%lished standard K does not reuire acourt order.


22/30

the dept of health learns of his ille#al status.

3hat should u tell him @

a.dont worry the dept of health does not ask or report immi#ration status

%.only people who are noncompliant with medications are reported to the #o&t.

c.dont worry I will fully treat u %efore we deport u.

d.iam sorry %ut there is nothin# I can do a%out this. There is mandatory reportin# of TB

Ans$A. dont worry the dept of health does not ask or report immi#ration status.

The immi#ration status is not the concern of the physician or the dept of health. There Is

not mandatory reportin# to the #o&t either %efore ,durin# or after the treatment of TB.

Incarceration to take TB medications may occur for a noncompliant patient %ut they do

not specifically face deportation for health reasons. Actually impaired health is one of the

#ranta%le reasons for asylum. andatory reportin# to immi#ration status would %e adirect

impairment of physician Hpt relationship.

1/'. A couple comes to see you after ha&in# tried in&itro fertilization K artificial

insemination. They are &ery happy %ecause now they ha&e a child. They ha&e a

si#nificant amount of left o&er sperm ,e##s, and some fertilized em%ryos K are thinkin#

a%out sellin# them.

3hat should u tell them@

a.it is le#al to sell only e##s

%.it is le#al to sell only sperm

c.it is le#al to sell %oth the sperm and e##s not the em%ryos

d,it is ille#al to sell any of them


23/30

e.it is le#al to sell all of them

Ans.9, it is le#al to sell %oth the sperm and e##s not the em%ryos. The pt can sell ordonate unfertilized #ametes such as sperm K e##s. An em%ryo can also %e donated ,

howe&er it is currently ille#al to sell em%ryos.

1//.


24/30

%perform the test %ut do not share the results with the employer.

c., do not perform the test

d.ask the pt if she wants the test done and the results reported.

e. perform the colonoscopy ,the employer is entitiled to know a%out current health

pro%lems not future ones,

f.include the test only if pt has family mem%ers with the disease.

Ans. d.ask the pt if she wants the test done and the results reported

6mpoyers do not ha&e the ri#ht to the confidential health info. you may perform certain

tests K report them to the employer with the consent of the pt.

1/).


25/30

"+ si#nificant risk of transmission to the patient.

ni&ersal precautions are supposed to pre&ail in order to pre&ent transmission. 6&ery

patient reuires mana#ement as if he were *I; N in order to interrupt transmission. this is

the meanin# of Guni&ersalG precautions

1/0.


26/30

1/=. A /0 yr old man with end sta#e renal failure has asked u to stop his dialysis. The pt

fully understands he will die if dialysis is stopped for more than a few days or weeks . he

is not depressed and not encephalopathic

3hat should u tell him@

a.I need a court order first

%.iam sorry ,I donLt feel comforta%le doin# that.

c.I cant do that. hysician assisted suicide is not ethical.

d.I will stop when u #et a kidney transplant

e.Althou#h I disa#ree with your decision I will stop dialysis.

Ans $ 6. Althou#h I disa#ree with your decision I will stop dialysis

the patient is competent K wishes dialysis to %e stopped. he is not #oin# to die the netmoment or the comin# hours, so it is not physician assisted suicide, anyway, #oin# to thecourts or ethics %oard, we should keep as our last option. if pt in coma, family mem%ersha&e conflict of interest K pt has no written order, then we #o to the ethics %oard, then tocourt , etc,......

1/>. A patient comes to the 67 with a #un shot wound in his thi#h. *e says he was shot

accidentally while huntin# with his cousin .


27/30

7eportin# of #un shot wounds is mandatory %ut from a different perspecti&e than other

forms of reportin#. The mandatory reportin# is %ased on pursuin# a criminal in&esti#ation

of the person# doin# the shootin#. 7eport e&en if the &ictim o%8ects. The societal need for

safety supersedes the pri&acy of the patient in the case of #unshot wounds.

15.


28/30

criteria. *e has an or#an donor card in his wallet indicatin# his desire to donate. The

or#an donor team contacts the family. The family refuses to si#n consent for donation.

3hat should %e done@@

a.remo&e or#ans anyway

%.wait for the pts heart to stop to remo&e or#ans.

c.4top the &entilator K remo&e or#ans

d.4eek a court order to o&errule the family

e.*onor the wishes of the family , no donation

Ans.e-Althou#h an or#an donor card indicates ptFs wishes ,it is still unaccepta%le tohar&est

or#ans a#ainst the direct wishes of the family. If we were to o&errule the family, there

would %e no point in askin# them consent. The or#an donor card is an indication of the

ptFs wishes %ut it is not fully %indin#.

152.


29/30

A7TI9IAT6 in any action which would directly cause the death of the condemned or

assist another indi&idual to directly cause the death of the condemned.

This includes startin# I; lines, miin# medications, formulatin# medication,

administerin# , or e&en #i&in# technical ad&ice. It is in fact e&en unethical to o%ser&e aneecution. *owe&er it is ethically permissi%le to #i&e aniolytic medications prior to theday of the eecution to relie&e the sufferin# of the condemned.

15'.


30/30

parents.what should u tell her@

a.i will #i&e u the care K keep the info confidential

%. I will not mention it to your parents unless they ask , I cant lie

c.iam sorry %u t I must tell them

d.i will not tell your parents %ut I must inform the father of the %a%y.

Ans$ a.i will #i&e u the care K keep the info confidential

renatal care is the #eneral eception to the parental notification rule and consent for

treatment of minors.

Documents

Medical Ethic More Then 100cases