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Background material for 4th year class at FOM KFMC on 31st May 2010Presented at a training program in medical ethico-legal training at Putrajaya 27th October 2008 by Professor Omar Hasan Kasule
CASES ON LIFE SUPPORT IN TERMINAL ILLNESS
Case #1: A patient with brain stem death is kept on artificial life support at the insistence of the family because announcing the death immediately will have an adverse effect on the values of the family business on the stock exchange.
Case #2: The family took an unconscious man to hospital reluctantly because they believed he was dead. He was admitted to the ICU and was put on artificial life support. For a period of 4 weeks the family insisted on withdrawal of life support because they would be ruined financially by the high ICU costs. The physicians refused withdrawal of life support because his brain stem was functional. The patient woke up in the 5th week.
Case #3: A patient admitted to the ICU after a car accident was confirmed by 3 specialist surgeons to be in a persistent vegetative state. The doctors wanted to discontinue life support but the family refused because there were signs of life like reflex flexion of joints and blinking of the eyes. The hospital decided to seek a court injunction after keeping the patient in the ICU for 6 months without any obvious improvement.
CASES ON REPRODUCTIVE ISSUES
Case #1: A mentally retarded sexually active 14-year old teenager was taken to the family planning clinic to receive contraceptives without the knowledge of her parents. Due to irregular use of the pills she became pregnant and her aunt took her overseas for an abortion. On return she advised her parents to take her for sterilization. The parents preferred hysterectomy because in her retarded condition she could not maintain menstrual hygiene. The family gynecologist preferred depo provera.
Case #2: A couple married for 10 years without a child decided to have IVF. Before the procedure was completed, the husband died. The wife insisted on using the stored semen of her dead husband. The relatives of the husband objected. The first wife who had been divorced 15 years earlier with one girl also asked for the semen for an IVF procedure that she hoped would enable her have another baby to act as a bone marrow donor for her daughter who had leukemia and had failed to find a matching donor.
Case #3: A 14-year old sexually active girl was treated at the outpatient clinic for sexually transmitted disease. The doctor advised her on the use of condoms to prevent disease. She asked the doctor to keep the matter a secret even from her parents. She became extremely promiscuous after that until the whole village knew about her behavior. The news deeply embarrassed the parents. They learned from a distant relative who worked at the outpatient clinic that she had been advised about the use of condoms by the doctor and that she had obtained the condoms from the family planning clinic.
Case #4: A married woman with 6 young children came to the hospital asking for an abortion because she had become pregnant while her husband was half-way through a 4-year prison sentence for violent behavior. She was afraid for her life. She had just discovered a secret about her husband from a police officer that the husband has killed his first wife 20 years earlier because of a jealous rage and had escaped the gallows on a legal technicality because of police incompetence in investigating the case.
Case #5: A 40-year old housewife with 8 living children is brought reluctantly to the contraceptive clinic by the husband. The husband asks for tubal ligation because he cannot afford to look after more children. The wife insists that Allah will provide for all the children irrespective of the husband’s financial situation.