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Presentation
at the 1st Ethics Scientific Day, King Fahad Medical City organized
by the Ethics Committee on 27th May 2014 by Professor Omar Hasan
Kasule Sr MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Chairman of the KFMC
Ethics Committee
CASE SCENARIO 1:
A 90 year-old
in ICU with stage 4 widely metastasized cancer and multi-organ failure was told
by the doctors that there was nothing they could do to reverse the course of
the disease and that they could only provide symptomatic treatment. He asked to
be discharged to die at home. His children objected saying that he needed
complex nursing that they could not provide at home. He was finally admitted to
a private hospice that provided palliative care at great expense.
CASE SCENARIO 2:
The thoracic surgeon wanted to carry out
a de-bulking operation to decrease lung cancer mass to enable the patient to breathe easier and he told the patient of the high
risk of death from haemorrhage. The 85 year-old patient was drowsy because of medication and was
suspected of suffering from dementia. The doctor was not sure whether the
patient was capable of understanding the explanations given and making serious
decisions about the operation and he had no relatives nearby.
CASE SCENARIO 3:
A 30 year-old
patient with multiple sclerosis had 5 years
while in good health, designated her husband as the decision maker. When she
lost consciousness the doctors needed a decision whether to put her on life
support. The husband who had by that remarried and lived in a separate house
decided against life support because it would prolong her suffering. Her father
intervened and decided for life support because that would be in her best
interests.
CASE SCENARIO 4:
A university professor with previous
episodes of transient stroke had written a directive and had it witnessed that
if he lost consciousness he would not like to be resuscitated. Years later he
was brought to the hospital unconscious from head injuries sustained in a car
accident. The doctors reading his directive in his shirt pocket decided not to
resuscitate him but his wife insisted that he be resuscitated.
CASE SCENARIO 5:
Doctors wrote a Do-not-resuscitate (DNR)
order for an 80 year-old grandmother with
disseminated untreatable ovarian cancer. Her family objected vehemently when
told of this decision and sought its reversal. Before the dispute was resolved
the patient collapsed after an episode of acute pneumonia unrelated to her
original condition. The nurses following the DNR order did not call the
resuscitation team.
CASE SCENARIO 6:
A 70 year-old
man with advanced cancer with severe pain is not
responsive to morphia asked the doctor to kill him and save him from suffering.
The doctor refused claiming that he could not commit illegal homicide. The
doctor also refused to give the patient any advice about suicide. On the
patient’s insistence the doctor agreed to stop hydration and nutrition to
enable slow death.
CASE SCENARIO 7:
A car accident victim who is in severe shock was wheeled into the Emergency Room with
un-recordable blood pressure or pulse. ECG showed low amplitude slow waves. The
doctor did not declare death, but against the insistence of family members
refused to institute life support because he reasoned there was no hope. The
patient was declared dead one hour later. The
family threatened to sue the doctor.
CASE SCENARIO 8:
A 90 year-old
man with multi-organ
failure and clinical signs of brain stem death was on life support and was occupying the last available bed in the ICU
because the doctors were afraid to disclose death to the family that had many
vocal and angry members. However when 50 survivors from an air crash site were
brought it, the doctors decided to withdraw life support from the old man to
free up at least one ICU bed.
CASE SCENARIO 9:
An ICU doctor kept a brain stem dead
patient on artificial life support to maintain the vitality of his organs until
the arrival of the transplant team to harvest the heart and lungs donated by
the patient while still conscious in favour of his cousin who was born with
severe congenital abnormalities and would die without the transplantation.
CASE SCENARIO 10:
A police man died suddenly during a
fight with criminals who were later arrested. The police authorities wanted to
carry out a post mortem to determine the cause of death in order to charge and
punish the criminals with homicide. Some members of the family objected to the
post mortem on the grounds that it was against the Shari ‘at. Other members
supported the post mortem because of insurance compensation purposes.