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Presentation at a training program for
family medicine resident s at the National Guard Madina 9-10 November 2014 by
Professor Omar Hasan Kasule Sr. MB ChB (MUK). M{H (Harvard), DrPH (Harvard)
Chairman of the Ethics Committee King Fahad Medical City.
SCENARIO
1:
·
An 80-year fully conscious and competent old man
with advanced incurable cancer needed palliative chemotherapy.
·
The family objected when the doctor wanted to
obtain informed consent from the patient because that would involve disclosing
the diagnosis which would make the patient very sad and depressed.
·
The family wanted to make the decision without
informing the patient.
·
What should the doctor do? Provide your moral
reasoning.
SCENARIO
2:
·
A 30-year old woman presented with classical
signs of acute appendicitis.
·
He consented to an operation to open the abdomen
and remove the inflamed appendix.
·
The surgeon found a previously undiagnosed
ovarian cyst and decided to remove it.
·
The removal was a simple and safe procedure that
would not increase the duration of the operation.
·
The head nurse refused because the patient had
not given consent.
·
What should the surgeon do? Provide your moral
reasoning.
SCENARIO
3:
·
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.
·
What should the healthcare workers do? Provide
your moral reasoning
SCENARIO
4:
·
The thoracic surgeon wanted to carry out a
de-bulking operation to decrease lung cancer mass to enable the patient breathe
easier and he told the patient of the high risk of death from hemorrhage.
·
The patient 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.
·
What should the doctor do? Provide your moral
reasoning.
SCENARIO
5:
·
A patient presented to the clinic with vague
complaints in the abdomen and worries about cancer.
·
Physical examination and investigations revealed
no pathology.
·
The doctor was angry with the patient for
wasting clinic time when he was in good health.
·
As the patient was leaving he told the doctor
that his uncle had died the week before of stomach cancer. The doctor did not
respond.
·
What should the doctor have done? Provide your
moral reasoning.
SCENARIO
6:
·
A young man sent for pre-employment examination
filled out a health questionnaire and mentioned no health problems at all.
·
Physical examination revealed a severely
dislocated shoulder and an unhealed acromial fracture.
·
When asked about them he admitted that they
caused him pain from time to time but that he was patient and did not care much
about them.
·
What should the examining doctor report? Provide
your moral reasoning.
SCENARIO
7:
·
An 80-year old diabetic man, whose son had died
last year from transfusion of mismatched blood, was admitted to the same
hospital for observation after falling at home.
·
He insisted that no procedure be done without
written approval by his physician son whom he wanted to sit by his bedside all
the time.
·
Nurses were inconvenienced by having to get
written permission for routine monitoring of vital signs and insulin
injections.
·
The nurses refused to comply to his wishes and
he refused to cooperate leading to a stand-off.
·
What should the doctor in charge do? Provide
your moral reasoning.
SCENARIO
8:
·
A young neurosurgeon planned to operate on a
patient with lumbar spinal injury that had a 5-10% chance of success.
·
He was perplexed about taking informed consent.
·
If he informed the patient that the operation
could go wrong and result in paraplegia with a 90% chance the patient would
refuse the operation.
·
If the operation was not carried out there was a
95% chance of further deterioration leading to paraplegia after a few months.
·
What should the neurosurgeon do? Provide your moral
reasoning.
SCENARIO
9:
·
A 30-year old patient of 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.
·
What should the healthcare workers do? Provide
your moral reasoning.
SCENARIO
10:
·
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.
·
What is the right course of action by the
doctors? Provide your moral reasoning.