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Presentation
at a training program ‘Applying the Principles of Ethics to Clinical
Practice:’ held at Aramco Dhahran April 6, 2015 by Professor Omar Hasan
Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics
Committee King Fahad Medical City.
Autonomy And Consent To Treatment
- The Patient's Autonomous Right to Consent
- Conditions of Informed Consent
- Refusal of Consent
- Proxy Consent
- Consent for Children
- Mental Patients
- Consent for the Unconscious
Case Scenario 1
A patient was brought to the emergency room by the police after
attempting to kill himself by hanging. He was unconscious when first brought in
and had a signed suicide note in his shirt pocket saying that he wanted to die.
The doctors ignored the note and started resuscitation measures. The patient
became conscious after 30 minutes and protested at the medical treatment
arguing that he wanted to die. The doctor was thinking of stopping
resuscitation measures when the patient’s father and wife arrived and
instructed the doctor to continue resuscitation.
Case Scenario 2
A 40-year old policeman refused surgery to drain a pyomyositis
abscess. He still refused surgery after the abscess burst spontaneously. The
surgeons sedated him and carried out the surgery without his consent.
Case Scenario 3
A 42-year old actress pregnant for the first time refused an
elective caesarean section because an abdominal scar would ruin her career. She
continued to refuse the procedure when labor became obstructed and signs of
fetal distress appeared. The obstetrician went ahead to operate on the basis of
consent by the husband. The baby was delivered alive and well.
Case Scenario 4
A conscious and competent patient told nurses on admission to the
ICU that he did not want his family to be told anything about his condition.
When his condition deteriorated the physicians wanted to consult his family
about end of life decisions but he refused to give up his right to
confidentiality.
Privacy And Confidentiality
- Privacy and confidentiality are often confused.
- Keeping confidentiality
- Breaching confidentiality
Case Scenario 1
A neurologist informed his wife over dinner about an elderly school
bus driver who had Parkinson disease and had to take an unusually high dose of
medication to suppress the tremors. The medication made the patient sleepy all
day. The wife asked for the name and realized that the patient was a driver for
her school transport company who had been coming to work late in the past 2
weeks. She dismissed him the next morning
Case Scenario 2
The manager of a national airline was worried about the erratic
behavior and mistakes of one of the senior pilots. He asked around and found
out the name and address of the pilot’s family doctor who was in private
practice. He wrote to the private practitioner to provide records about
treatment of the pilot for vision and psychological problems. He asked
specifically for information on drug abuse. The private practitioner called and
gave the information but told the manager that he could not put it down in
writing since he had not discussed the matter with the patient.
Disclosure
And Truthfulness
- Obligation to tell the truth
- What is disclosed
- Partial disclosure and white or technical lies
- Disclosures to others about the patient
- Giving bad news
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 pediatrician examined a child with multiple trauma wounds and
suspected that the father was responsible. He was reluctant to report because
the father would be imprisoned and the family would lose its bread winner. What
do you think is the correct approach?