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Presentation at the session on
‘Principles and practice of bioethics’ in the IIIT European Summer School held
in Sarajevo 7th August 2015 by Professor Omar Hasan
Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics
Committee King Fahad Medical City.
INSTRUCTIONS
·
Read the scenario carefully
·
Identify the ethical issue
·
Provide your solution to the
ethical issue relying on maqasid and qawaid
PALLIATIVE
CARE
Case scenario #1
A 90-year old in
the intensive care unit with stage 4 widely disseminated 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.
TERMINALLY
INCURABLE DISEASES AND EOL DECISIONS:
Case scenario #2
A 30-year old
patient of multiple sclerosis had 5 years before 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
#3:
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 #4:
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
#5:
A 70-year old man with advanced cancer
and severe pain 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.
Hint: withholding
food and hydration is passive euthanasia
Case scenario
#6:
A car accident
victim in severe shock was wheeled into the emergency room with un-recordable
blood pressure or pulse. 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 1 hour later. The
family threatened to sue the doctor.
Case scenario
#7:
A 90-year old
with multi organ failure and clinical signs of brain stem death was on life
support occupying the last available bed in the intensive care unit 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.
Scenario #8:
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.
SOLID
ORGAN TRANSPLANTATION AND DONATION:
Case scenario
#9:
An intensive care unit 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 favor of his cousin who
was born with severe congenital abnormalities and would die without the
transplantation.