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Presentation
at a medical ethics course held at Madina October 29, 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
Case 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.
Case 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?