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Presentation at a Medical Specialties Grand Round on February 20, 2019 held in King Fahad Medical City. By Professor Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard). Chairman of the Ethics Committee King Fahad Medical City.
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 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.
CASE
SCENARIO - 3
} 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 - 4
} 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.
CASE
SCENARIO - 5
} 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 - 6
} 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 - 7
} 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 - 8
} 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 - 9
} 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 - 10
} 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 - 11
} A 70-year old man
with advanced cancer with 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.
CASE
SCENARIO - 12
} A car accident
victim 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 1 hour later. The family threatened to sue the doctor.
CASE
SCENARIO - 13
} 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 favor of his cousin who
was born with severe congenital abnormalities and would die without the
transplantation.