There was no advance directive and she was not conscious at the time a decision needed to be made regarding transfusion. Family was consulted, and they agreed the patient should not receive a transfusion.
She died the next day. What would you have done under the circumstances? He was specific that the team not tell the family of his AIDS, a request to which the team tried to adhere despite obvious concern expressed by the family and requests for information. The family surmised his condition upon learning of the attending's specialty infectious disease.
What else could have been done to protect confidentiality? The resident in charge of her care states that the patient is unfit to be a mother, and that society will have to pay for her children. He proposes to her that she have a bilateral tubal ligation at the time of delivery. Explanations of the reasons for this, benefits, risks and alternatives are minimal. Is the issue a conflict between autonomy her right to more complete disclosure about the procedure and alternatives and social justice fair distribution and utilization of healthcare resources?
This case is especially timely in the face of the mother in California who chose to be implanted with six embryos despite having six other children already. Does the physician's obvious desire to act out of beneficence outweight the patient's desire for autonomous decisionmaking?
The issue in the case is whether physicians allow subtle biases, e. How can we be more alert to this? Should the family's willingness to accept the patient's refusal, despite his obvious lack of competence, be sufficient to override a decision to force basic supportive care? Jennifer Heer Ford reminds us of how painful, but necessary, it is to deliver "bad news" that may be part of informed consent.
Can this duty be relegated to others? Tricia Lee presented another case where the presentation of bad news to a patient, over the wishes of the family, was the central issue.
In some cultures the family is the "patient" — should more consideration be given to family's wishes? How do we balance this with respect for patient autonomy? How far should physicians go to get cooperation with other parts of a treatment plan? Under circumstances where the proposed procedure high risks and a low probability of success, should marginally competent patients be allowed to refuse?
This will doubtless become an ever more visible topic for clinicians and ethicists. He objects, but his mother wants to go ahead. How should the team proceed? How would you handle this? How can we overcome our natural response to provide better care for one over the other?
Should a lucid patient be able to refuse such treatment, or should involuntary treatment with Mucomyst be started? Barton described another situation where our capacity for empathy would surely be challenged — a year-old man who killed his wife before shooting himself. A great insight into the power of strong cultural values juxtaposed against maternal instincts.
The Hmong taught a lot of lessons to the Western culture, many of which are exposed in comparison to medical ethics for Hmong and for Americans. There is a serious problem with the high prevalence of antibiotic use in people and animals, as well as the advertisements for medications on television which inevitably encourage people to incorrectly believe they have symptoms and need medication.
What is particularly bothersome though is the idea that Western medicine is always right even though it often treats only the symptoms individually and not the illness, something which results in people taking medication after medication to then treat subsequent symptoms that are the direct result of the previous medication. The Hmong embodied this concept wholly with their disregard to regular medication and the use of only those medicines which were needed.
Another aspect of the culture which struck me was how the Hmong people, even those Christian converts, never gave up on their roots no matter what, always seeking out the traditional medications in tandem with Western medication.
Some Hmong patients will explain what treatment they thought would be best and remained optimistic about a particular condition.
Many are adamant about Hmong healing and will not follow directions from Western doctors for medications or transfusions, which can represent child abuse and a serious ethical dilemma for western doctors responsible for reporting such behaviors. It seems that with such different beliefs, the treatment of symptoms by the Western medicine will continually conflict with treatment of the entire condition or cause as Eastern medicine generally seeks to do in practice.
Upper Saddle River, NJ: Oxford University Press, Farrar, Straus, and Giroux, Jones and Bartlett Publishers, If you are writing an evaluation essay on medical ethics and find yourself in need of a topic, consider the 20 below: Are Medical Ethics the Same Everywhere?
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