Transcript Symptoms - BSHS-Jr-Religion-FrMcCabe

Chp 8 Medical Ethical Cases
RED means the case is
exactly the kind I WON’T
put on a Scantron test.
Patient: Herbert Orr, 75, Male
• Symptoms: leg pain, shortness of breath,
frequent mental impairment, and mild left-sided
weakness. His past history includes coronary
artery bypass surgery, with complications
requiring five months of hospitalization (two
months of dialysis and a lengthy stay in the ICU).
The patient says he wants to "die and go to God."
His wife prefers that he continue dialysis and live,
no matter how impaired he is.
• Diagnosis: pulmonary embolus, with a strong
possibility of stroke in the future, and renal
failure
• Treatment(s) proposed: dialysis
Patient: Herbert Orr, 75, Male
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•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Fail
Extraordinary
Patient: George, 27, Male
• Symptoms: George has had fever, headache,
diarrhea, constipation, and rash for a month. His
wife has been diagnosed with the same illness,
but in her case it is too late, it is terminal. She has
been sent to die at an island asylum for Typhus
cases. Though George's sickness could be cured
with antibiotics, he wants to go to the island
asylum and die there with his wife.
• Diagnosis: Typhoid fever
• Treatment(s) proposed: antibiotics
Patient: George, 27, Male
•
•
•
•
Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Pass
Ordinary
Patient: Alcibiades Moreno, 37, male
• Symptoms: He fell 47 stories off a window
washer platform. He's severely busted up:
broken bones, crushed organs, severe blood loss,
in a coma.
• Diagnosis: massive trauma
• Treatment(s) proposed: He needs immediate
lifesaving surgery. His recovery will be long and
include many surgeries, blood transfusions and
organ transplants.
Patient: Alcibiades Moreno, 37, male
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•
•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Fail
Extraordinary
Patient: George Sherill, 69, Male
• Symptoms: has a history of alcoholism,
depression and mania; has had a stroke and two
heart attacks; his kidney function is declining and
his lungs are deteriorating
• Diagnosis: bipolar, alcoholic, heart disease,
kidney disease, lung disease
• Treatment(s) proposed: intubation (tube
inserted in his windpipe to drain lung fluid)
Patient: George Sherill, 69, Male
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•
•
•
Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Fail
Extraordinary
Patient: Aziza (Somali immigrant), 22, Female
• Symptoms: Coughing up blood. She has refused
any treatment because she says she wants to
die.
• Diagnosis: pulmonary tuberculosis that had
spread past her lungs, and she has depression.
• Treatment(s) proposed: Standard drug therapy
(pills taken orally) would cure the tuberculosis.
The hospital offers the pills free of charge. If
she waits any longer than her disease will
become incurable.
Patient: Aziza (Somali immigrant), 22, Female
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•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Pass
Ordinary
Patient: Daniel Hauser, 13, male
• Symptoms: cancerous tumors
• Diagnosis: Hodgkin’s lymphoma
• Treatment(s) proposed: Chemotherapy offers a
90% cure rate, but without chemotherapy the
patient has only a 5% chance of survival. The
patient's family has chosen alternative
treatments due to their religious convictions. A
judge ruled that the family must get medical
treatment for their son.
Patient: Daniel Hauser, 13, male
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•
•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Pass
Ordinary
Patient: Herbert Herb III, 57, male
• Symptoms: short temper, trouble speaking,
dementia, loss of muscle control on his left
side
• Diagnosis: stroke
• Treatment(s) proposed: blood thinners to
dissolve the clot and prevent future clots
Patient: Herbert Herb III, 57, male
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•
•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Pass
Ordinary
Patient: Ed, 67, male
• Symptoms: mental disability, hearing impairment,
high blood pressure, diabetes, vision impairment. He
also has a defective esophagus, and he often inhales
his food and drink when trying to swallow. He
sometimes develops aspirate pneumonia.
• Diagnosis: aspirate pneumonia
• Treatment(s) proposed: antibiotics to treat the
pneumonia. The doctor also wants to put him
(temporarily) on a feeding tube and a ventilator, to
allow his lungs to heal. Ed doesn’t want a ventilator,
but Ed is not competent. Bert, Ed's brother, invokes
Ed's medical durable power of attorney, and must
decide whether to accept or reject the treatment plan.
Patient: Ed, 67, male
• This case is ambiguous. If the pneumonia is
not-so-bad and infrequent, then…
• Criterion #1 Pass
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Ordinary
Patient: Baby Jane Doe, newborn,
female
• Symptoms: rocker-bottom feet, heart murmur,
enlarged heart, congenital heart defect,
esophageal defect
• Diagnosis: Trisomy 18 Syndrome
• Treatment(s) proposed: during the early
development of the child, provide fluids,
electrolytes, and oxygen; remove carbon
dioxide from blood; after this phase, the child
may live for several years with moderate care
Patient: Baby Jane Doe, newborn, female
OEM: for the “incubation phase” procedures
• Criterion #1 Pass
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Ordinary
Nutrition/Hydration: obligatory
Patient: Madisyn Whitfield, 25, Female
• Symptoms: back pain, chills, and fatigue
• Diagnosis: Crohn’s disease and kidney stones
• Treatment(s) Proposed: feeding tube,
percutaneous nephrolithotomy (surgical
removal of stones)
Patient: Madisyn Whitfield, 25, Female
OEM:
• Criterion #1 Pass
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Ordinary
Nutrition/Hydration: obligatory
Patient: Krista Stryland, 32, Female
• Symptoms: obesity, lack of exercise, diet,
depression
• Diagnosis: insufficient metabolism, obesity
• Treatment(s) proposed: liposuction (which
will require lengthy recovery)
Patient: Krista Stryland, 32, Female
• We kicked this case around and considered
various possibilities.
• Really, the medical facts are insufficient.
Liposuction is just one of many possible
treatments.
Patient: Nancy Cruzan, 32, Female
• Symptoms: displays motor reflexes but no
indication of cognitive function, cannot
breathe on her own
• Diagnosis: persistent vegetative state, in
which she can live for years
• Treatment(s) proposed: ventilator, and
provide nutrition by feeding tube
Patient: Nancy Cruzan, 32, Female
OEM: for the ventilator
• Criterion #1 Pass
• Criterion #2 Pass
• Criterion #3 Fail
• Conclusion Extraordinary
Nutrition/Hydration: obligatory if the ventilator
is KEPT ON, optional if it is taken OFF.
Patient: Monica, 36, Female
• Symptoms: loss of muscle control and eventual
suffocation due to loss of control over respiratory muscles
• Diagnosis: motor neurone disease (motor nerves fail, and
the patient cannot control her movements; the mind is
virtually unaffected). People with MND usually die of
suffocation within 4 years of the onset of the disease.
Monica's condition has steadily declined. She is not
expected to live through the month, and is worried about
the pain that she will face in her final hours.
• Treatment(s) proposed: She asks her doctor to give her
morphine for pain if she begins to suffocate or choke. This
will lessen her pain, but it will also hasten her death
because it lowers respiration.
Patient: Monica, 36, Female
PDE: for the morphine (DI: pain control)
• Criterion #1 Pass (II: breathing suppressed)
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Good to do
OEM:
• Criterion #1 Pass, however the real benefit is pain
management
• Criterion #2 Pass
• Criterion #3 Pass
Conclusion
Pass but still optional. Pain management here is
optional because it does not offer an increase of health…it’s a
different kind of “real benefit.”
Patient: Terri Schiavo, 41, Female
• Symptoms: Suffered a full cardiac arrest,
followed by coma
• Diagnosis: Coma, persistent vegetative state
• Treatment(s) proposed: Physical therapy;
experimental therapy; remove feeding tube so
that she dies
Patient: Terri Schiavo, 41, Female
• Nutrition/Hydration: obligatory
• Note: she’s NOT DYING of anything. Depriving
her of food and water IN ORDER to kill her is
HOMICIDE.
Patient: Piña Colada, 78, Female
• Symptoms: jaundice, abdominal pain, history
of alcoholism
• Diagnosis: cirrhosis of the liver
• Treatment(s) proposed: liver transplant; note
that the patient does not have health
insurance to cover this expensive procedure,
and she also lives in a remote area, meaning
she would have to travel a great distance to
undergo the transplant
Patient: Madisyn Whitfield, 25, Female
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Fail
Fail
Extraordinary
Patient: Dax Cowart, 25, male
• Symptoms: Burned over 65% of his body from a freak
accident, with irreparable damage to his eyes, ears
and hands. Dax has attempted suicide many times
and repeatedly attempted to refuse treatment. He
has been treated against his will because it was not
clear that he was competent. Now that he is able to
communicate better, he is expressing his refusal of
treatment, and he is clearly competent.
• Diagnosis: extensive burns
• Treatment(s) proposed: Large doses of narcotics for
minimal pain relief, regular baths in a chlorinated
water to fight infection, and numerous bandages
covering his body, replaced daily. Long-term recovery
will require many surgeries to repair his skin.
Patient: Dax Cowart, 25, male
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•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Fail
Extraordinary
Patient: Walter White, 50, Male
• Symptoms: cough, shortness of breath, chest pain,
coughing up blood, blurred vision, headaches,
seizures, and symptoms of stroke
• Diagnosis: small-cell lung cancer
• Treatment(s) proposed: Chemotherapy leading to
surgical removal of the cancer. Note that the
patient’s insurance company will only cover a small
portion of the vast expense of treatment. On the
one hand, Walter does not want to plunge his family
into debt. On the other hand, Walther does not
want to leave his children without a father. Walther
never smoked but is a chemist, and has been in
contact with many dangerous chemicals during his
career.
Patient: Walter White, 50, Male
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•
•
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Criterion #1
Criterion #2
Criterion #3
Conclusion
Pass
Pass
Fail
Extraordinary
Patient: Karen Ann Quinlan, 21, Female
• Symptoms: Patient became unconscious after
arriving home from a party. She had consumed
diazepam, dextropropoxyphene and alcohol. She
collapsed. Twice she stopped breathing for 15
minutes or more. Her brain damage is profound
and permanent. After a few months, her parents
want to remove the ventilator.
• Diagnosis: she needs a ventilator to breathe for
her; also, persistent vegetative state
• Treatment(s) proposed: ventilator
Patient: Karen Ann Quinlan, 21, Female
OEM: for the ventilator
• Criterion #1 Pass
• Criterion #2 Pass
• Criterion #3 Fail
• Conclusion Extraordinary
Nutrition/Hydration: obligatory if the ventilator
is KEPT ON, optional if it is taken OFF.
Patient: Vera Lynn, 78, Female
• Symptoms: confusion, poor judgment, mood
swings, unable to retain information,
frequently falls, recently had a four month
hospital stay for pneumonia, and has had prior
strokes. Her confusion makes her difficult to
care for, and she is often dehydrated.
• Diagnosis: severe dementia, diabetes with
impaired vision, poor kidney function
• Treatment(s) proposed: IV fluids
Patient: Vera Lynn, 78, Female
• The medical facts are a little ambiguous, but
we interpreted the kidney function to be
poor, but still working and not declining. If
the kidneys were failing, the analysis would
be different.
• Nutrition/Hydration: obligatory
Patient: Jayden Aldona Gonzalez, 20
months, male
Symptoms: vomiting, head pain, unsteadiness
Diagnosis: aggressive brain tumor
Treatment(s) proposed: transported to
Children’s Hospital of Philadelphia for surgery
to remove the tumor
Patient: Jayden Aldona Gonzalez, 20 months,
male
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
Patient: Chris Sands, 24, Male
Symptoms: Hiccups as often as every two seconds a
day and cannot stop. Because of this, he has been
limited in his ability to be a back-up singer in his
band, “Ebullient.”
Diagnosis: The doctors aren’t sure, but suspect he has
an acid reflux condition caused by a damaged valve
in his stomach.
Treatment(s) proposed: Keyhole surgery to grab part
of Chris’s stomach and wrap it around the valve to
tighten it.
Patient: Chris Sands, 24, Male
OEM:
• Criterion #1 Fail
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Extraordinary
If, however, the doctors became sure of the
diagnosis, the analysis might be different.
Patient: Malcolm, 64, male
Symptoms: shortness of breath; a tumor is
compressing his airways to both lungs. Aggressive
treatment of the tumor has failed. The tumor has
not shrunk. He was put on a ventilator to assist
breathing. The doctors judge that his condition
cannot be improved. He becomes incompetent. His
wife wants to do everything possible to extend
Malcolm’s life. The hospital is bearing the majority
of the cost of his care.
Diagnosis: Incurable, terminal cancer of the esophagus
Treatment(s) proposed: Ventilator
Patient: Malcolm, 64, male
OEM: for the ventilator
• Criterion #1 Pass (assists breathing)
• Criterion #2 Pass
• Criterion #3 Fail
• Conclusion Extraordinary
Patient: Lauren Richardson, 23, Female
• Symptoms: a heroin overdose caused her to fall
unconscious and stop breathing. Lack of oxygen
severely damaged her brain. She is in a coma.
She is provided nutrition and hydration
artificially. She has no health insurance.
• Diagnosis: Anoxic brain injury, persistent
vegetative state
• Treatment(s) proposed: Removing nutrition and
hydration
Patient: Lauren Richardson, 23, Female
• Nutrition/Hydration: Obligatory
• NOT an OEM CASE!!!
Patients: Rital and Ritag Gaboura,
11 months, (both) Female
• Symptoms: Conjoined twins. Ritag’s heart is
failing. Untreated, both will die.
• Diagnosis: Vertical Craniopagus, which means they
are conjoined at the top of the skull and live at a
180 degree angle to one another. Heart failure
(Ritag).
• Treatment(s) proposed: Surgical separation. The
operation will be very long and risky, but both may
be saved.
Patients: Rital and Ritag Gaboura,
11 months, (both) Female
• We analyze this as two sick people who may
be saved by a long, difficult, risky surgery:
– Pass, Pass, Fail, Extraordinary
• What makes this case simple but still very hard
to analyze is the fact that both will die without
the surgery, and both might live with the
surgery. Still, the surgery is radical and
involves profound physical burden, so it’s
optional.
Patient: Milagros Cerron, 9 months, female
• Symptoms: She is born with a rare defect, born with several
organs only partially formed or missing. Because her legs are
conjoined, she has the appearance of a “mermaid.”
• Diagnosis: sirenomelia
• Treatment(s) proposed: Since this defect is very rare, and is
usually fatal within two days of birth, there is very little
medical technology and experience treating it. First, the
doctors will insert silicone bags between her legs to expand
the tissue in her legs and abdomen. Then they will perform
surgery to separate her legs. She has all the bones and
structures of normal legs, and she might walk one day.
However, her internal organs cannot not grow properly
because of her deformity. She has only one functioning
kidney. She is in constant danger of infection, and she may at
best live a few years. The cost of her care is covered by the
city of Lima, Peru.
Patient: Milagros Cerron, 9 months, female
• This case looks complicated but it’s really pretty
simple.
• Criterion #1 Pass (offers survival and improved
function)
• Criterion #2 Fail because the doctors have limited
technology and experience with this procedure.
They’re inventing the procedure (RARE).
• Criterion #3 Fail because the surgery is radical
and physically demanding, and because the city
of Lima, Peru is opting freely to pay for it
• Conclusion Extraordinary
Patient: Billy Thompson, 9, Male
• Symptoms: Ear infections, pneumonia, asthma,
neck pain, headaches
• Diagnosis: Tourette’s syndrome, insomnia; during
an examination, the doctor discovered a neck
injury
• Treatment(s) proposed: neck surgery. Repairing
the injury should reduce the Tourette’s tics,
decrease the neck pain and headaches.
Patient: Billy Thompson, 9, Male
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
Patient: Gretchen, 25, Female
• Symptoms: perfectly healthy; wants breast
implants to advance her modeling career
• Diagnosis: none
• Treatment(s) proposed: silicon implants to
augment breasts
Patient: Gretchen, 25, Female
OEM:
• Criterion #1 Fail
• Criterion #2 Pass
• Criterion #3 Pass
• Conclusion Extraordinary, in the sense that
she has no obligation to accept the
procedure…but I argue that she has an
obligation NOT TO GET the procedure
Patient: Gretchen, 26, Female
• Symptoms: Blurred vision, trouble retaining
information, memory loss, body tingles and
dizziness, muscle and joint pain, extreme anxiety
and depression, skin rashes, tremors, and
extreme fatigue
• Diagnosis: complications arising from silicon
breast implants
• Treatment(s) proposed: remove the silicon
implants; treat any infections discovered during
surgery
Patient: Gretchen, 26, Female
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
Patient: Dick Cheney, 69, Male
• Symptoms: Suffered five heart attacks since 37
years old, chest pains
• Diagnosis: Progressive congestive heart failure
• Treatment(s) proposed: Implantation of a left
ventricular heart assistance device (pump that
takes over some of the heart’s work), until a
transplant can be performed.
Patient: Dick Cheney, 69, Male
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
Patient: Gandalf, about 4000 years, male
• Symptoms: Patient started smoking a pipe when he
was young. Now he has a cough, fatigue, and failing
respiration. He has battled lung cancer for years
with chemotherapy and radiation.
• Diagnosis: terminal lung cancer
• Proposed treatment(s): Chemotherapy and radiation
can no longer help him. The doctor estimates that
he will die of cancer in six days. Ever dignified, he
requests that his IV hydration and his feeding tube
be removed, so he can be more comfortable. The
doctor says that dehydration can kill him in four days,
and starvation in eight days.
Patient: Gandalf, about 4000 years, male
• Hydration: obligatory
• Nutrition: optional
• Cancer will kill him AFTER dehydration would
but BEFORE starvation would.
Patient: Mary, 19, female
• Symptoms: high levels of anxiety and rapid
mood swings
• Diagnosis: bipolar disorder
• Treatment(s) proposed: a prescription
medication (lithium bicarbonate) taken twice
daily will reduce the severity of her depressive
and manic episodes; however, the pills have
side effects including headaches and
sometimes nausea
Patient: Mary, 19, female
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
Patient: Brittney Lee, 24, Female
• Symptoms: abdominal pain
• Diagnosis: abdominal aortic aneurysm, a
weakening in the wall of the thoracic aorta which
causes it to stretch and bulge
• Treatment(s) proposed: surgery to repair the
aorta (without which she will die). The scar left
by the surgery will definitely end her career as a
provocative dancer. She is paid to be an
objectified stage decoration for touring
performers such as Kenya East and 37 Cent.
Patient: Brittney Lee, 24, Female
OEM:
• Criterion #1
• Criterion #2
• Criterion #3
• Conclusion
Pass
Pass
Pass
Ordinary
• Note: her motive for claiming “emotional
burden” is disordered…that’s one job she OUGHT
to lose!
Patient: Ms. Bones, 18, female
• Symptoms: low energy, anxiety, fertility cycle
stopped, muscle atrophy, aching joints;
patient wants to fit into a size zero dress for
prom
• Diagnosis: malnutrition
• Treatment(s) proposed: increase caloric
intake, counseling; involuntary commitment if
necessary
Patient: Ms. Bones, 18, female
• Nutrition/Hydration: obligatory
• She wants to starve herself for vanity’s sake.
Duh. Go eat something.