In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case. Case One Mrs. G. has an aneurysm in her brain that, if untreated by surgery, will lead to blindness and probably death. The surgery recommended leads to death in 75% of all cases. Of those who survive the operation, nearly 75% are crippled. Mrs. G has three small children. Her husband has a modest job, and his health insurance will cover the operation, but not the expenses that will result if she is crippled.
In each case, answer the questions at the end of the
case and give researched references to support your assertions; also,
explain what would be the ethical course of action and the legal
requirements for action in the case.
Case One
Mrs. G. has an aneurysm in her brain that, if untreated
by surgery, will lead to blindness and probably death. The surgery
recommended leads to death in 75% of all cases. Of those who survive the
operation, nearly 75% are crippled. Mrs. G has three small children.
Her husband has a modest job, and his health insurance will cover the
operation, but not the expenses that will result if she is crippled.
When informed of this, Mrs. G. is in great emotional
turmoil for a week or so until she makes her decision. She refuses
treatment, because she does not like the odds. There was, after all,
only a one chance out of sixteen for a real recovery. In addition, she
could not come to grips with exposing her family to the risk of having a
mother who would be a burden and not a help.
Can a patient with serious obligations, such as a family, refuse treatment? What odds of recovery would be good odds?
Case Two
Mrs. S., an 85-year-old housewife, becomes aware of
breathlessness and is easily fatigued. She is known to have had a heart
murmur for 2 years. She consents to come to a research hospital for
cardiac catheterization, which confirms the presence of severe, calcific
aortic stenosis with secondary congestive heart failure.
Because of the unfavorable prospect for survival without
surgical intervention, the recommendation at the combined cardiac
medical-surgical conference is for an operation. The physician explains
the situation to Mr. and Mrs. S. and recommends aortic valve
replacement. It is noted that the risk of surgery is not well known for
Mrs. S,’s age group, and that early mortality is usually around 10
percent, with 80 percent achieving good functional results after 3
years. Her lack of an obvious disease makes her a relatively good
candidate for a successful surgical outcome, despite her age.
Mrs. S. appears to understand the discussion and
recommendation, but requests deferral of the decision and shows signs of
denial of the problem. She has no other medical problems, her husband
is in good health, and their marriage appears to be happy. They are
financially secure and enjoy a full set of social and recreational
activities. She returns on three subsequent occasions for simple,
supportive attention. The physician decides not to employ psychiatric
assistance or other measures to reduce her denial and begins to use
conversation to reduce her anxiety associated with her decision.
Does Mrs. S.’s apparent denial of her condition make
informed consent impossible? Is the physician ethical in reducing her
anxiety about her apparent refusal of treatment when the physician
believes treatment is medically indicated?
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