A comprehensice compilation of casses in medical ethics




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A COMPREHENSICE COMPILATION OF CASSES IN MEDICAL ETHICS


1. A 25- year old mother refused immunization for her 2-month old son. The social worker spoke to
the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the child.
(CORRECTION)IMMUNIZATION CAN BE WITH HELD FROM THE CHILD IF PARENTS ARE AGAINST IT.BECUZ LACK OF IMMUNIZATION POSES VERY LITTLE THREAT AND IT IS NEITHER LIFE OR LIMB SAVING.HOWEVER IF GLOBAL CAMPAIGN ON IMMUNIZATION REFUSED APPROPRIATE HEALTH AUTHORITIES SHUD BE NOTIFIED{BREAK CONFIDENTIALETY BECUZ POSING RISK TO OTHERS}

2. A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter.
The social worker spoke to the mother. (Important for Board examination)
Next step in management: surgical removal of the appendix should be preformed for the benefit of
the child.(RULE:PARENTS CANNOT WITHHOLD LIMB OR LIFE SAVING PROCEDURE TO THEIR CHILD)

3. A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended
amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death
is certain without surgery. Boy lives alone (Important. Next step in management: amputation should NOT be preformed. Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request,
except in a case of irreversible sterilization.

4. A 17-year old girl is a Jehovah’s Witness. She refuses a lifesaving blood transfusion. She is
aware of the consequences. she doesn’t live with her parents. She spoke to the social worker.
(Important)
Next step in management: blood transfusion should NOT be given because she is competent to make
the decision.

5. A 5-year old girl is a Jehovah’s Witness. She requires emergency blood transfusion. Her mother
refuses blood transfusion. A social worker along with two physicians spoke to the mother.
(Important)
Next step in management: blood transfusion should be given because the patient is not competent.
Mother cannot refuse her daughter’s treatment. {LIFE SAVING}


6. A 2-year old boy was brought to the ER by his parents for an injury. Physicians made the
diagnosis of child abuse. There are three other children living in the same household. Both
parents confess to child abuse but request the physician to keep it confidential. Social worker
was involved. (Important)
Next step in management: the case should be reported to Child Welfare Agency (CWA). All children
should be removed from the parents by the CWA.physicain cannot take totally prove or disprove
child abuse only CWA can and take the custody of children

7. A 15-year old boy with STD (sexually transmitted disease) came to see a physician. He asked
the physician not to tell his parents. (VERY IMPORTANT)
Next step in management: the physician should treat the patient and notify the appropriate health
authority, but should not tell his parents.

8. A 16-year old boy wants to use a condom. He comes to the clinic for free samples. He requested
the physician, however, not to tell his parents. (Important)
Next step in management: condom should be given and physician should not tell his parents.

9. A 30-year old male patient is recently diagnosed with HIV. He lives with his wife and two
other children but is promiscuous. He requested the physician not to tell his wife. He lost his
job recently. Social worker spoke to the patient. (Very Important)
Next step in management: physician should notify the appropriate authority (e.g. department of
health) for the safety of other specific persons who are engaged in unsafe sexual practices. The
physician however, should ask the patient to divulge the diagnosis to his wife and other sexual
partners.if failed contact the wife personaly

10. A very small premature infant was born in the delivery room by NSVD (normal spontaneous
vaginal delivery). The attending physician decided not to resuscitate the newborn. Physician
spoke to the mother. Mother started to cry. Newborn expired after 30 minutes. Is the physician
liable for the newborn’s death?
Answer: NO. Please remember, no physician in the USA has ever been found liable for withholding
or withdrawing any life sustaining treatment from any patient for any reason. ideally he shoudl have
asked for consent or DNR from parents

11. A physician picked up a car accident victim from the street and brought him to the ER in his
car. He did not want to wait for an ambulance because the patient’s condition was critical.
Physical examination in the ER reveals quadriplegia. Is the physician liable for this
consequence? (Very Important)
Answer: YES, because the physician did not protect the neck of the patient resulting in
quadriplegia. also good Samaritan laws not fully fulfilled. the physician should have stayed on the
site till relieved by appropriate people.

12. A policeman brought an alcoholic patient to the ER. The policeman asked the physician to give
him a sample of gastric contents by putting a nasogastric tube for laboratory study. The patient
refused insertion of a nasogastric tube. (Very Important)
Next step in management: nasogastric tube should not be placed. Blood alcohol level however
should be preformed. The policeman should not give orders to a physician.

13. A 60-year old man with a history of myocardial infarction (MI) suddenly develops ventricular
tachycardia. A physician from another department was present. The patient needs resuscitation.
(Very Important)
Next step in management: the physician must resuscitate that patient. Physician should not refuse
treatment because he belongs to another department.

14. A 15-year old homosexual boy wanted to change his sexual orientation. He was not successful.
He needed help. He requested the physician not to tell his parents. (Important)
Next step in management: physician should help him avoid homosexual activities. Physician should
not tell his parents about his homosexual activities.

15. A 15-year old homosexual boy is brought by his parents to a physician. His parents do not
accept their son’s sexual orientation. The boy refuses to change. (Important)
Next step in management: physician should tell his parent that homosexual activity is considered
as an alternative life style. Parents should talk to his son but should not force him to change
his homosexual activities.

16. A 16-year old girl becomes pregnant. Her mother wanted her to abort this pregnancy. The girl
wanted to continue her pregnancy despite difficulties. Her boyfriend is a high school drop out.
(Important)
Next step in management: physician should advise to continue this pregnancy because the girl is
partailly competent to make this decision only about her pregnancy.(controversial, diff states
diff rules, so unlikely to be tested on exam)

17. A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the
doctor not to tell her parents about this pregnancy. (Important)
Next step in management: abortion should be done and parents should not be notified. Please
remember, strict requirements for parental consent may deter many adolescents from seeking health
care.(abortion contraversial.diff states diff rules.so unlikely to be tested on exam)

18. Can a physician provide sterile needles for intravenous drug abusers? (Important)
Answer: YES. It reduces the risk of acquiring HIV or hepatitis. The patients should be referred
to appropriate health facilities.

19. A 26-year old pregnant woman went for antenatal check up. Sonogram revealed a 27-week old
fetus with erythroblastosis fetalis. Doctor recommended intrauterine fetal blood transfusion. She
refused the procedure. Social worker discussed the case with the mother. (Important)
Next step in management: doctor should receive a court to do the procedure which will help the
fetal condition.( A HIGHLY DEBATABLE ASPECT.MOTHER IS LIABLE FOR WITH HOLDING LIVE SAVING
PROCEDURE TO VIABLE FOETUS WHICH DOESNT PUT THE MOTHER AT RISK OF SERIOUS DAMAGE.HOWEVER AMERICAN OBSTETRIC ASSOCIATION MENTIONS NOT TO DO ANY OBS PROCEDURE ON REFUSAL OF MOTHER.MOTHER SHUD BE TOLD THAT SHE IS COMMITING AN ASSAULT AND THE CASE BE TAKEN IN COURT.


20. A 20-year old man tells his doctor that he is going to kill girlfriend. She lives in the
university dormitory. Doctor called the university alerted them about the threat and notified the
police. However, university security people did not protect her. She was killed by her boyfriend.
Who should be responsible for this killing? (Important)
Answer: the 20-year old man is responsible. Doctor did the right thing by notifying the
university and the police. The university is also responsible because they did not take any
preventive measures.

21. A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is
full-term and healthy. Social worker spoke to mother. (Important)
Next step in management: doctor can go to court to get permission for cesarean section for the
benefit of the fetus.FULL DESCRIPTION ABOVE.

22. A 30-year old pregnant woman ingested alcohol and illicit drugs (e.g., cocaine, crack) which
are harmful to the fetus. What should a physician do? (Important)
Answer: the physician should be careful in reporting this case because the pregnant woman may not
come back for prenatal care, which is important for both the mother and the fetus. However, if
the baby’s urine toxicology test is positive for illicit drugs, case should be reported to CWA
(child welfare agency).

23. A physician wants to study a group of children aging from 10-12 year old. Physician already
got the consent from the parents. However, he didn’t discuss the study with the children. A child
refused to participate. Should the physician force the child to participate? (Important)
Answer: no, because a child can refuse to participate in a research study.

24. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with
the patient who understood the procedure. Can the patient give consent? (Important)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.

25. A 65-year old schizophrenic patient needs coronary angiography because of suspected
myocardial infarction. Cardiologists explained the procedure to the patient who did not
understand the procedure. Who can give the consent on behalf of the patient? (Important)
Answer: the patient’s relative can give the consent. If nobody is available to give the consent,
court order should be obtained. If a psychiatric patient does not understand the procedure, he or
she cannot give the consent.

26. A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to
congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with
the mother. She understood the procedure. Can she give the consent? (Important)
Answer: yes, because she understood the procedure.

27. A newborn is diagnosed with either trisomy 18 or 13 with TE (tracheoesophageal) fistula which
requires surgery. Mother request surgeon to repair the TE-fistula. What should a surgeon do?
(Important)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisomy 18
or 13) are nonviable. If the patient survives, surgeon can put a gastrostomy feeding tube for
nutrition. However, please remember that a patient with trisomy 21 (Down syndrome) with TE
fistula should be operated on. (LAW OF MEDICAL FUTILITYAPPLIED HERE)

28. A 45-year old terminally ill patient wanted to die. He has pancreatic cancer and has been
suffering from constant pain. He asked the physician to give him some medication which can
expedite his death. What should a physician do? (Very Important)
Answer: physician cannot give any medication which will expedite the death. However, physician
can prescribe medication to minimize the pain. The dose should be appropriate. Physician-assisted
suicide is illegal everywhere (except in the state of Oregon).IEAALY PT REQUEST PHYSICIAN
ASSISTED SUICIDE IF a-DEPRESSED b-IN PAIN.IF THESE SITUATIONS RESOLVED NOT REQUESTED BY PT.ON USMLE NEVER GO FOR PHYSICIAN ASSISTED SUICIDE.THOUGH IT IS CONTRAVERSIAL.

29. A 47-year old man came to a doctor for chronic low back pain and dysuria. The diagnosis of
metastatic prostate cancer was made after appropriate investigation. Should the doctor tell the
bad news to the patient? (Important)
Answer: yes physician must tell the truth to the patient.

30. A surgeon wanted to perform cholecystectomy on a patient. The surgeon is not sure whether the
patient has decision-making capacity. What is the next appropriate step? (Important)
Answer: consultation with a psychiatrist or neurologist may be helpful. Sometimes it is necessary
to discuss the case with hospital attorneys, ethic committees, or ethic consultants. In a
difficult case, the ultimate judge of a patient’s competency is a court.

31. A 45-year old widow was admitted to an ICU (intensive care unit) with ruptured intracranial
aneurysm. She is comatose and is placed on a mechanical ventilator. She has a 20-year old son who
did not keep any relation with his mother. However, he came to see his mother. His mother made a
written proxy advance directive which indicates that her 50-year old female neighbor should make
the substitute decision. Who is the right person to make the substitute decision in this
situation? (Important)
Answer: 50-year old neighbor should make the substitute decision. Please remember, the most
appropriate person to make the substitute decision is someone designated by the patient while
still competent, either orally or through a written proxy advance directive. Other substitute
decision makers, in their usual order of priority, include a spouse, adult child, parent, brother
or sister, relative, or concerned friend. For a patient who has no other decision maker
available, a public official may serve as a decision maker.

32. The right of patients to refuse medical intervention: patients can refuse dialysis,
cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition and hydration,
even if such a decision results in the patient’s death. A patient’s decision to withdraw
(discontinue) or to withheld (not to initiate) life-sustaining treatment is not considered
suicide and physician participation is not considered physician-assisted suicide. Physicians do
not have any legal risk.

33. Can a medical student introduce himself or herself as a ‘doctor’ to the patient? (Important)
Answer: no. a patient can refuse a medical student from performing any procedure. However,
medical students are allowed to perform a procedure under appropriate supervision If the patient
agrees to that.

34. Should a bus driver hide history of epilepsy from his employer? (Important)
Answer: no. He has requested his physician not to mention his epilepsy to the employer because
this would result in the loss of his job. The physician is obligated not only to his patient but
to the community. The patient should notify his employer and try to find a non-driving job in the
company. If the patient disagrees, physician may notify the appropriate authority for the safety
of the patient and the community.

35. A 50-year old make is diagnosed with stomach cancer. He requested the physician not to tell
his wife. The following day, the wife calls to inquire about her husband’s diagnosis. (Important)
Answer: the physician should not divulge the husband’s diagnosis. However, the physician should
encourage the patient to reveal his diagnosis to his wife.

36. A 29-year old man is diagnosed with presymptomatic Huntington’s disease. This disease is an
autosomal dominant (50% chance of having the disease in each pregnancy). He requested his
physician not to tell the diagnosis to his wife. The wife wants to have children. (Important)
Answer: physician should ask the patient to seek genetic counseling and to urge him to discuss

the matter with his wife. Since there is a risk of harm to the future children, physician can
divulge the diagnosis to protect the future children.

37. An 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and
returns to the college dormitory. What should a physician do in this situation? (Very Important)
Answer: physician should report to the college authority and recommend that the suspected
individual should be isolated during the course of his illness.

38. A 39-year old nurse is diagnosed with hepatitis B antigen-positive. She is working in a
dialysis unit. She told her doctor. However, she did not tell the hospital authority because she
is afraid to lose her job. (Very Important)
Answer: physician should ask the nurse to divulge her medical condition to the hospital
authority. If she refuses, physician should notify the hospital authority for the protection of
patients.

39. A 20-year old man with severe head injury was admitted to a small hospital. The patient needs
neurosurgical intervention which is available in a nearby university hospital. Hospital refused
to accept a patient who has no medical insurance.
Answer: university hospital must accept the patient.

40. A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want
to perform surgery because the patient does not take care of himself. Is this the right decision?
(Important)
Answer: no. Surgery should be performed if it is medically indicated. (DONT EVER BE FOOLED BY TV
PROGRAMES LIKE DR.HOUSE.IF U REMEMBER THE EPISODE ON BULIMIA AND IPECAC POISONING)

41. A newborn male is diagnosed with anencephaly. His 1-year old sibling needs a kidney. His
parents requested the physician to remove the kidney from the anencephalic child and to
transplant that kidney in the 1-year old sibling. What should a physician do?
Answer: surgeon should perform the kidney transplant.

42. A 50-year old man is in a persistent vegetative state. Physician decided to discontinue
nutrition and hydration for that patient. Is this the right decision?
Answer: yes. This is an acceptable practice in most states. Few states require clear evidence
that the patient would have chosen this course.

43. A medical student requested his attending to perform a pelvic examination on a patient who is
anaesthetized for appendectomy. Is this ethically acceptable?
Answer: no. The patient did not give consent to perform a pelvic examination.

44. A 20-year old woman slashed her wrists and wanted to die. She was unconscious and was brought
to the ER. What should a physician do? (Important)
Answer: physician should take care of the patient. Psychiatric consultation and social worker
evaluation are indicated. A suicide attempt is very often a ‘cry for help’ AND RENDERS THE PT
INCOMPETENT REGARDING MEDICAL DECISIONS

45. A 90-year old man was diagnosed with having Alzheimer’s disease 10 years ago. It is difficult
to feed him. He cannot recognize his family members. He developed recurrent aspiration pneumonia.
What should a physician do?
Answer: physician should discuss this with the family and should respect their decision.

46. A 1-day-old infant was diagnosed with hypoplastic left heart syndrome. The patient is
stabilized with the use of prostaglandin. Physician discussed this case in detail with the
parents. What should the parents decide in this situation?
Answer: the parents can choose a staged surgical repair of the heart, a final heart
transplantation if the organ is available, or allow the infant to die.(BEST INTEREST STANDARAD
REMEMBER THE CASE OF DOWN SYNDROME AND TE FISTULA)

47. A 55-year old woman with severe developmental disability recently is diagnosed with breast
cancer. Her mental age is estimated at a 2-year old level. Her family members do not want any
more intervention. What should physician do?
Answer: physician should discuss this case with the hospital ethics committee members. The usual
consensus is ‘not to do anything’ because of her severe mental disability.(NEVER COMPETENT
PATIENT APLLY BEST INTEREST STANDARAD)

48. A 49-year old woman with cervical cancer has a history of noncompliance. She had surgery a
month ago. She missed several appointments. Can a physician force her for chemotherapy?
(Important)
Answer: no. Physician can talk to her regarding the importance of chemotherapy. However, the
patient must make the final decision.

49. An internist has been managing a diabetic patient for the last 10 years. The patient’s
condition is progressively getting worse. The patient is also not happy with the physician’s
management. What should a physician do in this situation?
Answer: physician should find another physician (e.g., endocrinologist) who might be more
successful with the patient in this particular circumstance.

50. An internist recently refused to see a patient who he has been seeing for the last 5 years.
Internist stated that the patient was rude to him. The patient went to see another physician who
requested the patient’s medical record. What should the internist do in this situation?
Answer: internist should provide the medical records of the patient to the new physician.

51. An internist refused to see a complicated hypertensive patient who he has seen for the last
10 years. Internist did not give any notice to that patient. The patient was angry with the
physician. The patient was recently admitted to a hospital with the diagnosis of stroke. Is the
internist responsible for the patient’s condition?
Answer: yes. The legal charge of abandonment can arise when the physician without giving timely
notice, ceases to provide care for a patient who is still in need of medical attention. Internist
is not obligated to find him another physician. However, patient should have sufficient time to
arrange for another physician.


52. A physician went to vacation for 2 weeks. He did not find another physician to cover him. He
is very sincere. One of his patients with hypertension developed severe headache. The patient has
an appointment with the doctor as soon as he comes back from vacation. The patient did not look
for another physician and decided to wait. The patient suddenly collapses and was diagnosed to
have intracranial hemorrhage. Is the physician responsible for this patient? (Important)
Answer: yes. The physician has a legal obligation to arrange for coverage by another physician.

53. An ophthalmologist performed a cataract surgery on a patient who went home after the
operation. In the evening, the patient started vomiting and complained of severe headache. The
ophthalmologist refused to accept that the symptoms were due to postoperative complications. The
patient wanted to see the doctor immediately but he refused to see that patient. The patient went
to the nearest ER and was diagnosed to have dislocation of the lens and partial retinal
detachment. Is the physician responsible for the patient’s condition?
Answer: yes ophthalmologist failed to judge the patient’s condition seriously enough to warrant
attention.

54. A 70-year old Chinese man is diagnosed to have severe osteoarthritis. He told his doctor that
he is using Chinese herbal medicine. He is feeling better. However, he had two episodes of dizzy
spells since he started that herbal product. What should a doctor suggest to this patient?
(Important)
Answer: the doctor should suggest to discontinue the herbal product which may be causing the
dizzy spells.

55. A 35-year old woman is diagnosed to have chronic throat infection. She is frustrated with the
conventional medicine. She told her doctor that she is using an alternative homeopathic medicine.
She is feeling much better and she has no other complications. What should a doctor suggest to
this patient?
Answer: the patient can continue an alternative homeopathic medicine. Alternative medicine
therapy is accepted in the society and is also used along with conventional therapy.

56. A 45 year old woman is diagnosed to have UTI (urinary tract infection). She told her doctor
that she could not afford to purchase antibiotics. However, she is using herbal medicine that is
cheaper. She is complaining of fever and dysuria. What should a doctor suggest to this patient?
(Important)
Answer: the patient should discontinue the herbal medicine immediately and should start
antibiotics as soon as possible.MAY EVEN BE FREE.REMEMBER THE CASE FROM KAPLAN QBANK

57. A 13-year old boy with suspected meningitis refuses therapy. His parents also support that
decision because they are supposed to go on vacation the following day. What should a physician
do in this situation? (Important)
Answer: the patient should be admitted and treated in the hospital. If they refuse, legal action
should be taken.(MEMGITIS TREATMENT IS LIFE SAVING)

58. A 2-year old girl is admitted with the diagnosis of intestinal obstruction. Her mother has a
psychiatric problem. Her mother is not capable of giving the consent. Her father died one year
ago. What should a surgeon do in this situation?
Answer: legal steps may be taken to provide a surrogate decision-maker.IN EMERGENCY LIKE THIS ONE
USE
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