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Chp 8 Medical Ethical Cases

Chp 8 Medical Ethical Cases. RED means the case is ambiguouV , exactly the kind I WON’T put on a Scantron test. Patient: Herbert Orr, 75, Male.

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Chp 8 Medical Ethical Cases

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  1. Chp 8 Medical Ethical Cases RED means the case is ambiguouV, exactly the kind I WON’T put on a Scantron test.

  2. 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

  3. Patient: Herbert Orr, 75, Male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  4. 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

  5. Patient: George, 27, Male  • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary

  6. 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.

  7. Patient: Alcibiades Moreno, 37, male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  8. 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)

  9. Patient: George Sherill, 69, Male  • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  10. 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.

  11. Patient: Aziza (Somali immigrant), 22, Female • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary

  12. 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.

  13. Patient: Daniel Hauser, 13, male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary

  14. 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

  15. Patient: Herbert Herb III, 57, male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary

  16. 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.

  17. 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

  18. 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

  19. 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

  20. Patient: Madisyn Whitfield, 25, Female • Symptoms: back pain, chills, and fatigue • Diagnosis: Crohn’s disease and kidney stones • Treatment(s) Proposed: feeding tube, percutaneousnephrolithotomy (surgical removal of stones)

  21. Patient: Madisyn Whitfield, 25, Female OEM: • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary Nutrition/Hydration: obligatory

  22. 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)

  23. 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.

  24. 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

  25. 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.

  26. 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.

  27. 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.”

  28. 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

  29. 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.

  30. 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

  31. Patient: Madisyn Whitfield, 25, Female OEM: • Criterion #1 Pass • Criterion #2 Fail • Criterion #3 Fail • Conclusion Extraordinary

  32. 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.

  33. Patient: Dax Cowart, 25, male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  34. 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.

  35. Patient: Walter White, 50, Male • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  36. 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

  37. 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.

  38. 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

  39. 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

  40. 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

  41. Patient: Jayden Aldona Gonzalez, 20 months, male OEM: • Criterion #1 Pass • Criterion #2 Pass • Criterion #3 Pass • Conclusion Ordinary

  42. 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.

  43. 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.

  44. 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

  45. Patient: Malcolm, 64, male OEM: for the ventilator • Criterion #1 Pass (assists breathing) • Criterion #2 Pass • Criterion #3 Fail • Conclusion Extraordinary

  46. 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

  47. Patient: Lauren Richardson, 23, Female • Nutrition/Hydration: Obligatory • NOT an OEM CASE!!!

  48. Patients: Rital and RitagGaboura,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.

  49. Patients: Rital and RitagGaboura,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.

  50. 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.

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