ABSTRACT
It is generally accepted that the Patient's Bill of Rights applies to all patients including prisoners. Yet, a prisoners' incarcerated status generally prohibits inmates from making any decision that may shorten his/her life, and as such, the de facto medical decision maker becomes the medical director of the state correctional facility. This case study highlights the challenges that arise when the ethically appropriate response to a hospitalized prisoner's terminal medical condition warrants decisions that are in conflict with that advocated by the correctional facility.
Subject(s)
Hospitalization , Laryngeal Neoplasms/therapy , Mental Competency , Patient Rights/ethics , Prisoners/psychology , Fatal Outcome , Humans , Laryngeal Neoplasms/diagnosis , Male , Middle Aged , TracheostomyABSTRACT
The increasing survival of adolescents with cancer, achieved through intensive therapy, is often associated with sterility. For most teenagers, the ability to have biological children is psychologically and socially important. Methods of preserving fertility, some standard and other experimental, have proliferated, but their use raises ethical issues. This review poses three hypothetical cases, describes the preservation methods, and identifies and analyzes the ethical issues. The discussion asks what needs to be told, who decides what to do, when can a pediatrician refuse to follow a family's choice, and what is the pediatrician's role as advocate for adolescents.
Subject(s)
Adolescent Medicine/methods , Antineoplastic Agents/adverse effects , Decision Making , Infertility/chemically induced , Adolescent , Adolescent Medicine/ethics , Cryopreservation , Humans , Parents , Sex FactorsSubject(s)
Child Advocacy/ethics , Hockey/injuries , Informed Consent/ethics , Pediatrics/ethics , Professional-Family Relations/ethics , Adolescent , Adult , Child , Communication , Cystic Fibrosis/therapy , Family Conflict/ethics , Female , Humans , Intubation, Intratracheal , Knee Injuries/rehabilitation , Parent-Child Relations , Respiration, Artificial/ethics , United StatesABSTRACT
A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement. The patient demanded that he be allowed to eat a normal diet despite being told that it could lead to his death. The patient wanted to go home, but there was no one there to care for him. Additionally, neither a nursing home nor hospice would accept him in his present condition. The case is especially interesting because of the symbolic value of food and the plight of the patient who has no alternative to hospitalization. The hospital staff experienced considerable stress at having to care for him. They were uncertain whether their obligation was to respect his autonomy and continue to provide food or to protect his health by avoiding aspiration, pneumonia, and possible death by denying him food. This ethical dilemma posed by the professionals' duty to do what is in the patient's best interest versus the patient's right to decide treatment serves as the focus for this case study. Ethical, legal, and healthcare practitioners' considerations are explored. The case study concludes with specific recommendations for treatment.
Subject(s)
Mental Competency/legislation & jurisprudence , Personal Autonomy , Respiratory Aspiration/nursing , Respiratory Aspiration/prevention & control , Treatment Refusal/legislation & jurisprudence , Aged , Enteral Nutrition , Humans , Male , Nursing Care/ethics , Treatment Refusal/ethicsSubject(s)
Bioethical Issues/standards , Codes of Ethics , Health Policy , Pediatrics/standards , Academies and Institutes , Child , Child, Preschool , Female , Humans , Infant , Male , Pediatrics/ethics , Policy Making , United StatesSubject(s)
Codes of Ethics , Ethics, Medical , Pediatrics , Practice Guidelines as Topic , Child , Ethics Committees , Humans , Societies, Medical , United StatesSubject(s)
Ethics, Medical , Living Donors/ethics , Parental Consent , Child , Child Advocacy/ethics , Child Welfare/ethics , Humans , Parent-Child RelationsABSTRACT
Two principles are commonly perceived as being central to decision-making for critically ill newborns: the patient's best interest standard, and the authority of the parents to speak for the newborn as the surrogate decision-makers. In this essay, these 2 principles are examined in the context of a particular setting, that of a critically ill newborn with a mother in early adolescence. Alternatives to the patient's best interest standard are explored, including consideration of other interests in addition to those of the patient, such as the interests of the young mother and other family members. Also, we discuss a model of shared decision-making, wherein "parental authority" may be shared between the young adolescent mother and an adult relative, such as her own mother.
