Oncology Ethics Cases
Case One: Who Decides About "Juanita"?
This patient is 9 years old and has advanced AML (Leukemia). She was originally treated in her hometown in south Texas, but failed to respond to any of four regular and experimental chemotherapy protocols. Her pediatrician, in consultation with a major pediatric center, has advised this family, that there is one other possible treatment to consider--a bone-marrow transplant (BMT). This will involve traveling to the pediatric center, and remaining there for several months. After talking with their pediatrician about the potential risks and benefits, as well as the cost of BMT treatment, the parents decided not to choose it. Their pediatrician indicated that such treatment was the "last, best hope" she could offer Juanita. The family refused, and was reported to Child Protective Services, who sought an order from Family Court, that required them to go to the pediatric center for the BMT. The judge stated that she believed the family had a "moral and legal obligation" to try this treatment. The family complied with the order, even though it was very difficult, and required them to take other small children with them. The screening revealed no "exact match" for BMT, but it was done, using the closest match available (from the mother). This treatment proved ineffective and the oncologists said they could try the BMT again, but with little hope of success. Juanita asked to go home where "she could be with her family and her friends, for as long as she lived". Her parents agreed and asked to go home.
In view of the court order, the physicians and the parents asked for a meeting with the Ethics Committee to review the case. The physicians did not oppose the parents' wishes, but wanted further direction, as to the next appropriates steps to be taken. The Ethics Committee and the hospital legal counsel met with the parents and physicians.
Some of the questions the physician wants to raise include:
NOTE: Be sure to provide a brief response to all three questions.
This quiz/activity is worth 5 points and your responses submitted are confidential. I would like to see your thoughts without regard to there being a right or wrong point of view. Feel free to relate any cultural and/or philosophical considerations you may have.
The physicians primary ethical obligation for this case must be providing a well happy and qualified life as the client wish to have it for the further life . Here in the case the client had undergone the only possible method of BMT and that was not a great sucess and we cant attempt for it again and the clint wish to stay in the home until the last breath and as a physician he should consider the patient rights and ethics to have a life what she wish until her last breath
2.How might the physician proceed to deal with the conflict in this case?
The case is clear evidence of no cure and the only option of BMT was tried and was a failure and then its better to have a Nature healing which includes leaving the client of his wish to have a life as he want and he wish. Thus the client will be happy for what he have until his last breath.
3.What questions from the Four Topics Chart relate to Juanita’s case?
The four topics chart includes
a) medical indications :- this includes
1. What is the patient’s medical problem? Is the problem acute?
Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical
treatments not indicated?
4. What are the probabilities of success of
various treatment options?
5. In sum, how can this patient be benefited by
medical and nursing care, and how can harm be avoided?
Here in this case we had no other options but a try to have BMT with a less chance of benifit .. inspite of leaving the patient it was better to try something than nothing thus the client was tried for BMT but unfortunately that was not effective in her case
b)prference of client:- this includes
1. Has the patient been informed of benefits and risks of
diagnostic and treatment recommendations, understood this
information, and given consent?
2. Is the patient mentally capable and legally competent or is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for an incapacitated patient? What standards should govern the surrogate’s decisions?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Here in this case the client is minor and of 9 years old and the parents with lack of knowledge and certain ethical issuea have refused the BMT even after explaining this is only option and even not a gurantee but just a try . Later on as the court decided to proceed the procedure was done without a success rate and later the client wish to stay at home for furyher life and ethically considering the client autonomy that must be the decision to be agreed .
c)Quality of life :- this include Beneficence and Nonmaleficence
and Respect for Autonomy
Here in the case we just tried to improve the quality of life by BMT so when its a failure its better to send back home and have a quality care without anyother treatment or with supportive care needed
d)contextual features (justice) :-all ethical ,financial factors should be considered and then the care must be provided for the clent