Question

Case Presentation:

            Mr. J, a 65-year-old married man, presented at the emergency room in acute respiratory distress. He was anxious, alert, and gasping for air. His shortness of breath made talking with him difficult. He was accompanied by his wife and nephew.

            Mr. J was fairly well known at this hospital because he had been treated there for almost a decade for his chronic pulmonary disease. His illness progressed over the years to the point where he required assistance dressing and eating, and this assistance was provided by his wife, who cared for him at home. Mr. J had been admitted to the hospital ten months before, at which time he was intubated and placed on a respirator. Later, there was great difficulty weaning the patient from the machine, but the pulmonologist managed to do so after two weeks. According to the family, Mr. J expressed strong feelings at that time that he should never be placed on a ventilator again.

            During the current presentation, Mrs. J and her nephew spoke with the attending physician in the Emergency Department while Mr. J was taken to the treatment room. They explained what they believed to be the patient’s wishes. That is, they asked that Mr. J be given any helpful medications but not be intubated. They also asked that his code status be “do not resuscitate.” The family said the Mr. J should be made “comfortable” and that necessary medications could be given to him.

            The family did not enter the treatment room with the physician. The physician examined the patient, and in the presence of the nursing staff and respiratory therapists, the physician explained the need for intubation to Mr. J, who agreed to this by nodding his head “yes.” This process took place quickly due to the emergency conditions. Mr. J was intubated and placed on a ventilator within ten minutes of admission. Upon learning of the intubation, the family became very upset.

1. Case Question: In one or two sentences, what is the problem and what is the decision to be made?

2. Parties involved and positions: List the parties to the conflict/discussion/consultation and describe their positions in the discussion. (What do they want or not want to be done?)
   1. Patient:
   2. Family members:
   3. Medical team members:

3. Ethical issues: What are the ethical issues involved in the case and what are the positions of the various parties? List ethical principles in conflict or theories of interest.

4. Options available: What are the options available to the parties and what are the potential outcomes of each option?

5. Principle priority: Given all of the facts of the case, the principles/theories involved and the potential outcomes for the parties, which principle and/or theory should take precedence in this case? Why?

6. Case analysis: Although it is virtually never the job of the ethics consultant to decide what to do, for these case analyses, you are asked to state what you see as the preferred option for the parties in this case. What do you think should be done and why?

Answer 1

the problem here is informed consent was taken by the physician but it is not written but in verbal form.this means that there is no proof for the physician to say that the patient gave consent. the situation must be explained to the family that there was no other option other than intubating the patient.

the parties to the conflict are:

1. patient: he did not wanted to be intubated but agreed due to emergency situations.

2. family: family do not wish mr.j to be resucitated but must be given helpful medications.

3. medical team: resuscitation and intubation is required in order to save the life.

ethical issues: the ethical issue involved is principle of informed consent. this principle applies in this case because before performing any invasive emergency procedure, it is mandatory that the physician must get the wriiten informed consent from patient or family. doctor took informed consent but verbally.this is not justifiable. informed consent must be in written form and requires patient consent with signature. the ethical principle in conflict is informed consent.

options available:

1. the options available are administration of medications but there is no assurance that the patient may survive.

principle priority:

the principle which must be given priority is justice which means fair treatment to all patients. the physician has explained the situation to the patient and made him understand and gave the best tretment possible. so he did justice to his patient.

case analysis: doctor has done justice to his patient by following the ethical principle of justice. the patient family must be explained about principle of justice inorder to solve the conflict.