Medical Ethics Case Study
According to Dr. Charles M. Culver, ethical dilemmas in medicine “are more conspicuous and more openly discussed than they were ten or twenty years ago,” due to two important factors, namely, “the increased sophistication of medical technology and medical treatments” and because “patients are demanding more of a voice in making decisions about their treatment” (1990, p. 3). Thus, the case study described below is a prime example on how ethical dilemmas in medicine can often become overwhelming, so much so “that the decisions of doctors and medical specialists are sometimes questioned as to their motives and aspirations” (Haring, 1973, p. 245).
In this case study, 72-year-old Joanna Alexander suffers from Alzheimer’s Disease and diabetes. The latter disease has brought about gangrene in both of her feet, a rather common result in those suffering with diabetes. Her physician is convinced that, in order to save her life, both of her feet must be amputated. However, Ms. Alexander has make it clear to her physician that she does not wish any surgical procedures to be performed at any time, despite knowing that the gangrene in her feet will eventually kill her. Also, Ms. Alexander’s immediate family agrees with her and refuses to give their consent for the amputation, due to feeling that the physician’s motivation for the amputation centers around the testing a new post-amputation experimental medication on Ms. Alexander. Obviously, Ms. Alexander’s family members only have her safety and well-being in mind, for her death would mean considerable financial gain for these family members.
Characteristics of the Dilemma:
In essence, what is one to do in such a situation? Although the physician, being a highly-trained medical specialist/surgeon, fully realizes that Ms. Alexander will die from the gangrene infection in her feet if amputation is not performed, the question is whether he is bound by ethical considerations to yield to the wishes of his patient and her family members or use his better judgment as a physician and perform the operation without their consent.
In addition, since Ms. Alexander suffers from Alzheimer’s Disease, “characterized by confusion, memory failure, disorientation and… hallucinosis” (Glanze, 1990, p. 49), she may not fully understand that the gangrene in her feet requires immediate attention or else she will die prematurely (depending, of course, on how far her Alzheimer’s has progressed). The opinion of her family is also quite perplexing, for they surely know that gangrene will lead to Ms. Alexander’s death; their fear of the physician’s alleged motivation for using Ms. Alexander as a “guinea pig” for the post-amputation experimental medication is also perplexing. Obviously, they wish for Ms. Alexander to live as comfortable as possible for the time she has left and are not concerned about gaining financially from her death.
For this situation, Dr. Culver offers some advice on how the physician should act in the case of Ms. Alexander. First, “a family may be deeply divided about the appropriate treatment for their loved one,” which, in the case of Ms. Alexander, is between the family and the physician. Such disagreements “can be exceedingly difficult, if not impossible, to resolve in a short time at the bedside of a… patient” (1990, p. 195). Thus, the physician in this case faces one of the most common predicaments associated with medical ethics, that is, whether to override the concerns and disagreements of family members and proceed with an operation that will, in the long run, provide relief to the patient and extend his/her life.
Another aspect has to do with prognosis which can often be “a critical factor in a patient’s choice of desired levels of treatment,” especially when the patient suffers from a “disorder of the central nervous system” (Culver, 1990, p. 95) as in the case of Ms. Alexander and her Alzheimer’s. Her physician obviously knows that Ms. Alexander’s Alzheimer’s will eventually cause her premature death, for in most instances, the prognosis of Alzheimer’s is no more than seven-year from the onset of the disease (Glanze, 1990, p. 49). Worse yet, gangrene can lead to death within a very short time if not treated; in some cases, the gangrene may be too advanced which, in the case of Ms. Alexander, requires amputation. Thus, the prognosis for gangrene is death.
Therefore, exactly how should the physician in this case respond to the desires of Ms. Alexander and her family members and what should he do — operate or let his patient die a rather horrible and painful death? Clearly, there is no solid resolution to this case unless the physician can convince Ms. Alexander’s family members of his professional sincerity and the need to amputate. Perhaps this case could best be resolved via some type of group consultation, made up of physicians and other medical specialists, who could then come to an agreement with Ms. Alexander’s family members regarding whether to amputate or allow Ms. Alexander to die prematurely.
Culver, Charles M., Ed. (1990). Ethics at the Bedside. Hanover: University Press of New England.
Glanze, Walter M., Ed. (1990). Mosby’s Medical, Nursing and Allied Health Dictionary. St. Louis: C.V. Mosby Company.
Haring, Bernard. (1973). Medical Ethics. Notre Dame, IN: Fides Publishers.
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