- What are the relevant features of the case?
- What is the problem?
- What are the possibilities for the resolution of the case (alternatives)?
- What are some of the key considerations with respect to the three principles or other guiding principles (e.g. consent)?
- What is your recommendation? Why?
- Why is your recommendation better than the alternative(s)?
Note: If you have questions regarding the instructions, it is likely the case that your colleagues also have similar questions; therefore, please write them on the Discussion Board instead of in a private email to me.
Case #1:
John, a 67-year-old previously capacitated, functional patient, is admitted to the ICU for severe pneumonia (with no other noted co-morbidities) and requires mechanical ventilation with heavy sedation. His 23-year-old wife, Sue arrives with what she states is a copy of the patient’s advance directive and demands that the ventilator be discontinued. The resident feels uncomfortable with this request and calls for an ethics consult.
Case #2:
Betsy, a 42-year-old mother of 3 discovers that she is pregnant again as a result of failed contraception. Neither Betsy nor her husband, Bill wants another child, but neither of them favour abortion. Betsy decides given her age and a history of Down syndrome in the family, that she wants an amniocentesis to determine the health status of her fetus. If the fetus is healthy, Betsy has decided to continue the pregnancy to term. Otherwise, she would like to have a therapeutic abortion. Although, Betsy is torn she feels that she cannot cope with caring for a disabled child especially since she already has 3 children under the age of 10 at home. Bill wants to continue the pregnancy regardless. He claims, “Children with Down Syndrome are not only capable of giving and receiving affection, and leading rewarding lives, they are also adoptable.” At 18 weeks, amniocentesis reveals that Betsy is carrying an afflicted fetus and she requests an abortion. Bill is very upset with this decision and insists, “We owe this child a chance at life.” An ethics consultation is called.
Case #3:
Tina, a 5-year-old girl was born with serve developmental disabilities due to encephalopathy which has left her profoundly impaired, with the mental life and physical abilities of a 6-month-old child. Her parents look after her at home and are financially strained by this care-giving. The province has provided a nurse for the girl, but only for a few hours a day. They inquire as to the possibility of ceasing their child’s physical maturation—specifically, they would like her bone growth halted and her sexual maturation prevented to avoid menstruation and pregnancy. They argue that she will never benefit or understand her sexual development and that a smaller size will make her easier to care for and less likely to develop pressure sores and feeding problems and inevitably, require institutionalization. An ethics consultation is called.
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