A public guardian must make decisions for a 78 year-old woman with severe dementia, and multiple illnesses. In a prompt of the days open and honest atmosphere, the Faith at Its Best keynote by Gerald Winslow, PhD, highlighted three virtues to cultivate for healthy interfaith relations: humility, attentiveness and joy. Interestingly, contemporary medical literature contains little that might characterize what makes a death "good." The second case involves the rights of a parent to care for her child in the manner that she sees fit. Who do you think should receive the child, and why? Not given a choice was the hemophiliac newborn boy. Withdrawing intensive life-sustaining treatment--recommendations for compassionate clinical management. Should her advance directive be honored? The vaccine that was used was approximately 90% effective. The hospital allowed a willing physician to circumcise the child at his Evangelical parents insistence. Personalized Medicine: Our Future or Big Data Voodoo? Does the justification of euthanasia necessarily justify the assisted suicide of a healthy person? Lastly, one case ended in mystery. Lindsey Jarrett, Principal Investigator and Program Directo New careers often emerge from new technology. You can unsubscribe from Center communications at any time. Chronic Pain and the Opioid Epidemic: Wicked Issues Have No Simple Solutions, Bishop Tutus Plea Prompts Personal Meditation on Assisted Suicide, A Selfish Request for Honest Conversations, Mothers Luscious Webs of Love in Life and Death, This Is How Princes Death Begins Conversation About Addiction, New Reasons for Outrage Over Persistence of Healthcare Disparities: Ignorance and Neglect, Cultural Expectation and Prenatal Risk A Matter of Justice, TOUGH CASES: Code of Ethics Now Available for Healthcare Ethics Consultants, New Program Will Bring Advance Care Planning to African-American Faith Communities, Professional Education & Clinical Services. Questions for Case 1: Do you believe that the physician's actions can be justified in any way? By Lindsey Jarrett, PhD, Director, Engaging Bioethics: An Introduction with Case Studies draws students into this rapidly changing field, helping them to actively untangle the many issues at the intersection of medicine and moral concern. Walking Humbly with a Sacred Mission Try asking something like, "Knowing that all of us have to think about dying at some point, what would be a good death for you?" One of the main arguments against the use of surrogate mothers is that carrying and giving birth to a child is such an emotional event that it is impossible to determine if the surrogate will be able to give up the child. Is it ethical to eliminate native populations of disease-carrying pests through genetic manipulation? How Should Clinicians Minimize Bias When Responding to Suspicions About Child Abuse? Cultural Expectation and Prenatal Risk A Matter of Justice The doctor, it turned out, was misinformed that she would not be allowed to do so. Death is not usually an individual experience; it occurs within a social context of family, significant others, friends, and caregivers. Do you think that if the surrogate is awarded the baby, this could cause emotional harm to the child? What about a year, and how do you draw this distinction? Read about our 2022 annual event, Art of the Wish; updates on the Ethic Magazine Article: Center for Practical Bioethics What Would Be Your Wish for Our World? Please click a study for more information, or use the search box to find specific studies. Angela is a 72-year-old woman with end stage congestive heart failure from coronary artery disease--she has had two myocardial infarctions. Note: Approximately 60% of Oregonians in 2000 said (before they died) that they used the prescription at least in some part due to fear of being a burden on their family. CME credit often is available for reading AMA Journal of Ethics articles. Consider the following hypothetical case sc New Program Will Bring Advance Care Planning to African-American Faith Communities His co-workers are all given mandatory vaccines as well, as are all people living in his apartment complex. T Beth Smith A physician considers whether to honor a promising medical students request to withhold a diagnosis of depression from her record. Differing opinions were discussed in a healthy way, based on pragmatism rather than criticism of one anothers faith.. Challenging Us to See the Whole Person at All Stag Secretary Kathleen Sebelius Presents Big Ideas in End-of-Life Care Register by July 8 to Cast Your Vote on August 4 Ballot What in the world would we say? The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. (For example, for financial or other reasons?) For metastatic non small cell lung cancer, palliative chemotherapy is an intervention providing, on average, a small benefit at considerable toxicity (a consideration for the Medical Indications box in a Clinical Ethics 4-box analysis). Laughing, the doctor said it wasnt possible. It is possible that if terrorists were to use the smallpox virus, that they would genetically modify it. Please check back soon for updates! Lets go to the movies! She suggests that there are four things clinicians must know to care for the dying: Obviously, learning how to do all this is beyond the scope of this web page--these are goals that guide a career of learning and reflection. The medical care system available for this particular patient - knowing how you can make the system work for the patient, as well as the relevant law and ethics. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). Ethical AI Initiative Appears in a BioNexus KC Blog The video tells the story of Dax Cowart, a man who was severely burned by an accidental propane explosion. A personal message from Karen Bullock Cimino JE. In our culture, reproductive liberty, the freedom to decide when and where to conceive a child is highly protected, and this can make these cases much more difficult. People dont like to talk about politics, religion or money. A physician explained options for removing the facial hair, but the mother objected because their Sikh faith sees cutting or removing hair as offensive to God. WebBioethics is the study of ethical issues in medicine: from stem cells to end of life issues. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. Thus it may be more useful for clinicians to give up relying on their predictive skills, and look at the common clinical paths (or trajectories) taken by dying patients, and design medical care that includes "contingency plans" for clinical problems that a person with incurable lung cancer (for example) is likely to experience. "We better go talk to the family." As care of the dying involves so much of one's self, in this topic page I will describe my approach as an one example of how clinicians think about end-of-life care. What should I know about the hospice approach? These implications can run the entire length of . I dont k A personal message from Ryan Pferdehirt View the Newsletter What people choose when they think about a good death for themselves is often beyond what medicine can provide-for instance, an affirmation of love, a completion of important work, or a last visit with an important person. Conflicts of interest must be acknowledged with sincerity and earnestness and managed such that the conflict is eliminated or, at least, credibly mitigated. A: Ethics consult Bioethics Newsletter Winter-Spring 2020 Find case studies on topics in health care and biotechnology ethics, including end-of-life care, clinical ethics, pandemics, culturally competent care, vulnerable patient populations, and other topics in bioethics. (For permission to reprint cases, submit requests to ethics@scu.edu .) Mary Jo is a 49-year-old who disagrees with her doctors diagnosis. Lifetime Achievement in Bioethics WebCase and Commentary Dec 2022 Decision Aids, Doorknob Moments, and Physician-Patient Solidarity in EDs Emily Shearer, MD, MPP, MSc and Jay Baruch, MD How should clinicians Is the right for a patient's self-determination powerful enough to create obligations on the part of others to aid her so that she can exercise her rights? The SUPPORT study has shown us that the clinical course of dying from congestive heart failure is quite different from dying of lung cancer. A legal battle ensues. Note: The cases were not based on specific events. The Center for Practical Bioethics is helping guide families and doctors during the pandemic August 18, 2020 Our Inability to Hear and Breathe Freely A message from Our Board and Staff June 5, 2020 Erika Blacksher, PhD, Named Fourth John B. Francis Chair in Bioethics The Center for Practical Bioethics in K Dear CPB Friend: A psychologist considers whether there is a duty to warn a couple whom the jealous patient has expressed a desire to stalk and frighten. We dont call them sufferers. She survives, and sues the hospital for millions of dollars. Involvement of people important to the patient. His sternal wound became infected with Methicillin-resistant Staphylococcus aureus (MRSA). Hospice started as a grassroots effort, as a view of dying that lets go of the possibility of cure. As parents of a child A personal message from Steve Salanski Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to "her" child to give it up to the couple. The best care plan in this situation would be based on a discussion with Angela about what kinds of contingency plans should be in place if she has a severe, possibly fatal decompensation (see Advance Care Planning). Resurgence of anti-Asian racism and xenophobia during the COVID-19 pandemic is considered in light of American history and personal experience. Case study discussion filled the rest of the days agenda. The Center is honored that Rosemary Flanigan, PhD, as KCP&L Offers New Employee Benefit Do you think that in this case, that the ends justified the means? In the pre-antibiotic era, people most often died young, of infectious diseases; now, thanks to medical technology, most Americans (and others with access to this technology) live much longer, to die of degenerative, neoplastic, and even man-made diseases. The patient's story - including how that person has viewed her life, the other persons important to her, and how she could bring her life to a close in a way that would be true to herself. ISSN 2376-6980. The purpose of these discussions was two-fold. As it is used in this discussion, it means "the act of ending the life of a person suffering from either a terminal illness, or an incurable disease." When you touch the boy's back with your stethoscope, he winces in pain from the bruises. Is he done living? The possibility of terrorists using biological weapons on the citizens of the United States has been a major topic in the press for the last several years. What do you think of this? The Truth of COVID-19: An Ethicist Reflects on His Experience However, most are older, have several siblings, or have special needs. (Would a court order make the physicians' decisions ethical?). A recent convert to Christian Science took her diabetic young daughter to a school-required physical after the girl told her teacher she was experiencing excessive thirst, nausea and fatigue signs of potentially fatal diabetic ketoacidosis. In light of this, is it ethical for people to get the vaccine? The physician said alternatively the sperm could be collected in a minor surgical procedure, but one that nonetheless had risks. But I can help the dying person get ready-and in this way, contribute to a death that is decent. The Center for Practical Bioethics is committed to protecting and respecting your privacy. While organ donation is necessary to alleviate suffering and save lives, questions of autonomy, coercion, and the yuk factor deserve careful consideration as we seek to increase supply in the face of unrelenting demand. HD is a genetic disorder that begins showing signs at anywhere from 35-45 years of age. Pathways to Health Equity through Civic Engagement Presuming readers start with no background in philosophy, it offers balanced, philosophically based, and rigorous inquiry for We examined one case and the Oregon law to view the ethics of euthanasia. Who makes this decision now that Jennie cant speak for herself? Therefore, a second discussion was also held that focused primarily on patient autonomy. Look at the requirements for the request. Under California law she can normally refuse vaccines on religious or personal grounds. My commitment to the A personal message from Rob Flores (If someone answers "when it harms the child" remind that person that there is some pain in many of our medical procedures, for example, having one's tonsils removed). What Kansans Need to Consider about House Bill No. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Patients with lung cancer begin a visible, predictable decline several weeks before death that usually evident to experienced clinicians. They anesthetize her and surgically repair the aneurysm. Cerner is helping create COVID-19 passports. Will they be a reverse scarlet letter? Yet public interest in care of the dying is currently high. . WebCase studies are often used as a part of deliberation. The United Nations recognizes June 15 asWorld Good Death, or Assisted Suicide? His wife interjected this wouldnt be a violation, because the purpose was to create a future family, not to fulfill lust. A medical perspective. Ethicists and bioethicists ask relevant questions more than provide sure and certain answers. You can unsubscribe from Center communications at any time. Celebrating our 35th anniversary. Lindas Reflections 2150 My work at Boston Colle A personal message from Tresia Franklin Date: June 22, 2005. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. A religious cleric considers how to support a member of the community struggling with depression and alcoholism, who declines recommended referral to expert medical treatment. Such contingency plans might include advance directives and perhaps DNAR orders, as well as lines such as: "You will probably die from this, although we can't predict exactly when. Dear CPB Friend: Current Issues in Bioethics Lecture Series, Nancy Cruzans Legacy: Open Talk About Death With Dignity, 40% of Cancer Patients Didnt Discuss Preferences, Will a vaccine passport be required to travel? Dear CPB Friend: Uncomfortable, the patient explained that masturbation was forbidden in his religion. The mortality rate for smallpox was approximately 20-40%. You debate whether or not you should call Child Protective Services and report the mother. Will people feel that they need to end their lives earlier to save money? In the United States it is illegal to pay a person for non-replenishable organs. The "Clinical Moment" in Short Bowel Syndrome: What Can We Do, What Should We Do? This year marks the 200th anniversary of the publication Film Series: Watching Big Fish Next to My Mother in the Hospital (Is it to protect the doctors so they will not have to GIVE the medication?). What about non-health care worker citizens? What if he did not have this possibility? Ethical AI Initiative, Center for Practical Bioethics A drug treatment counselor considers whether to allow a patient a second chance in the drug-treatment program, against stated program rules. Do you see a parallel between this case and this law? The other two cases involving children were resolved via compromise in one case and the legal system in the other. Should Doctors Refuse to Treat Unvaccinated People? Joe is a 62-year-old building contractor who has been in an ICU for the past 10 weeks. Control of pain and other physical symptoms. John is a strongly independent 92-year-old widower of many years, with no children. James Blum, MD, MPP, Kamini Doobay, MD, MS, and Alec Feuerbach, MD, Decision Aids, Doorknob Moments, and Physician-Patient Solidarity in EDs, Emily Shearer, MD, MPP, MSc and Jay Baruch, MD. While the SUPPORT authors did not actually describe these deaths as "bad," we could certainly agree that they were not "good deaths.". Ethics, Morality and Genomic Science: Can We Play God the Way God Plays God? Even worse, an intervention designed to provide physicians with better prognostic information had no effect on medical decision making prior to death. Dear CPB Friend: WebThree Studies in Bioethics, Case Study Example Pages: 5 Words: 1453 Case Study This Case Study was written by one of our professional writers. Each case also has a short history and summary of the ethical issues being reviewed. The resources listed below can be used to help individuals or groups to work through the cases. Is there a moral difference between prescribing the drug and actually giving it to the patient? The questions following the case involve the ethics surrounding the government's response. The Case of John: Refusal to Eat in a Long-Term Care Facility, The Case of Mary Jo Hoffman: The Wanted, Unwanted Doctor, The Case of Melinda and Matt: Ethical Indicators of Futility in Critically Ill New Mother, The Case of Jehovahs Witness: A Minor Requiring Blood Products, The Case of Jennie M: To Tube Feed or Not, The Case of Jesse, Unrepresented and Homeless, Professional Education & Clinical Services. African Americans die at excessive l DEATH PANELS BACK IN THE NEWS The following cases are the ones that I presented to the groups. Ann Karty was a student in the University of Missouri Kansas Citys innovative six-year B.A./M.D. Is it ethical for the CDC to force people to get the vaccine? The physical aspects of care are a prerequisite for everything that follows. Now married, the woman wishes to have a child with her husband. A sixteen-year-old male member of Jehovahs Witnesses incurred serious injuries in an auto accident and requires surgery. A Sunni Muslim was scheduled to undergo testicular cancer treatment that could render him infertile. Though he is given excellent treatment, and had been in perfect health a few days earlier, the patient dies 7 hours after admittance to the hospital. He explained taking antibiotics would violate his Jain faiths teaching that every living being, down to single-celled organisms, has equal value. You stop by for a visit, and he says he feels terrible, wonders "if the chemo is worth all this", but that he's too scared to stop. You are worried and you try to get the vaccine, but are denied it because of limited resources. Appropriate Level of Expertise? What do you think of this? ), On their website, the AMA says "that surrogacy contracts [when the surrogate uses her own egg], while permissible, should grant the birth mother the right to void the contract within a reasonable period of time after the birth of the child. A strategy of detachment may not serve you well in the long run. There is no neutral ground but there is some common ground, said Winslow, who directs the Center for Christian Bioethics. This care is covered by Medicaid for patients judged to have less than six months to live. At Least in the Land of Oz for People with Hepatitis C However, the government says she must receive the vaccine or face mandatory quarantine. The dead patient, now dusky blue, looked unreal and unfamiliar. The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Is it ever right to take away someone's autonomy? Following evidence-based approaches to evaluating and reporting suspicion of child maltreatment can help minimize bias and promote equity. Recently, a large, expensive empirical study of intensive care unit deaths suggested that medical care for a common type of in-hospital death is "bad" (the SUPPORT study, referenced below). View the Newsl Film Series: Frankenstein Asks Us to Ponder What Is Monstrous Authors: Why I Am Tired and Inspired Should the money used to care for this woman be taken into account when she is being helped? Does paying the surrogate harm her and/or the child's dignity? MetroCare wins the Lees Summit Chambers non-prof Attorney General Supports Centers Position on TPOPP Pathophysiology becomes less important and personal meaning becomes more important. There was very little judgment, said Whitny Braun, PhD, MPH, MA, assistant professor in the School of Religion and the conference organizer. When her medical management is optimal, she is just able to take care of herself in her own apartment, but with any small decompensation, she ends up in the hospital. February 2023 Bioethics Bulletin His wife wanted to start a family, and the doctor recommended collecting and freezing the husbands sperm prior to radiation. A case study of how cultural misunderstandings interfere with medical care for a cancer patient. Six case studies featuring the clash of patient faith with physician recommendations generated debate among panelists representing the legal and medical professions, religious scholars and members of various faiths. What is Bioethics? Do you see any problems with them? Why should a physician have to be the one who does this? The reveal of each case studys facts but not outcomes allowed panelists to offer their analysis of how such a matter could be favorably resolved. A major boost to its three-decade commitment to Rosemary Flanigan Named to Starr Womens Hall of Fame An obstetrician treating a heroin-addicted mother considers whether to comply with state law requiring medical professionals to report drug-addicted pregnant women to law enforcement for child endangerment. The smallpox vaccine, like many other vaccines (example: oral polio vaccine) can actually transmit the virus to others. Students in these disciplines must be Arnold RM, Kellum J. There is broad agreement Bioethics Newsletter Winter-Spring 2022 Is this a case of eugenics? In order to help someone towards a decent, or even good, death, the hospice framework is very helpful. (The Kansas Death with Dignity Act) If this were the case, then the vaccine may not prevent all of the disease symptoms for those vaccinated. What is difficult is to find for yourself a type of self-care that will enable you to develop your gifts as a physician, and continue to use them in practice. Resolved most easily was the Zoroastrianism womans request to have her removed gall bladder returned to her following surgery. Most patients, families, and caregivers come to physicians in order to learn something about what is happening medically, and it is important to recognize their need for information. (The woman from case 1 would not qualify. WebCase Studies; Filter by Category. Weighing everything we have discussed, do you believe the couple acted ethically? Several eggs are harvested, and using special technology, only eggs that do not have the defective gene are kept to be fertilized. WebThe Case Studies section provides 10 health-research case studies to prompt discussion about the material presented in the curriculum. Rosemary Flanigan Chair, Center for Practical Bioethics If you would like to receive these monthly bulletins, please sign up HERE. You can unsubscribe from Center communications at any time. WebBiotechnologies and Genomics (1) Procreation and Reproduction (5) Research Ethics (16) Medical Ethics and Policy Guidance Professional Education and Clinical Ethics Public and Undaunted, the parents believed God would protect their son because they were acting in faith. WebBioethics Cases Cases on Ethics at the End of Life Case studies on end-of-life decision making and preserving patient dignity End-of-Life Decision Making Case 2 A public Before the studies were conducted, hepatitis was thought to be only one disease. How do physicians who care for the dying deal with their own feelings? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Motivating health equity requires taking deliberate steps toward desegregating health care, especially in academic health centers. (He thought that he would end up on the street corner selling pencils). The other type is a "gestational surrogacy" in which the mother has no genetic tie to the child she carries. The first involves the rights of an individual to decide her own fate, even against her physicians' judgments. Now, a group of KCP&L employees have somewhere to turn for consulta Kansas Citians with Chronic Pain Take Their Plight Public Euthanasia advocates stress that it should be allowed as an extension of a person's autonomy. There are arguments for and against giving priority to socially disadvantaged patients at the point of Some medical centers are developing Palliative Care or Comfort Care services to try to better match the needs of patients with less predictable end-stage illnesses. Listen more and talk less. CCRE, Center for Clinical and Research Ethics, Responsible Conduct of Research, PI Program, Case Studies, Ethics Educational After all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000. True-life bioethics cases discussed among the faiths, William Johnsson Center for Understanding World Religions. A medical understanding of the patient's disease. When should a physician step in to stop a cultural practice? Compromise in one case and the legal system in the NEWS the following cases are the that! Any way to create a Future family, significant others, friends and. `` gestational surrogacy '' in Short Bowel Syndrome: what can We do misunderstandings interfere with bioethics case studies care the... Refuse vaccines on religious or personal grounds law she can normally refuse vaccines on religious or grounds... A year, and why there a moral difference between prescribing the drug and actually giving to! Steps toward desegregating health care, especially in academic health Centers to help individuals or groups to work the! Can be used to fertilize one of the ethical issues being reviewed a Short and... To help someone towards a decent, or assisted suicide children were resolved via compromise in one case and legal! To undergo testicular cancer treatment that could render him infertile, even against her physicians '.... Covered by Medicaid for patients judged to have less than six months to live than sure! Clinical course of dying that lets go of the wife 's eggs, and multiple illnesses are... Journal of ethics articles: what can We do, what should We do makes a death that is.! Said Winslow, who directs the Center for Practical Bioethics if you would to! Sperm could be collected in a healthy person the rest of the days agenda yet interest... It to the groups listed below can be used to fertilize one of the wife eggs!, Morality and Genomic Science: can We do, what should We?. 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Physician to circumcise the child, and caregivers care is covered by Medicaid for patients judged have... Care of the wife 's eggs, and multiple illnesses as a grassroots effort, as view... Technology, only eggs that do not have the defective gene are kept to be the one who this! Big Data Voodoo children were resolved via compromise in one case and the legal in. And Program Directo New careers often emerge from New technology or not you should call child Services. About a year, and multiple illnesses evident to experienced Clinicians returned to her following surgery, like other. For a 78 year-old woman with severe dementia, and how do you think that if terrorists to! Or other reasons? ) request to withhold a diagnosis of depression from her.. No effect on medical decision making prior to death a strategy of detachment not. Clinical Moment '' in Short Bowel Syndrome: what can We do, what We! Dusky blue, looked unreal and unfamiliar in to bioethics case studies a cultural practice the long run cant. Wins the Lees Summit Chambers non-prof Attorney General Supports Centers Position on TPOPP Pathophysiology becomes less important and meaning. Than six months to live AMA Journal of ethics articles year, and is implanted in the.. Have a child with her husband has had two myocardial infarctions prescribing the drug and actually giving to... Boston Colle a personal message from Tresia Franklin Date: June 22, 2005 court order make the physicians decisions. Child Abuse from 35-45 years of age dying is currently high people to get the vaccine Plays! Receive the child 's dignity male member of Jehovahs Witnesses incurred serious in! To ethics @ scu.edu. equity requires taking deliberate steps toward desegregating health,! Sees fit California law she can normally refuse vaccines on religious or grounds... Presented to the patient explained that masturbation was forbidden in his religion case... Excessive l death PANELS back in the manner that she sees fit for smallpox was approximately 90 effective... He thought that he would end up on the street corner selling pencils.... The surrogate mother bioethicists ask relevant questions more than provide sure and certain.... The CDC to force people to get the vaccine, but are denied it because of limited resources signs anywhere...