LORMA COLLEGES

College of Education and Sciences

ETHICS: CASE ANALYSIS

Autonomy
Autonomy essentially means "self rule," and it is a patient's most basic right. As such, it is a health
care worker's responsibility to respect the autonomy of her patients. However, at times this can be
difficult because it can conflict with the paternalistic attitude of many health care professionals.
The following two cases address patient autonomy. The first involves the rights of an individual to
decide her own fate, even against her physicians' judgments. The second case involves the rights of
a parent to care for her child in the manner that she sees fit.

Case 1:

A woman enters the emergency room with stomach pain. 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). The physicians inform her that the
only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also
inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a
few short minutes. 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. Even after much
pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her
correct state of mind and knowing that time is of the essence, the surgeons decide to perform the
procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives,
and sues the hospital for millions of dollars.

Questions:
1. Do you believe that the physician's actions can be justified in any way?
2. Is there anything else that they could have done?
3. Is it ever right to take away someone's autonomy? (Would a court order make the physicians'
decisions ethical?)
4. What would you do if you were one of the health care workers?

Case 2:

You are a general practitioner and a mother comes into your office with her child who is complaining
of flu-like symptoms. 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. You ask the mother where the bruises came from,
and she tells you that they are from a procedure she performed on him known as "cao gio," which is
also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a
coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and
improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in
pain from the bruises. You debate whether or not you should call Child Protective Services and report
the mother.

Questions:
1. Should we completely discount this treatment as useless, or could there be something gained
from it?
2. When should a physician step in to stop a cultural practice? (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)
3. Should the physician be concerned about alienating the mother and other people of her
ethnicity from modern medicine?
4. Do you think that the physician should report the mother?

Neferthea N. Quinquito, LPT

 LORMA COLLEGES
College of Education and Sciences
ETHICS: CASE ANALYSIS

Autonomy Part 2

Maintenance of patient autonomy is one of the major ethical focuses of physicians. Therefore, a
second discussion was also held that focused primarily on patient autonomy. This discussion also
took a superficial look at euthanasia. For this discussion, a 58 minute video, Dax's Case (produced
by Unicorn Media, for Concern for Dying ; produced by Donald Pasquella, Keith Burton ; directed by
Donald Pasquella New York : Filmakers Library, c1984) was used. The video tells the story of Dax
Cowart, a man who was severely burned by an accidental propane explosion. The burns disabled
Dax, and the physicians forced treatment on him. Though he survived the treatment, he still argues
that he should have been allowed to refuse it so that he could die. The video is very useful; however,
the videos of Dax's burn treatments are very graphic and the video should be reviewed before it is
shown to a group of students.
Questions:
1. In the video, one of the physicians says that burn patients are incompetent to make decisions
when they first enter the hospital because they are in such a great deal of pain. However,
patients such as Dax can be in a great deal of pain for a very long time. In such cases, what
should be done to determine competence, and when should this be done?
2. Do you think the fact that Dax could not see a future for himself should have been taken into
account when determining his competency? Could this have clouded his judgment? (He
thought that he would end up on the street corner selling pencils)
3. Do you think that the fact that Dax was going to recover, and had the possibility of living a
happy life, made not treating Dax like suicide… or murder? What if he did not have this
possibility?
4. After his recovery, Dax attempted suicide. Should the physicians have let him die? Is it ever
correct for a doctor to allow a patient to kill himself?
5. Do you ever think that it is correct for a physician to break a competent patient's autonomy?
If so, is this one of those cases?
6. Do you think that in this case, that the ends justified the means?

Euthanasia
The word "euthanasia" draws its roots from Greek meaning "good death." 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." The AMA is against physicians assisting in
euthanasia. There is currently only one state in the US that allows for euthanasia, and that is
Oregon, where in 1997, the "Death With Dignity Act" went into effect. Euthanasia advocates stress
that it should be allowed as an extension of a person's autonomy. Those who are against
euthanasia often say that it can lead to the devaluation of human life, and to a slippery slope in
which the old and disabled will be killed on the whims of healthy people. We examined one case and
the Oregon law to view the ethics of euthanasia.

Case 1

A woman was diagnosed with motor neurone disease (the same

disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves,
making control of movement impossible, while the mind is virtually unaffected. People with motor
neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the
inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to
live through the month, and is worried about the pain that she will face in her final hours. She asks
her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her
Neferthea N. Quinquito, LPT
 LORMA COLLEGES
College of Education and Sciences
ETHICS: CASE ANALYSIS
pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble
breathing.

Questions:
1. Does she have a right to make this choice, especially in view of the fact that she will be dead
in a short while (say six hours)? Is this choice an extension of her autonomy?
2. Is the short amount of time she has to live ethically relevant? Is there an ethical difference
between her dying in 6 hours and dying in a week? What about a year, and how do you draw
this distinction?
3. 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? She clearly cannot kill herself. She
can't move, but should someone be FORCED to help her, or to find someone to help her?
4. Should the money used to care for this woman be taken into account when she is being helped?
Do you think that legalizing euthanasia could create conflicts of interest for the patient/ or the
doctor? Will people feel that they need to end their lives earlier to save money?
5. Ask each student: If you were the physician, what would you do? Note: if you would pass her
off to another doctor knowing he or she would do it, does this free you from you ethical
obligations?

Neferthea N. Quinquito, LPT