What Would You Do? Test Yourself on This Ethical Dilemma

Kenneth W. Goodman, PhD

Disclosures

August 08, 2012

In This Article

Editor's Note:
This interactive case follows 1 patient and pinpoints some of the ethical issues that her physician encounters. How would you deal with these issues? Did you choose the best option? Read through the case, select the options that best reflect your own views, and read what bioethicist Kenneth W. Goodman, PhD, Professor and Director, Bioethics Program, University of Miami, Florida, has to say about the choices.

Introduction

Kenneth W. Goodman, PhD

Ethical challenges or dilemmas may arise at any time during medical practice. You might even face several ethical issues during the care of a single patient. Some major ethical dilemmas may involve life-or-death issues, whereas others involve small instant decisions that weigh on your conscience.

These unheralded daily decisions ultimately define you as a person and illuminate your standards and stances toward patient care and the role of a devoted physician.

Look at this patient-care case, which involves several ethical decisions; then, take the self-test at various points. See how your responses compare to those of your colleagues, and look more deeply into the reasons why you chose as you did.

Situation: The Case of Anne R.

Your longtime patient, Anne R., is a relatively frail, 85-year-old woman who has lived more or less successfully at home since her retirement 20 years ago. Paul, her husband of 47 years, died 10 years ago. In many respects, she is still mourning his loss. Her life is generally solitary, inactive, and boring.

Anne has 2 daughters who live with their families in Houston and Toronto, both 3-hour plane rides away. They try to visit for holidays, and each daughter attempts to arrange to have her visit at least once a year. They seem to be a dedicated and loving family, albeit separated by nontrivial distance. However, Anne is increasingly reluctant to travel.

Anne has several maladies that you have been managing: atrial fibrillation; an arteriovenous malformation that causes occasional, and sometimes severe, gastrointestinal bleeding; chronic obstructive pulmonary disease; and osteoporosis. She has fallen twice but suffered only minor bruises.

Nine years ago, you partly convinced Anne of the importance of advance directives, although she winced and turned away when you raised the issue. In a designation of surrogate, she named both her daughters to make decisions for her if she became unable to do so, but she also declined to complete a living will. "I can't think about that right now," she said.

One night at 11:50, you receive a call from a hospitalist at General Medical Center, where you have privileges. Anne apparently had begun to feel very poorly and called 911. A workup in the emergency department showed atrial fibrillation. She is currently stable but uncomfortable. Her daughters do not yet know of this episode. You need to decide what to do.

What Should You Do?

Decision Point: Should You Go to the Hospital to See Anne?

Pro: You know Anne better than the doctors at the hospital do, and she is frightened and alone, with several comorbidities. You know it would be supportive and helpful to go, and you might be able to provide some information or help in some way.

Con: It is late and you're tired. You tell yourself that your presence would add very little. Anne could be transferred to the floor or admitted to the critical care unit, in the capable hands of others, until tomorrow.

Would you go to the hospital?

Would you wait until the next morning?

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