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Name: Ma. Fatima Louise L. Barreiro March 6, 2013

Section: 3DMT Sir Ray Ann Cagampang

Making Right Choices

Case I:

A 64-year-old woman with MS is hospitalized. The team feels she may need to be placed

on a feeding tube soon to assure adequate nourishment. They ask the patient about this in the

morning and she agrees. However, in the evening (before the tube has been placed), the patient

becomes disoriented and seems confused about her decision to have the feeding tube placed. She

tells the team she doesn't want it in. They revisit the question in the morning, when the patient is

again lucid. Unable to recall her state of mind from the previous evening, the patient again agrees

to the procedure.

Source:Ethics in Medicine. University of Washington School of Medicine

Retrieved from http://depts.washington.edu/bioethx/topics/consntc1.html

Reflection: Referring to the case above, A 64 year old women is diagnosed with Multiple

Sclerosis. The medical team recommended that the woman be placed on a feeding tube as soon

as possible to assure that she gets adequate nourished. The woman seemed to be disoriented as

confused with her decision due to memory loss.

The principle of Informed Consent is the process by which a fully informed patient can

participate in choices about her health care. It comes from the legal and ethical right that the

patiend has to direct what happens to her and from the ethical duty of the physician to involve

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the patient in her health care. The principle must follow several elements; the nature of the

decision/procedure, reasonable alternatives to the proposed intervention, the relevant risks,

benefits, uncertainties related to each alternative, assessment of patient understanding and the

acceptance of the intervention by the patient

Informed consent includes the discussion of the following elements. As a physician,

you are obligated to discuss the issue, the recommendations and proposed

interventions for your patient. Considering the patients competency to decide at hand,

this patient's underlying disease is impairing her decision making capacity. If

the patients wishes are consistent during her lucid periods, this choice may

be considered her real preference and followed accordingly. However, as her

decision making capacity is questionable. Getting a surrogate decision

maker involved can help determine what her real wishes are. If no

appropriate surrogate decision maker is available, the physicians are

expected to act in the best interest of the patient until a surrogate is found

or appointed.

In cases of emergency like this, when patient is incompetent of

deciding and no surrogate decision make is available, it is the obligation of

the doctor to do his/her best to include the decisions of the patient in her

health care. The principle of beneficence may require the physician to act on

the patients behalf when her life is at stake.

Case II:

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Mr. Fredrickson, 60-year-old man had a heart attack and is

admitted to the medical floor with a very poor prognosis. He asks

that you not share any of his medical information with his wife. He

does not think she will be able to take it. His wife catches you in the

hall and asks about her husband's prognosis.

Source:Ethics in Medicine. University of Washington School of Medicine.

Retrieved from

Reflection: Mr. Fredrickson have experienced a heart attack. He wishes that

his medical information be confidential and not be informed to his wife.

This case involves the principle of Confidentiality. Confidentiality refers to a

respect for an individual's autonomy and their right to control the information relating to their

own health. This principle not a single ethical principle in itself, rather it is linked in to several

bioethical principles.

As a physician, it is your duty to maintain confidentiality for an individuals autonomy

and right to control the information relating to their own health. Mr. Fredrickson decides that you

keep his health information from his wife. However, the wife is certainly affected by her

husband's health and prognosis. As a doctor, without permission from the patient to inform his

wife is generally unjustifiable. Every effort should be made to encourage an open dialogue

between them. It remains his responsibility to do so and talk it over with his wife. In cases where

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the spouse is at special risk of harm correlated to the diagnosis of the patient, it remains the

patients decision if he/she is to inform the spouse.

As a physician, you have fulfilled and maintained the professional relationship shows a

respect for autonomy, beneficence towards the patient and a desire to act non-maleficently.

Keeping the information confidential, as a doctor, creates a trusting environment by respecting

patient privacy can encourage the patient to be honest as possible during courses of visit.