What do we know?

Idara C. Eshiet

Competency

1. How do you determine if a patient is competent when presented with a case?

2. If a patient is said to be drunk is the patient considered competent?

3. A patient that self mutilates is he/ she considered competent?

Informed Consent

1. When do you give informed consent?2. If a patient waives informed consent how

do you go ahead with the procedure?3. How do you get consent from a patient

who doesn’t speak English?4. A 23 year old man comes in for an

appendectomy. While performing the procedure you see multiple polyps on his colon. Do you do a biopsy of the polyps?

Emancipated Minors

1. What makes a minor emancipated?2. Is a pregnant minor considered an

emancipated minor?3. Can a minor live with his/ her

parents and still be emancipated?

HIV status

You are a cardiothoracic surgeon who is HIV positive. You have a patient scheduled to have surgery done. Do you need to inform the patient of your HIV status?

Mentally- ill patients

1. Do doctors commit patients?2. When a patient is committed what

does that mean?3. Can a committed patient refuse

treatment?4. Can minors be committed?

Case 1

A 15 year old female patient comes to see you for routine check- up prior to going to summer camp. You have been her physician for the past yrs. You have done the physical exam and your findings are unremarkable. As you are filling out her forms she tells you that she is going to summer camp with her new boyfriend and they have decided to start having sex . She wants a prescription for OCP’s. she also requests that you do not tell her parents. What will you do?

a. Give her the prescription and promise not to tellb. Counsel and give her advicec. Tell her you have to tell her parentd. Report to the hospital ethics committee

Case 2

A 5-year-old boy with Down syndrome is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute lymphoblastic leukemia. The physician recommends a bone marrow aspiration to confirm the diagnosis and subsequent cytogenetic studies as needed. The patient's parents refuse to consent to the procedure because they think such an invasive test will cause their son too much unnecessary pain. Without confirmation of the diagnosis and results from cytogenetic testing, the patient's treatment may be adversely affected.

Which of the following is the most appropriate next step for the physician?

(A) Accede to the parents' wishes to spare their son further pain(B) Consult child protective services(C) Discuss options to manage the potential pain during the

procedure(D) Do the necessary procedure despite the parents‘ objections(E) Explain that the child will die if the procedure is refused