Read the case study presented at the end of Chapter 8 (Guido, p.133) which begins, “The patient was hospitalized for extreme low back pain…”
Was there informed consent for the initial medications given to the patient?
How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
Was the informed consent deficient to the degree that there was a lack of informed consent for the patient for the second dose of medications?
How would you decide this case?
Read the case study presented at the end of Chapter 9 (Guido, p. 150) which begins, “Jimmy, a Floridian, has undergone two liver transplants.”:
What questions would you anticipate the judge to ask Jimmy to ascertain his level of maturity, understanding of the full consequences of his lack of action, and possible alternative reasons for requesting that he be allowed to make his own medical decisions?
How should the judge evaluate the mother’s response to her son’s request?
Does the state of residency factor into the judge’s decision?
Are there additional issues that should be addressed prior to deciding the outcome of this case?
How would you decide the case?
Jimmy Chang, a 20- year- old college student, is admitted to your institution for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission. His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because “Jimmy has suffered enough.”
You are his primary nurse and must assist in somehow resolving this impasse.
What do you do about the informed consent form?
Who signs and why?
Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective.
Now decide the best course of action based on a purely legal perspective.
Did you come to the same conclusion using both an ethical and a legal approach?
SEE CASE STUDIES BELOW:
You be the Judge: Chapter 8 page 133.
The patient was hospitalized for extreme low back pain so intense that he could not be scheduled for a magnetic resonance imaging (MRI) until his fifth hospital day. His physician explained to him that the Dilaudid and Ativan he would receive the next day to numb his pain for the MRI could cause respiratory depression or arrest in patients like himself who were on high doses of opiates. The patient agreed to be given the medications. At 8:15 A.M. the next day, a nurse gave the patient the medications, but the MRI had to be postponed. With the physician’s new orders and the patient’s verbal consent, the nurse gave a second dose of the same medications at 11:30 A.M. About 5:00 P.M., the patient became stuporous. Vital signs were taken, oxygen was initiated, and Narcan was prepared for injection. At 6:00 P.M., the critical care code team was called, as the patient was in full cardiopulmonary arrest. The patient was successfully resuscitated and was discharged the next day. The patient then sued, claiming residual psychological symptoms and failure to obtain valid informed consent for the second dosage of medications administered at 11:30 A.M.
1. Was there informed consent for the initial medications given to the patient? 2. How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
3. Was the informed consent deficient to the degree that there was a lack of informed consent by the patient for the second dose of medications? 4. How would you decide this case
Chapter 9 page 150
You Be the Judge
Jimmy, a 15-year-old Floridian, had undergone two liver transplants. An only child, he lived with his mother, a single parent. He was prescribed immunosuppressant drugs that caused severe debilitating side effects in an attempt to prevent his body from rejecting the second liver transplant. Understanding that his life expectancy was limited and that the medications were causing the debilitating side effects, Jimmy elected to stop taking the immunosuppressive medications. When his attending physicians discovered that he was no longer taking the prescribed medications, they instituted court proceedings against his mother for child endangerment. Jimmy was readmitted to the hospital at the same time in an attempt to ensure that he restarted the immuno-suppressive mediations. A juvenile court judge held separate meetings with Jimmy, his mother, and the health care team in an attempt to resolve the issue. His mother, at her meeting with the judge, expressed anguish as she felt that not taking the medications would hasten her son’s death, but she was also resolved to the fact that she felt he was mature enough to fully under-stand the consequences of his non-actions. Jimmy assured the judge that he understood the consequences of his non-actions, but he was tired of taking medications that merely increased his pain and suffering and wanted, as stated in his final comment, “some time to be free of pain. I am going to die anyway.” The health care team were unable to assure the judge that taking the medications would greatly increase Jimmy’s longevity.
Questions
1. What questions would you anticipate the judge to ask Jimmy in order to ascertain his level of maturity, under-standing of the full consequences of his non-actions, and possible alternate reasons for requesting that he be al-lowed to make his own medical decisions? 2. How should the judge evaluate the mother’s response to her son’s request? Is she really supportive of his decision? 3. Does the state of residency factor into the judge’s decision?
4. Are there additional issues that should be addressed prior to deciding this outcome of this case? 5. How would you decide the case?
