Our recently published Bioethics in Context covers a wide range of topics, including: appropriate measures one should take to obtain informed consent and to protect patient privacy, dealing with patients who exhibit signs of mental illness, responding to sensitive cultural and religious concerns, and balancing the needs of medical researchers with those of patients participating in clinical trials. The book is uniquely up-to-date in its discussion of health care law, and unpacks the complex web of American policies, including the Patient Protection and Affordable Care Act, so as to make it intelligible to those without legal expertise. Useful case studies and examples are embedded throughout, and a companion website offers a thorough curated database of relevant legal precedents as well as additional case studies and other resources.
We’ve included one of the case studies from the extensive website component below. Test your prowess at Bioethics by attempting the discussion questions – can you get them all right?
Patient Accepts One Treatment but Under Surgery Needs Additional Procedure
Sally Violet is a 21 year old woman who has faced a series of difficult medical interventions. Kidney failure, pulmonary obstruction, and liver disease are among her problems. Due to her circumstances, she is not likely to live for more than 10 years. However, she is beginning to resist medical intervention. Her parents talked her into one more surgery. She reluctantly agreed, but in return received a promise from her parents that they will not pressure her into any other intervention after this one. This surgery, she insists, will be the last intrusive procedure she will undergo. “It isn’t worth it anymore,” she said. Her doctors, including her surgeon, Dr. Stoer, know about Sally’s attitude, and believe it to be unfortunate. Who knows what medical advances may help Sally during the next 10 years? She might live longer than anyone thought.
Sally undergoes surgery, but during the surgery Dr. Stoer unexpectedly discovered what appears to be a malignant growth. Malignant or not, it needed to be removed because it could become life threatening. Given that Sally may reject another surgery, Dr. Stoer decides to seek permission from Sally’s parents to remove the tumor, rather than wait until Sally wakes up and recovers. Although potentially malignant, there is no urgent need to resect it at this time. In fact, the standard procedure would have been to close, give limited radiation, then resect or debulk the tumor. Sally’s parents agreed to the extension of the surgery, as Dr. Stoer predicted they would.
After the surgery Sally feels betrayed. She believes that she might have a battery claim against Dr. Stoer because he fully understood she did not want any additional procedures. Given that Sally is dependent on her parents financially and as caretakers, she doesn’t think she will go forward with a lawsuit, but wishes she could. She doesn’t blame her parents, because she understands their desire for her to live. But a professional, she says, should know better than to deny a person informed consent.