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EthicsCaseStudyForm edit

Title UTMB Human Subjects-Ethical Conflicts_No areas
Long Title UTMB Human Subjects-Ethical Conflicts in the Doctor-Patient Relationship
Contributor/Contact Michele A. Carter, PhD (mcarter@utmb.edu)
Contributor Details Michele A. Carter, PhD?
Director, Ethics Support Key Resource, Institute for Translational Sciences
CTSA UTMB Galveston
Case Study Provided Mr. J, a 35-year-old husband and the father of two children, has already had two kidney transplants as a result of polycystic disease of the kidney, and he now has an elevated PRA. He has been on dialysis for 2 1/2 years and has become increasingly reluctant to continue treatments. In the past couple of weeks, he has been showing up late for hemodialysis and signing off early. Two days ago, he refused to come for his scheduled hemodialysis. As his condition deteriorated, his wife called an ambulance and had him brought in to the ER, demanding that he be dialyzed. She insists that he is depressed because he has recently lost his job and that the doctors should not allow him to stop dialysis. She believes that the doctors will be killing him if they stop the dialysis treatments. Her husband is a young man, she says, and she needs him to help bring up their children.
Data Acquisition, Management, Sharing and Ownership Topics No Data acquisition_management_sharing and ownership Topics
Mentor and Trainee Responsibilities Topics No mentor and trainee responsibilities topics
Publication Practices and Responsible Authorship Topics No publication practices and responsible authorship topics
Peer Review Topics No peer review topics
Collaborative Science Topics No collaborative science topics
Research Misconduct Topics No research misconduct topics
Conflicts of Interest, Law and Policy Topics No conflicts of interest_law_and policy topics
Human Subjects Human subjects research
Citation English, Dan "The Patient-Physician Relationship," in Bioethics: A Clinical Guide for Medical Students. 1994 W.W. Norton & Co: NY, pp. 1-15.
URL

RCR Keyword

Other RCR Keywords Human Subjects; Human Value; Judgment; Doctor-Patient Relationships; Ethical Conflicts; Personal; Cultural; Humanistic; Moral; Family; Transplant
Case Difficulty Advanced
Type of Case

Source for Topic Areas Du Bois, J., & Dueker, J. (2009). Teaching and Assessing the Responsible Conduct of Research: A Delphi Consensus Panel Report. Journal of Research Administration, 40(1), 49-70.
References English, Dan "The Patient-Physician Relationship," in Bioethics: A Clinical Guide for Medical Students. 1994 W.W. Norton & Co: NY, pp. 1-15.
Other Overall Objective:
Medical Students will demonstrate understanding of the core ethical values operating in the doctor-patient relationship, and demonstrate basic skills in problem solving regarding ethical conflicts in the doctor-patient relationship.

Background:
• Ethics is concerned with human experience and human value. To value something is to regard it as a desirable and worthwhile thing to have or possess. Ethical values are concerned with judgments about what is good/bad, right/wrong/, and just/unjust in our conduct, actions, or relationships with other people.
• The relationship between the physician and the patient is a helping relationship. Like other relationships where people entrust to others something they value, it is also a moral relationship.
• Ethical values such as trust, caring, helping, honesty, respect, fairness, and integrity are the moral cement of the doctor-patient relationship and are essential for good care.
• Teaching about human values in medicine is an intrinsic part of the process of training good doctors. An understanding and appreciation of the ethical values in medicine helps to cultivate sensitivity to personal, cultural, humanistic, and moral concerns and conflicts that can arise in the everyday practice of medicine.

Discussion:
1. What does Mr. J's conduct say about what he values or disvalues?
2. What does Mrs. J's conduct say about what she values or disvalues?
3. What is the doctor's primary ethical obligation in this case? Where does this obligation come from?
4. Do you agree or disagree that not providing the patient dialysis treatment would be a form of killing him?
5. Can a physician ever withhold life-sustaining treatment such as dialysis on a patient like Mr. J? What further information is needed in order to answer this question?
6. In your opinion, is it ethically okay to let Mr. J continue to refuse hemodialysis? Why or Why not?

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Topic revision: r4 - 13 Nov 2011 - 19:25:04 - MarkYarborough
 
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