Name: Ma. Fatima Louise L.

Barreiro Section: 3DMT

March 6, 2013 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

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:

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 <http://depts.washington.edu/bioethx/topics/confiden.html> 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

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.