Chapter 11

Ethics

1 True or false: Adult patients of sound mind are allowed to refuse life-saving treatments.

True. You should not force blood products, antibiotics, or any other treatments on a patient who does not want them.

2 What should you do if a child has a life-threatening condition and the parents refuse a simple, curative treatment (e.g., antibiotics for meningitis)?

First try to persuade the parents to change their mind; if this fails, attempt get a court order to give the treatment. Do not treat until you have talked to the courts unless it is an emergency. Even with Jehovah’s witnesses who do not want their children to receive a blood transfusion, you should seek the court’s assistance in getting the transfusion if it is the only treatment option available.

3 True or false: People with terminal illnesses can choose to die.

True. This is the rationale behind hospice care. Let competent people die if they want to do so. Do not commit active euthanasia, but respect a patient’s wishes for passive euthanasia.

4 What is the difference between active and passive euthanasia?

Active euthanasia is the intentional hastening of death, whereas passive euthanasia is withholding treatments and “letting nature take its course.”

5 With whom can you discuss your patient’s condition?

Only with people who need to know because they are directly involved in the patient’s care and with people authorized by the patient (e.g., authorized family members). Do not tell a medical colleague who is uninvolved with the patient’s care how that patient is doing, even if the colleague is a friend of yours or the patient.

6 In what situations are you allowed to breach patient confidentiality?

Break confidentiality only in the following situations:

 The patient asks you to do so.

 Child abuse is suspected.

 The courts mandate you to do so.

 You must fulfill the duty to warn or protect (if a patient says that he is going to kill someone or himself, you have to tell someone, the authorities, or both).

 The patient has a reportable disease.

 The patient is a danger to others (e.g., if a patient is blind or has seizures, let the proper authorities know so that they can revoke the patient’s license to drive; if the patient is an airplane pilot and is paranoid, hallucinates, and suffers from schizophrenia, then authorities need to know).

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