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Essex County College

PTA 101
Ethical Issues
Case Example 1
A dental assistant is working with a dentist in the examination of a new patient. The patient has a
severely abscessed tooth and will require extensive root canal work. As the assistant prepares for
the invasive procedure the patient mentions that his lover has recently died of A!"# and that he
too has A!"#. The assistant free$es. %e is afraid of getting infected with the A!"# virus. Can he
refuse to assist in this procedure&
Case Example '
A nurse(s aide in a hospital is making rounds to pick up lunch trays. An elderly patient has not
eaten her food)again. The aide asks if the patient wants her lunch to be heated. The patient
shakes her head no. *+lease ,ust tell them ! ate everything. ! don(t want any more food. ! ,ust
want to die.- The aide leaves the room with the tray but is upset. .ithout food the patient will
starve to death. !f she lies to the nurse at the patient(s request is she helping the patient commit
suicide& Can a competent adult refuse to eat& !s the patient competent&
Case Example /
A nurse(s aide has been employed by a family to take care of a 01year1old girl severely brain
damaged in a near1drowning accident when she was /. "uring the / months the aide has been
employed he has gotten to know his young patient well. Although the girl cannot talk he has
learned what foods she likes and does not like that she sleeps better if she is placed on her right
side that she cries whenever she hears loud noises and that she likes to listen to music. 2ne day
the aide accompanies the patient and her mother to a doctor(s office)the patient needs minor
surgery on her hand to remove a small cyst and that will be done in the doctor(s office. The
doctor asks the aide to stay with the child to help hold her hand in place while the minor surgery
is done. The aide notices that the doctor is not preparing to give the child a numbing shot on her
arm where the surgery is to be done. The aide asks about this and the doctor states *#he doesn(t
need anything. #he(s ,ust a vegetable.- %ow should the nurse(s aide begin to solve this moral
dilemma& .here should any healthcare professional begin when faced with a bioethical
problem&
Case Example 3
A medical assistant is employed in an oncologist(s office. %e greets a patient he knows well a
4'1year1old woman with leukemia. %er bloodwork shows that her white blood cell 5.6C7 count
is down. The assistant gives this result to the doctor who orders an infusion of fresh fro$en
plasma 588+7. The assistant reminds the doctor that the patient is a 9ehovah(s .itness a religious
group that refuses all blood products including 88+ in treatment. The doctor becomes angry.
*9ust tell her it(s medicine that ! ordered. "on(t tell her it(s a blood product. !t(s not red so she(ll
never guess. !t(s the only thing ! have that can help her right now.- #hould the medical assistant
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lie to the patient at the request of the doctor& Either he must obey the doctor and lie or refuse to
reveal to the patient that the doctor has ordered a blood product for her or he must disobey the
doctor and inform the patient that her treatment is a blood product. %is only other option is to
leave the office)which will cost him his ,ob and will still not assist the patient. The medical
assistant must make a choice.
Case Example :
A high school student studying in a health professions course at school spends a day following a
nurse in her practice in an obstetrics1gynecology clinic. .hile at the clinic a classmate patient
comes in to be treated and is recogni$ed by the student. The patient is pregnant and is upset and
unsure about what to do about her pregnancy. The nurse with the student watching and listening
spends a lot of time counseling the patient. ;ater the health professions student is stopped by a
friend in her class. *%ey ! saw you with "idi in the clinic- the friend observes. *.hat was she
in for& !s she pregnant&- #hould the health professions student reveal the patient(s diagnosis&
Case Example 4
An elderly woman is transported to an Emergency "epartment with severe respiratory distress.
#he has severe end1stage lung disease and has clearly expressed to her family friends and
physicians that she does not want her life artificially prolonged. %owever her loving husband
and family cannot bear the thought of her death and beg that *everything be done- to preserve
her life. They state that she is mentally depressed by her condition and her family is best able to
decide her medical treatment. %er attachment to a respirator will allow her to survive. !f this is
done she may or may not recover sufficiently to come off the respirator. .hat should be done&
Case Example 0
A 13 year old female is brought against her will to the E< by her parents. The teenager has been
missing from home for three days and when she returned home was found to have bruises on her
neck she could not explain. %er parents want her to be evaluated for possible sexual abuse. "r.
=reen obtains a history from the parents and discovers that the parents have recently separated.
Their daughter provides a vague story of her three day adventure including sleeping over at her
girlfriend(s boyfriend(s house going to sleep and waking up with marks on her neck. .hat
should be done&
Case Example >
A 30 year old woman is brought by a paramedic ambulance to the hospital because of severe
in,uries sustained in a ?@A. #he demonstrates signs of shock including significantly low blood
pressure and appears to be in need of a blood transfusion to prevent death. The emergency
physician "r. .hite explains the seriousness of her in,uries the need for immediate blood
resuscitation and the high risks including possible death if the transfusion is not administered.
!n spite of her in,uries she is conscious and appears to comprehend the seriousness of her
medical condition. #he refuses the transfusion and clearly explains her religious ob,ections since
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she is a 9ehovah(s .itness. "r. .hite faces the ethical decision as to whether save the patient(s
life and live her a blood transfusion against her will or honor her religious beliefs and allow her
to die. .hat should be done&
Case Example A
A woman enters the emergency room with stomach pain. #he undergoes a CT scan and is
diagnosed with an abdominal aortic aneurysm a weakening in the wall of the aorta which causes
it to stretch and bulge 5this is very similar to what led to 9ohn <itterBs death7. The physicians
inform her that the only way to fix the problem is surgically and that the chances of survival are
about :CD:C. They also inform her that time is of the essence and that should the aneurysm burst
she would be dead in a few short minutes. The woman is an erotic dancerE she worries that the
surgery will leave a scar that will negatively affect her workE therefore she refuses any surgical
treatment. Even after much pressuring from the physicians she adamantly refuses surgery.
8eeling that the woman is not in her correct state of mind and knowing that time is of the
essence the surgeons decide to perform the procedure without consent. They anestheti$e her and
surgically repair the aneurysm. #he survives and sues the hospital for millions of dollars.
FuestionsG
"o you believe that the physicianBs actions can be ,ustified in any way&
!s there anything else that they could have done&
!s it ever right to take away someoneBs autonomy& 5.ould a court order make the
physiciansB decisions ethical&7
.hat would you do if you were one of the health care workers&
Case Example 1C
Hou are a general practitioner and a mother comes into your office with her child who is
complaining of flu1like symptoms. Ipon entering the room you ask the boy to remove his shirt
and you notice a pattern of very distinct bruises on the boyBs torso. Hou ask the mother where the
bruises came from and she tells you that they are from a procedure she performed on him known
as Jcao gioJ which is also known as Jcoining.J The procedure involves rubbing warm oils or
gels on a personBs skin with a coin or other flat metal ob,ect. The mother explains that cao gio is
used to raise out bad blood and improve circulation and healing. .hen you touch the boyBs back
with your stethoscope he winces in pain from the bruises. Hou debate whether or not you should
call Child +rotective #ervices and report the mother.
FuestionsG
#hould we completely discount this treatment as useless or could there be something
gained from it&
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.hen should a physician step in to stop a cultural practice& 5!f someone answers Jwhen it
harms the childJ remind that person that there is some pain in many of our medical
procedures for example having oneBs tonsils removed7
#hould the physician be concerned about alienating the mother and other people of her
ethnicity from modern medicine&
"o you think that the physician should report the mother&
!n the Inited #tates it is illegal to pay a person for non1replenishable organs. The fear is
that money will influence the poor to harm their bodies for the benefit of the rich. "o you
see a parallel between this case and this law& Can allowing surrogate mothers to be paid
for their troubles allow poorer women to be oppressed&
"oes paying the surrogate harm her andDor the childBs dignity&
!s it selfishDconceited for this couple to want children of their own genetic make1up& !f
yes does this change if you can JeasilyJ have a child& 5KoteG 2ver 1CCCCC children in
the I.#. are waiting to be adopted. %owever most are older have several siblings or
have special needs.7
2n their website the A?A says Jthat surrogacy contracts Lwhen the surrogate uses her
own eggM while permissible should grant the birth mother the right to void the contract
within a reasonable period of time after the birth of the child. !f the contract is voided
custody of the child should be determined according to the childBs best interests.J "o you
see any problems with this& 5.hatBs a reasonable time& !n a way can you steal the
surrogateBs child&7
2ne of the main arguments against the use of surrogate mothers is that carrying and
giving birth to a child is such an emotional event that it is impossible to determine if the
surrogate will be able to give up the child. Though adults enter into the contract the child
could ultimately suffer if a long custody battle ensues 5as it could in states where
surrogacy contracts hold no legal value such as @irginia7. .ith the possibility of such
battles do you think it is acceptable for parents to use a surrogate mother&
"o you think that if the surrogate is awarded the baby this could cause emotional harm to
the child&
.ho do you think should receive the child and why&
Case Example 11
A married couple wishes to have a childE however the /' year old mother knows that she is a
carrier for %untingtonBs disease 5%"7. %" is a genetic disorder that begins showing signs at
anywhere from /:13: years of age. !ts symptoms begin with slow loss of muscle control and end
in loss of speech large muscle spasms disorientation and emotional outbursts. After 1:1'C years
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of symptoms %" ends in death. %" is a dominant disorder which means that her child will have
a :CN chance of contracting the disorder. 8eeling that risking their babyBs health would be
irresponsible the couple decides to use in vitro fertili$ation to fertili$e several of the wifeBs eggs.
#everal eggs are harvested and using special technology only eggs that do not have the
defective gene are kept to be fertili$ed. The physician then fertili$es a single egg and transfers
the embryo to the mother. Approximately A months later the couple gives birth to a boy who
does not carry the gene for the disorder.
!s this a case of eugenics& JEugenicsJ is defined as Jthe hereditary improvement of the
human race controlled by selective breedingJ 5dictionary.com7
.ould it be acceptable for the parents to select for sex as well or should they only select
an embryo that does not have %"& %ow would this be different&
!s it ethical for this couple to have a baby when the mother could begin showings signs of
%" when the baby is ,ust a few years old&
.ith this technology possible would it be ethical for this couple to have a child without
genetically ensuring it would not have the disease& .hat if we did not have this
technology would it be ethical for a known carrier to have a child& 5!f not how far
should this carry& a carrier for cystic fibrosis 5which is recessive7& 7
.eighing everything we have discussed do you believe the couple acted ethically&
Case Example 1'
A mother brings her son into the emergency room during an asthma attack. Though both
of his parents work they cannot afford medical insurance for themselves or him. They
also earn too much money to qualify for state or federal aid. %e is treated for his asthma
attack at the hospital and he and his mother leave. Two weeks later they return to the
hospital in a virtually identical scenario.
FuestionsG
"o you think that this boy is receiving adequate care&O#houldnBt he be able to see a
primary care physician before his condition gets so acute that he must visit the E<&
#hould everyone be entitled to a basic Jminimum of health careJO or to the exact same
health care&
"o you think that health care is a right& !f so are we forced to honor this right&
!f you answer *right- to this question is this right relative or universal& "oes this right
exist because of the wealth of the Inited #tates or is it applicable everywhere& !s health
care a luxury&
"oes having money entitle a person to better health care& 5they may have worked harder
for their greater wealth7
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Case Example 1/
An upper middle class middle aged Canadian man is playing racket ball when he suddenly feels
a pop in his knee. !n pain he makes an appointment with his general practitioner and is seen the
next day. %e is given pain medication and is referred to an orthopedic surgeon 5he has no choice
of who he will see7. After a week wait he is seen by the orthopedic surgeon and is told he will
need surgery. Two weeks later surgery is performed on the manBs knee. The physician who is not
very good does a poor ,ob on the knee and the man walks with a slight limp for the rest of his
life. The surgery costs the man no money directly however he pays for it with higher taxes.
FuestionsG
.hat do you think of this manBs experience in comparison to case 1& .hich situation
seems worse and why&
"oes it seem like it took too long for him to receive care& 5The physicians will perform
surgery on the more urgent patients first and then on the less serious.7
.hat do you think about not being able to choose your own physician& 5KoteG !n the
Inited #tates many insurance companies limit which physicians you choose.7
2ne suggested solution for our current health care woes is that care for the elderly be
decreasedDeliminated. 8or example people over the age of >C will no longer be placed on
life support which costs approximately P1CCCC per day to operate. .hat do you think of
this&
.hat do you think could be a good middle ground solution to this problem&
Case Example 13
"ateG 9une '' 'CC:. A '01year1old man is brought into a Kew Hork City emergency room with a
1C11degree fever and what he believes is chickenpox 5@aricella7. After a brief examination the
/:1year1old physician is pu$$led because the pox do not appear to be typical of the varicella1
$oster virus. .orried he calls in another physician for her opinion. #he takes one look at the
patient determines he has small pox and immediately orders him to be quarantined. #he notifies
the Centers for "isease Control and +revention 5C"C7 and asks them what should be done.
.hile doing background on the patient he tells the physicians that he is a flight attendant and
that he has flown to 2rlando 8; ;os Angeles CA Chicago !; and #eattle .A in the past few
weeks while working. Though he is given excellent treatment and had been in perfect health a
few days earlier the patient dies 0 hours after admittance to the hospital.
The C"C decides that mandatory small pox vaccines will be administered to all workers in the
KHC hospital and to all patients who were in the E<. %is co1workers are all given mandatory
vaccines as well as are all people living in his apartment complex. They also ship stored
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quantities of the vaccine to all of the cities where the man had flown to for work. The vaccines
are offered to citi$ens of these cities. 8inally all people along with their families who had been
on the manBs flights in the weeks preceding the appearance of the disease are forced to receive
the vaccine.
FuestionsG
KoteG The flight attendant was most likely given small pox by a bio terrorist who flew on his
plane sometime during the past weekDweek and a half. The terrorist would have been contagious
but would not have shown symptoms. @irtually every person the man came into contact with
would have gotten the virus.
!s it ethical for the C"C to force people to get the vaccine&
An ;A woman on the flight is religiously opposed to vaccines. Inder California law she
can normally refuse vaccines on religious or personal grounds. %owever the government
says she must receive the vaccine or face mandatory quarantine. .hat do you think of
this&
"o you think that for more common diseases for example measles that it is ethical for
the state to allow people to refuse vaccines 5even for religious grounds7& .hat if their
refusal can harm others who cannot have the vaccine such as people who are
immunocompromised like A!"# patients&
!s it ethical for someone to refuse the vaccine&
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