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  #1  
Old 01-21-2012
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Medicolegal and Ethics Parents refused antibiotics for their child with meningitis!

A 10-y-old boy develops meningococcal meningitis and is hospitalized in the pediatric intensive care unit. The boy's parents do not believe in the use antibiotics in treating disease and refuse intravenous administration of ceftriaxone to their son. After a thorough discussion, the parents continue to refuse antibiotics. What is the most appropriate next step?

A. Do not administer antibiotics in accordance with the parents wishes.
B. Make the child comfort care
C. Confront the parents and inform them of their ignorance
D. Administer antibiotics despite parental rejection
E. Obtain a court order to administer antibiotics
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  #2  
Old 01-21-2012
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Ans E . . . .
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Old 01-21-2012
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Seems D is the answer but im not sure........
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Administer antibiotics despite parental rejection
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Old 01-21-2012
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Ans D ....... yes parents cannot refuse treatment to child for their beliefs ...
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Old 01-21-2012
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Going to court would be the best thing but in the exam I would go with A, You cannot forcefully give the drug cos its not an IMMEDIATE risk
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Old 01-21-2012
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A,,,......
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Old 01-21-2012
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i would say A
he's underage so his parents make the calls right? so whatever they say, goes.
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Old 01-21-2012
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In life threatening condition parents can not deny medication for the child so Its D.because untreated meningococal meningitis is life threatening
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Old 01-21-2012
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Eeeeeeeeeeeeeeeeeeee
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Old 01-21-2012
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ill go with D but honestly i feel C could be the answer too
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Old 01-21-2012
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I will go with E b/c its is simply treatable & u cant wait for parent's wish & let the child die..... so in practical life & exam i will go with E
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Old 01-21-2012
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Default Answer is "D".

Answer is "D".

If there is any danger to life or limb to any child, a physician can take the required action necessary or deny parents for the best interest of child.

Physician is under both legal and ethical obligation to do so.

Simple.
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Old 01-21-2012
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In a life or a limb saving situation the parents cannot deny medical care for the child, as meningococcal meningitis is highly communicable disease it posses risk to others also......so 2 rules apply here.....
(actually 3 in fact, that is never go to court)

rule 1. in a life or limb saving situation parents cannot deny medical care to children
rule 2. do not harm others
rule 3. dont go to court, and the decision should be made by the physician

So my call is D........!!!!!!!

May God help us......!!!!!!!!!! :sorry:
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Old 01-21-2012
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the answer is d..While parental authority to make medical decisions for their children is broad, it does not include choices that may seriously harm their children. As long as the physician has used reasonable clinical judgment in treating the child, legal liability should be minimal.
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Hard... Ill go with D but E maybe consider too
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Old 01-22-2012
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so whats the answer ??
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Old 01-22-2012
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PLz we need the answer Miss patho!!!!!!!!!!
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Old 01-22-2012
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Choice (E) is the answer.

For simple life-saving procedures in children, in this case intravenous antibiotics, the first step is to attempt to persuade the parents. If this fails, the next step is to obtain a court order to administer the antibiotics. The other choices are incorrect.
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Old 01-22-2012
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Quote:
Originally Posted by miss patho View Post
Choice (E) is the answer.

For simple life-saving procedures in children, in this case intravenous antibiotics, the first step is to attempt to persuade the parents. If this fails, the next step is to obtain a court order to administer the antibiotics. The other choices are incorrect.
hey where id this qs from ???? i have read a number of places a court order is never a right answer .. either you go with what the parent says or you do what you feel correct , becoz if giving the antibiotic is an live saving procedure as in this case , you dont need a court order for it ......

anyways if thats the answer then be it , BS is a mess ..........
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Old 01-22-2012
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Quote:
Originally Posted by miss patho View Post
Choice (E) is the answer.

For simple life-saving procedures in children, in this case intravenous antibiotics, the first step is to attempt to persuade the parents. If this fails, the next step is to obtain a court order to administer the antibiotics. The other choices are incorrect.
Thanks very nice Question.i m happy,its probably first tough ethic Q i got right
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Old 01-22-2012
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Quote:
Originally Posted by miss patho View Post
Choice (E) is the answer.

For simple life-saving procedures in children, in this case intravenous antibiotics, the first step is to attempt to persuade the parents. If this fails, the next step is to obtain a court order to administer the antibiotics. The other choices are incorrect.
meningococcal meningitis is life threatening dz and with fatality range 10-20%,you need IV administration of Ceftriaxone.anyone with meningitis should receive Rx,any delay would worsen.Here Brain is at stake i shld say.So,i completely DISAGREE to go to the court.i would rather give the antibiotic and save a life!
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  #23  
Old 01-22-2012
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Default Strongly DISAGREE

Hi

Guys...The correct answer is "D".

I strongly disagree with Ms Patho too who said it is "E". She/he must be making a joke.

Going to the court is the "worst" possible answer. Even asking to the "Ethical committe" if it is option would be WRONG.

It is crystal clear rule: In case of LIFE or LIMB saving treatment, child must get immediate required treatment even if parents deny it based on their faith, concept etc.....

USMLE requires us to know where to make a "judgement call". It is our call..a physician's call and judgement.

Anyone who replied "E" as a correct reply must understand this aspect. This concept of "making correct calls under pressure situations" is heavily tested in CK.

Let's use our common sense...a child having meningococcal meiningitis is at stake of acquiring at least "life long neurological deficit eg blindness, deafness, paresis , anything" in case of delay of minutes or hours if not the life.

If you go to "court", you are wasting prescious time in a procedure which would lead to none but "delay" in life saving treatment. (I fear even court would disqualify you as a doctor if you do this.. Call your insurance company if you plan to go to court)...

It is our (physician's) call not anyone's else.

So correct answer is "D" ............................not "E".

Regards
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  #24  
Old 01-22-2012
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Quote:
Originally Posted by doctorKEMC View Post
Hi

Guys...The correct answer is "D".

I strongly disagree with Ms Patho too who said it is "E". She/he must be making a joke.

Going to the court is the "worst" possible answer. Even asking to the "Ethical committe" if it is option would be WRONG.

It is crystal clear rule: In case of LIFE or LIMB saving treatment, child must get immediate required treatment even if parents deny it based on their faith, concept etc.....

USMLE requires us to know where to make a "judgement call". It is our call..a physician's call and judgement.

Anyone who replied "E" as a correct reply must understand this aspect. This concept of "making correct calls under pressure situations" is heavily tested in CK.

Let's use our common sense...a child having meningococcal meiningitis is at stake of acquiring at least "life long neurological deficit eg blindness, deafness, paresis , anything" in case of delay of minutes or hours if not the life.

If you go to "court", you are wasting prescious time in a procedure which would lead to none but "delay" in life saving treatment. (I fear even court would disqualify you as a doctor if you do this.. Call your insurance company if you plan to go to court)...

It is our (physician's) call not anyone's else.

So correct answer is "D" ............................not "E".

Regards
yup agree completely ...... and i am pretty sure thats the ans , atleast i would mark that in exam even though this qbank might give it E ....
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Old 01-22-2012
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I would pick D for sure!!!!!!!!!!
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  #26  
Old 01-22-2012
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But this situation is not emergency yet.if the condition becomes emergency then only physician can administer antibiotic to a minor without the consent of parents.

If BP falls or very high fever etc then the condition is LIMB LIFE saving treatment.and these signs absent in the question.

so going to court i believe is right choice here.i remember dr dougherty (kaplan) discussed this issue .ans E is correct

Last edited by step_enhancer; 01-23-2012 at 12:01 AM.
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  #27  
Old 01-23-2012
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I completely agree that answer should be D. Meningococcal meningitis is an emergency condition they need an immediate IV antibiotic administration as the fatality rate in untreated is high.
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Old 01-23-2012
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Quote:
Originally Posted by step_enhancer View Post
But this situation is not emergency yet.if the condition becomes emergency then only physician can administer antibiotic to a minor without the consent of parents.

If BP falls or very high fever etc then the condition is LIMB LIFE saving treatment.and these signs absent in the question.

so going to court i believe is right choice here.i remember dr dougherty (kaplan) discussed this issue .ans E is correct
Does a boy admitted in pediatric intensive care unit not an emergency???????......well it is surely a life threatening disease( meningococcemia)....u never know the course of the infection!!!!!!
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Old 01-23-2012
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Default Plz...Pay attention

Hi Guys

Please pay attention to the 1st line of the question which I am pasting here:

"A 10-y-old boy develops meningococcal meningitis and is hospitalized in the pediatric intensive care unit."

Now...some of my friends say that "there is no fever or no other signs or symptoms are given revealing the extent or severity of the disease.......so this is not "emergency". ......

There is no need to look for signs of symptoms. We are given an "established" DIAGNOSIS of MENINGOCOCCAL MENINGITIS.

A complete diagnosis of a deadly contagious/infectious disease and the child is already had been admitted in "Intensive Care Unit ie ICU"...." .

What does this ICU is for? It is a place where extremely "unstable" patients are kept under extreme watch with all type of possible monitors ie a unit of "highest possible level of health care"....

This ICU is more than just "ER or ED"...

The child is in already facing danger of dying or developing permanent focal or generalized neurological or other deficits.

Yet some of my friends are not satisfied and looking for the fever, nuchal rigidity or some sort of signs and symptoms like seizures etc...Wow...

(We are provided with a perfect diagnosis plus severity/gravity of the disease by telling us that child is in ICU. What else is needed to figure out?)....

So anyone who wants to go to court instead of starting "Epirical Antibiotic Therapy". Then "be my guest"...But please call your insurance company before doing so. (I have nice snak waiting for you.. )

I am impressed.....
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Old 01-23-2012
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iam completely confused now the answer from the site i get is E but from discussion i read seems D more suitable
so i will decide after i start reading ethics kaplan book and listen to video to decide

but according to my step 2 ck information the answer is D :t oosad::to
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Old 01-23-2012
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Quote:
Originally Posted by miss patho View Post
iam completely confused now the answer from the site i get is E but from discussion i read seems D more suitable
so i will decide after i start reading ethics kaplan book and listen to video to decide

but according to my step 2 ck information the answer is D :t oosad::to
stuff on internet are not always correct
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Old 01-23-2012
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Quote:
Originally Posted by miss patho View Post
iam completely confused now the answer from the site i get is E but from discussion i read seems D more suitable
so i will decide after i start reading ethics kaplan book and listen to video to decide

but according to my step 2 ck information the answer is D :t oosad::to
actually i m confused too. could physician start antibiotics by himself or he needs permission from court????? so i m confused with D or E.
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  #33  
Old 01-26-2012
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Hi

Do not get confused. I checked with Kaplan videos too. A very simple and basic simple rule applies here which is :

A child can not be deprived of any "Life/Limb" saving treatment even if parents deny it due to any reason.

No court order, No hospital ethics committee, No counsultation is requred.
It is your call. So make the "call".

It is very much similar to declaring a brain dead and turning off the life support. (After having second opinion of another physicican...You can turn off the life support even if family threats you of anything.)

If, in the case of child, let's assume, a child has minor lacerations which needs stiching in physician's view but parents denys saying that let the nature take its course or natural body mechanisms shoud be allowed to heal this. Then you MUST not stich. (But remember: it is not ischemic limb. It is just lacerations or other injury which may cause disfigurement but NOT life/limb threatening.

One more point. The answer "E" can be a printing mistake or a typo.
So using common sense and our knowledge is good in such cases rather than getting confused. Trust yourself too.
Regards:
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