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  #1  
Old 12-27-2015
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Default ethics doubts

Q) at what age do children become competent enough to decide what treatment they should receive?
eg 17-year old girl is a Jehovah’s Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. ans is not to give transfusion
eg2 A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important) Next step in management: amputation should NOT be preformed.

(im excluding the special cases of stds prenatal care and emancipated minors...but in situations like the above r they the right answers? and hw shud v decide the age?
major doubt about abortions also
A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important) Next step in management: abortion should be done and parents should not be notified. (is this correct? i read that abortions require parental consent in minors)

Q) tracheoesophageal fistula repair in trisomy 13...ans shud not be done...does this come under physiological futility?

Q)A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important) Answer: no. Surgery should be performed if it is medically indicated.
a liver transplant is not given to a person who continues to drink then y is this case different?

Q) is slow code ever a right answer? like a terminally ill patient with no hope of survival/quality of life but the family requests to do everything (DNR status not known)

Q)is domestic/spousal abuse reportable by the physician?

Q) can the physician divulge information to a child about his/her diagnosis even if the parents have asked the doc not to do so?

any explanation wud be appreciated
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  #2  
Old 12-27-2015
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Quote:
Originally Posted by winterfire View Post
Q) at what age do children become competent enough to decide what treatment they should receive?
eg 17-year old girl is a Jehovah’s Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. ans is not to give transfusion
eg2 A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important) Next step in management: amputation should NOT be preformed.

(im excluding the special cases of stds prenatal care and emancipated minors...but in situations like the above r they the right answers? and hw shud v decide the age?
major doubt about abortions also
A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important) Next step in management: abortion should be done and parents should not be notified. (is this correct? i read that abortions require parental consent in minors)

Q) tracheoesophageal fistula repair in trisomy 13...ans shud not be done...does this come under physiological futility?

Q)A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important) Answer: no. Surgery should be performed if it is medically indicated.
a liver transplant is not given to a person who continues to drink then y is this case different?

Q) is slow code ever a right answer? like a terminally ill patient with no hope of survival/quality of life but the family requests to do everything (DNR status not known)

Q)is domestic/spousal abuse reportable by the physician?

Q) can the physician divulge information to a child about his/her diagnosis even if the parents have asked the doc not to do so?

any explanation wud be appreciated

Where did you get those answers?

In the first question about blood transfusion and osteosarcoma. Minor=no competence to make decision. Therefore, what they think does not matter (not the case with emancipated minors, but in that question we have no grounds to think that the minor is emancipated). Decisions are made by parents, guardians, etc. However, nobody can refuse life or limb saving procedures. Even if it said that their parents are against it, they do not have the right to refuse life or limb saving procedures. So I would think that the answer in both of those cases is to do the procedure anyways. If we were dealing with competent individuals, then they can refuse any procedure, including life and limb saving procedures (not the case with those questions)

18 or over=competent (of course unless there are other factors that deem them incompetent).

Question about abortion. Laws vary state by state. The best answer would be to encourage discussion with the parents. As far as I know, some states allow abortions without parental consent, some do not. Since USMLE is not a state exam, it is probably only going to ask questions about what is true in the whole country.

No idea about trisomy 13.

Valve replacement surgery. Yes, should be done. A surgeon does not have the right to deny treatment because he/she does not agree with the patient's "lifestyle" even if it is obviously harming the patient. The best answer would be to do the operation and discuss quitting drugs with the patient.

Liver transplant case is different because it is not the surgeon that decides who gets the liver. If the transplant committee or whoever is in charge decides that an alcoholic should get a liver, then a surgeon has to do the operation. In addition, there is not necessarily a shortage of heart valves, there is a waiting list for the liver. I do not know the details of how they decide who gets the organ but I am guessing that it will probably go to somebody who will make it last the longest.


As long as what you are doing is not futile, you go all out on all patients. DNR usually means that the patient does not want to have his life supported artificially, or to get his heart restarted, CPR, etc. Treating a patient differently because they signed a DNR is never the right answer. You only stay away from things that the patient does not want to be done. Everything else, same treatment as anybody else.

Domestic violence/spousal abuse is not reportable. You advise the patient to get out of an abusive relationship but thats about all you can do. You are obligated to report if your patient depends on the person that is abusing them. For example, elderly. When a caretaker is abusing an elderly patient, you have to report. Your patient does not have an option to "leave an abusive relationship". As opposed to spousal abuse situation. You are also 100% obligated to report any suspicion of child abuse.

I do not know the answer to the last question.
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  #3  
Old 12-27-2015
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Quote:
Originally Posted by winterfire View Post
Q) at what age do children become competent enough to decide what treatment they should receive?
If they are legally emancipated by the court, then a minor (less than 18 years of age) is considered competent. Competency is always decided by a court and is a legal statement. Doctors can only decide capacity, not competency.

Quote:
Originally Posted by winterfire View Post
eg 17-year old girl is a Jehovah’s Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. ans is not to give transfusion
If she is not legally emancipated, then she cannot decide anything. Answer is transfuse her. The state has made these rules to protect minors and act in their best interest.

Quote:
Originally Posted by winterfire View Post
eg2 A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important) Next step in management: amputation should NOT be preformed.
He is a minor. His parents should decide what treatment he should receive. (unless its limb or life saving). The doctor can recommend all possible treatment options. If the amputation is going to save his life, then that should be considered. Encourage some discussion maybe? More details required on this one.

Quote:
Originally Posted by winterfire View Post
(im excluding the special cases of stds prenatal care and emancipated minors...but in situations like the above r they the right answers? and hw shud v decide the age?


18 years of age onwards, they can decide for themselves, and can get an abortion without parental notification.

Quote:
Originally Posted by winterfire View Post
(
Quote:
Originally Posted by winterfire View Post
major doubt about abortions also
A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important) Next step in management: abortion should be done and parents should not be notified. (is this correct? i read that abortions require parental consent in minors)
No. Abortion cannot be done, without the parents consent. She can consent only to prenatal care, not to getting an abortion. Answer should be "encourage discussion." Physician should advice for her to tell her parents herself, and get them to consent for the abortion.

Quote:
Originally Posted by winterfire View Post
Q) tracheoesophageal fistula repair in trisomy 13...ans shud not be done...does this come under physiological futility?
I'm not too sure on this one. I would say, the surgery is not going to extend the infant's life to a significant extent. Maybe something less invasive should be considered.

Quote:
Originally Posted by winterfire View Post
Q)A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important) Answer: no. Surgery should be performed if it is medically indicated.
a liver transplant is not given to a person who continues to drink then y is this case different?
If someone continues to drink and gets a new liver, chances are he's going to destroy the new one too. By doing that, somebody else on the transplant list, who does-not drink, and who can potentially take care of his health, and stay healthy is being denied a liver.
In this scenario, a commercial valve can be replaced, without the ethical dilemma quoted above.

Quote:
Originally Posted by winterfire View Post
Q) is slow code ever a right answer? like a terminally ill patient with no hope of survival/quality of life but the family requests to do everything (DNR status not known)
Not too sure about this one, but IMO, No. Slow code is never the right answer. If they ask you to do everything, do everything unless its prolonging the inevitable, but discuss options first.

Quote:
Originally Posted by winterfire View Post
Q)is domestic/spousal abuse reportable by the physician?
No. The physician should ask her if she has a safe place to stay incase of an emergency, and offer support including shelter details, without being judgmental.

Elder abuse and child abuse is mandatory reportable.

Quote:
Originally Posted by winterfire View Post
Q) can the physician divulge information to a child about his/her diagnosis even if the parents have asked the doc not to do so?
No. Parents decide what information is to be given to their minor child. Ask the child first, how much they know. Then ask the parents how much information they want passed on to their child.

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Old 12-27-2015
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thank u gokulramani and nodo

@nodo: i found these questions on this forum 139 ethics questions (with answers)

but i think there a lot of mistakes in there...

can anyone recommend any good source for ethics questions and explanations plz
(i have 100cases of ethics by conrad fischer 2006 edition...is there a latest version available?)
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Old 12-27-2015
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Q) what shud a physician do if parents refuse vaccination for their kids? honor their wishes?

Q) A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is full-term and healthy. Social worker spoke to mother. (Important) Next step in management: doctor can go to court to get permission for cesarean section for the benefit of the fetus.

a pregnant lady can refuse c section...bt in this case wudnt it put the pts life at risk as well, in addition to the fetus's?
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Quote:
Originally Posted by winterfire View Post
Q) what shud a physician do if parents refuse vaccination for their kids? honor their wishes?
Parents can decide for their kids if they should be vaccinated or not. The only time a parent CANT decide, is in a scenario where vaccination might potentially put the others at risk. Classic example, sibling 1 down with meningioccal meningitis. Parent wants to take the child home to other siblings, etc.

Quote:
Originally Posted by winterfire View Post
Q) A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is full-term and healthy. Social worker spoke to mother. (Important) Next step in management: doctor can go to court to get permission for cesarean section for the benefit of the fetus.

a pregnant lady can refuse c section...bt in this case wudnt it put the pts life at risk as well, in addition to the fetus's?
The patient can decide what to do with her body.
A foetus is not a person, until he/she is born. So technically, while in utero, she/he is a part of the mothers body. So, as long as she is a competent adult, the patient gets to decide.
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Old 12-28-2015
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Quote:
Originally Posted by winterfire View Post
thank u gokulramani and nodo

@nodo: i found these questions on this forum 139 ethics questions (with answers)

but i think there a lot of mistakes in there...

can anyone recommend any good source for ethics questions and explanations plz
(i have 100cases of ethics by conrad fischer 2006 edition...is there a latest version available?)
Do not trust those 139 questions. Go with Fischers 100 cases. I would suggest you watch Kaplan 2010 lecture on ethics, go through First Aid and read Fischers book. 100 cases is like a gold standard for ethics preparation. Then do a bunch of questions from a qbank. It will probably take a whole day but its worth it.

I would not worry about the latest edition. Amazon reviews say that nothing has been changed.
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Old 12-29-2015
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@nodo: thank you for ur advice! i ll check those out
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