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  #1  
Old 08-12-2011
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Medicolegal and Ethics ethic case

11-year-old boy with a history of ulcerative colitis is seen by the physician for follow up of his condition. He reports that he is still experiencing many episodes of bloody diarrhea despite maximal medical therapy.. The physician strongly recommends a total colectomy. He and his parents belong to a recognized religious group that states a body should not be altered in any way, the parents refuse to consent to surgery and wish to continue with medical therapy. What is the most appropriate next step in the management of this patient?

A. Consult ethics review committee
B. Obey the parent's wishes and have them sign a refusal form
C. Obtain a court order to provide treatment
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Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
11-year-old boy with a history of ulcerative colitis is seen by the physician for follow up of his condition. He reports that he is still experiencing many episodes of bloody diarrhea despite maximal medical therapy.. The physician strongly recommends a total colectomy. He and his parents belong to a recognized religious group that states a body should not be altered in any way, the parents refuse to consent to surgery and wish to continue with medical therapy. What is the most appropriate next step in the management of this patient?

A. Consult ethics review committee
B. Obey the parent's wishes and have them sign a refusal form
C. Obtain a court order to provide treatment
B) do not treat!
because UC can still be managed with those high efficacy TNF-alfa inhibitors if you want and the progression to colon cancer takes around 10 years, but by then, the kid will be >18 and make a decision for himself, so still, that fatal complication can be avoided.
I think its B, but i still want to know whats the answer given?
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Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
11-year-old boy with a history of ulcerative colitis is seen by the physician for follow up of his condition. He reports that he is still experiencing many episodes of bloody diarrhea despite maximal medical therapy.. The physician strongly recommends a total colectomy. He and his parents belong to a recognized religious group that states a body should not be altered in any way, the parents refuse to consent to surgery and wish to continue with medical therapy. What is the most appropriate next step in the management of this patient?

A. Consult ethics review committee
B. Obey the parent's wishes and have them sign a refusal form
C. Obtain a court order to provide treatment
Hmmm..I would think C.considering maximal medical efforts failed and he is at risk for fatal complications like toxic mega colon.....but no sure...
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  #4  
Old 08-12-2011
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Originally Posted by Kais_MD View Post
Hmmm..I would think C.considering maximal medical efforts failed and he is at risk for fatal complications like toxic mega colon.....but no sure...
Agree, i would also go with option C..
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Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
11-year-old boy with a history of ulcerative colitis is seen by the physician for follow up of his condition. He reports that he is still experiencing many episodes of bloody diarrhea despite maximal medical therapy.. The physician strongly recommends a total colectomy. He and his parents belong to a recognized religious group that states a body should not be altered in any way, the parents refuse to consent to surgery and wish to continue with medical therapy. What is the most appropriate next step in the management of this patient?

A. Consult ethics review committee
B. Obey the parent's wishes and have them sign a refusal form
C. Obtain a court order to provide treatment
I read in MTB , that if parents are refusing for life threatening condition , then you should get court order ,
and here it looks like the medical treatment is failing and need colectomy , So i'l go for C too....
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Old 08-12-2011
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yes i will also go with c.......
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Old 08-12-2011
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the correct answer is
B. Obey the parent's wishes and have them sign a refusal form

i choose wrong c too so i post the q
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Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
the correct answer is
B. Obey the parent's wishes and have them sign a refusal form

i choose wrong c too so i post the q
Can u plz explain why it's B? I was thinking either A or C.
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since 1972 there is law allow parents to refuse rx of thier child if not life threating condition and doctor must not rx against their will and parents must sign refusal rx paper
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  #10  
Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
the correct answer is
B. Obey the parent's wishes and have them sign a refusal form

i choose wrong c too so i post the q
thank god i got this one right!
anywayz, where did you get this q miss patho? it was a gud one!
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Old 08-12-2011
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Originally Posted by cool_atomic View Post
thank god i got this one right!
anywayz, where did you get this q miss patho? it was a gud one!
hmmm i had a similar question but only one thing was changed..The person was showing signs of toxic mega colon...So i guess in that scenario you can obtain a court order and treat..
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Originally Posted by Kais_MD View Post
hmmm i had a similar question but only one thing was changed..The person was showing signs of toxic mega colon...So i guess in that scenario you can obtain a court order and treat..
from a q book
and i think toxic megacolon must be rx surgically not medically
while uc can be rx medically and not threat patient life like toxic mega colon
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Old 08-12-2011
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Originally Posted by Kais_MD View Post
hmmm i had a similar question but only one thing was changed..The person was showing signs of toxic mega colon...So i guess in that scenario you can obtain a court order and treat..
yeah, maybe if the pt has toxic megacolon like "NOW", then maybe we can treat someway or the other, but not now.
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Old 08-12-2011
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Quote:
Originally Posted by miss patho View Post
from a q book
and i think toxic megacolon must be rx surgically not medically
while uc can be rx medically and not threat patient life like toxic mega colon
Tx of toxic megacolon:

The objective of treatment is to decompress the bowel and to prevent swallowed air from further distending the bowel. If decompression is not achieved or the patient does not improve within 24 hours, a colectomy (surgical removal of all or part of the colon) is indicated. Fluid and electrolyte replacement help to prevent dehydration and shock. Use of corticosteroids may be indicated to suppress the inflammatory reaction in the colon if megacolon has resulted from active inflammatory bowel disease. Antibiotics may be given to prevent sepsis.

The risk of death and shock has been reported to be lower in children, however most children required colectomy in one case-control study

So i guess that its not all surgical in the management!
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Old 08-15-2011
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Quote:
Originally Posted by Kais_MD View Post
hmmm i had a similar question but only one thing was changed..The person was showing signs of toxic mega colon...So i guess in that scenario you can obtain a court order and treat..
if the patient is having toxic megacolon so it needs urgent intervention and there is no alternative medical therapy for this condition so u can go for choices tht enables u to proceed with the treatment ..i think i faced a question like a patient with ALL with severe pancytopenia and the parents requested to hold therapy and it was to go for court permission
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Old 08-15-2011
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Originally Posted by youssef2310 View Post
if the patient is having toxic megacolon so it needs urgent intervention and there is no alternative medical therapy for this condition so u can go for choices tht enables u to proceed with the treatment ..i think i faced a question like a patient with ALL with severe pancytopenia and the parents requested to hold therapy and it was to go for court permission
you are missing the point here. we are talking about surgical therapy and not general medical treatment.
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  #17  
Old 08-31-2011
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Originally Posted by miss patho View Post
since 1972 there is law allow parents to refuse rx of thier child if not life threating condition and doctor must not rx against their will and parents must sign refusal rx paper

i still dont get it.....!!
there r clear cut 3 categories in minors if parents refuse treatment..
  • emergency............dr is allowed to proceed
  • nonemergent but critical..........get court order
  • non critical, routine..........respect parents wishes
i stongly think that this child falls in 2nd category...And as it is already mentioned in the scenario that maximal medical management is not making him any better, how can we say that tnf alpha blockers might make him better...?? plus even if he doesnt develop toxic mega colon, he will bleed to death....!!
plz someone explain....??is there anything im missin??
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