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  #1  
Old 03-22-2012
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Medicolegal and Ethics Parents refusing to consent to surgery

A 15-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 and intestinal cramping despite maximal medical therapy. He has been in hospital several times for stabilization and medical therapy. The physician strongly recommends a total colectomy. During the explanation of the procedure, the physician discusses the risk and benefits of surgery. He and his parents belong to a recognized religious group that states a body should not be altered in any way. Based on this principle, 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
D. Remove the parents from the room and determine the patient's wishes alone
E. Take custody of child and provide treatment

pls give expln..
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Old 03-23-2012
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I'm between A & D, more prone to D.. what is the answer?Thank you.
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Old 03-23-2012
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Withholding lifesaving therapy for a child is considered comparable to child abuse, so i will go for C, but on a 2nd look, not really sure because of A option.
I'm in between A and C because I'm not so sure if you need a review from the ethics committee before court order.
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Old 03-23-2012
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It`s mostly c .
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Old 03-24-2012
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i will go for B.
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Old 03-24-2012
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I would say D...

Not A, because that's never the answer on the boards
Not E - it is not a medical emergency
B and C are iffy - it's a tough question because it's not a medical emergency, but may or may not be a medical necessity. Is it lifesaving therapy?
15 is old enough to have input, so I think it would be done before B or C - I would go with D.
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Old 03-24-2012
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Quote:
Originally Posted by Mondoshawan View Post
I would say D...

Not A, because that's never the answer on the boards
Not E - it is not a medical emergency
B and C are iffy - it's a tough question because it's not a medical emergency, but may or may not be a medical necessity. Is it lifesaving therapy?
15 is old enough to have input, so I think it would be done before B or C - I would go with D.
ans given is B.

it cant be D because child is still a minor <18 and need guardian consent.

comments?
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Old 03-24-2012
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Quote:
Originally Posted by tyagee View Post
ans given is B.

it cant be D because child is still a minor <18 and need guardian consent.

comments?
I guess that's the answer - maybe we have to know enough about GI to know that surgery is not necessary in this case?
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Old 03-24-2012
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1.in case of life saving or limb saving dont listen to parents , just treat the child
and in this case i feel its not life threatning(i.e., withholding colectomy will not kill the child)
2.in case of minor trauma which needs suturing or simple things ,listen to parents
3.in case where child needs treatment defenitely but not immediately like juvelnile DM or this present case ...hand over the thing to court.

i felt this might be the answer any input highly appreciated
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Old 03-24-2012
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if it's not life saving, sure not emergency, ans is B.
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Old 04-09-2012
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Quote:
Originally Posted by um aala View Post
if it's not life saving,sure not emergency,ans is B.
Lifesaving? No
Emergency? No
Surgery? Yes >> need consent
Consent given? No>> Can't do surgery
Patient minor? Yes>> parents are the guardian
Decision: respect patients/parents wishes.

However, since the child is 15, there is thing called child assent which the child >7 years can give in absence of parents so that he/she is not under any influence (coercion?). With that in mind "D" is a valid answer.
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Old 04-10-2012
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The answer which occurred to me was definitely B..

As been said, in life threatening condition there are two possibilities:

a- In cases of emergency (e.g Bleeding that needs blood transusion) go with the treatment

b- Not an emergency (e.g Leukemia that needs chemo) go with a court order.

However in this case (UC) surgery is not an absolute indication, and it can be treated medically. So parents' decision should be followed because both treatments are indicated. Another e.g would be a Grave's disease with no contraindication to surger nor to PTU.
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