An Ethics Casebook for Hospitals

Mark Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics, Director of the Neiswanger Institute for Bioethics and Health Policy, and Chair of the Department of Medical Education at the Loyola University Chicago Stritch School of Medicine. A former President of the American Society for Bioethics and Humanities, Mark has been a leader in the effort to promote quality in clinical ethics case consultation. Rosa Lynn B. Pinkus, PhD, served as Professor of Medicine/Neurosurgery, Associate director for the Center of Bioethics and Health Law and director of the Consortium Ethics Program, University of Pittsburgh. She retired in December 2013 and currently teaches a graduate bioethics course for the Department of Bioengineering, University of Pittsburgh. Katherine Wasson, PhD, MPH, is an associate professor and bioethicist at the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago Stritch School of Medicine.  She is an educator, researcher and clinical ethics consultant and the Principal Investigator for the Assessing Clinical Ethics Skills project.

Preface Acknowledgments

Section 1: Consent and Capacity Case 1: Truth Telling and Cultur—-Using an Interpreter in a Consultation (Skill Builder Case)

Case 2: What Does She Really Want? Coercion, Persuasion, and the Family

Case 3: "He Doesn't Know What He's Saying" Advance Directives in Emergency Setting

Case 4: "Please Don't Cut Off My Leg" Going from a Wish to a Plan of Care

Case 5: Consent and the Elderly—Is the Patient Her Own Best Spokesperson?

Case 6: "I Don't Want Any Tubes" Capacity and the Care of a Patient with a Kidney Transplant

Case 7: Caring for a Patient Who Uses Heroin—Fairness and Professional Responsibility

Practical Commentary and Cheat Sheet Conceptual Framework Further Reading

Section 2: End-Of-Life Decision Making

Case 8: The Stroke Case—"I Can't Be Responsible for Killing Your Mother" (Skill Builder Case)

Case 9: Futility—"But She Said She Wanted Everything" (Skill Builder Case)

Case 10: Withdrawing Treatment—Easier Said Than Done

Case 11: The Letter and Spirit of a Directive—Making Decisions with a Patient of Variable Capacity

Case 12: How Competent Does a Surrogate Need to Be? A Decison Maker Who Might Not Appreciate the Choice to Be Made

Case 13: How Does a POLST Form Help? When a Surrogate Contradicts a Valid DNR Order

Case 14: Withdrawing Treatment and the Family's "Returning Hero"—When One Family Member Says "Go" but the Surrogate Says "No"

Case 15: "They're Crazy!" The Micromanaging Family

Practical Commentary and Cheat Sheet Conceptual Framework Further Reading

Section 3: Decision Making for Minors

Case 16: "God Can Do Miracles, and He Will Heal Jessica" A Pediatric Patient Wants to Forgo Treatment but Her Parent Disagrees (Skill Builder Case)

Case 17: Transfusions as a Preventive Measure for a Witness Child—Do the Child's Medical Interests Outweigh Family Integrity?

Case 18: IV Drug Addiction and the Perfect Son—Difficult Decisions in Treating a Chronic Opiod User

Case 19: "She'll Never be Able to Take Care of That Child!" Family Integrity and the Newborn's Best Interest

Case 20: Families and Hope—Fostering the Patient's Self-Determination

Case 21: Who's the Patient? Dealing with a Formidable Advocate

Practical Commentary and Cheat Sheet Conceptual Framework Further Reading

Section 4: Organizational Ethics

Case 22: "If We Do This, They'll All Come Here" A Kidney Transplant for an Undocumented Immigrant? (Skill Builder Case)

Case 23: "But She's Our Patient" Margin and Medical Mission

Case 24: Charity Care—What Are The Criteria?

Case 25: "What's the Use?" Capacity, Addiction, and Fairness

Case 26: A Teaching's Hospital Transfer Policy—Who is Responsibile for This Patient?

Practical Commentary and Cheat Sheet Conceptual Framework Further Reading

Index

About the Authors