Teaching Bioethics

(from Eric)

For the last 3 sessions of the Christian Philosophy of Medicine course, I had our students break into groups of 3 or 4 and present the following cases.  Very interesting discussions ensued.  Just for those who are curious, here were the 8 cases presented, 7 of which are more or less based on true stories we have experienced in the last few years (the exception is the Ebola case)

1. A man comes to you, admitting to having visited a prostitute last week.  This week, the prostitute texted him, saying that she is HIV+.  He wants an HIV test.  It is negative, but you explain that it takes weeks to months to convert an HIV test.  He is married, and does not want to tell his wife, because he regrets his actions, but knows that his marriage will be over if he tells her.

2. A patient is hospitalized on the service where you are the doctor.  1 day later, he is confirmed to have Ebola.  Your service has 3 nurses, 1 man and 2 women, all married, and one woman has 3 children.  None of them want to treat the patient, being afraid of contracting Ebola.  The hospital has decided that only 1 nurse will treat the patient, to limit exposure, and it is for you to decide who.

3. A 70 year old lady presents in a coma, and is put on a mechanical ventilator.  The next day, CT of the brain shows massive cerebral hemorrhage.  Recovery is impossible.  She is a widow with 2 sons that are present.  One wants her to remain on the ventilator, in whatever circumstance, which could be months.  The other wants to withdraw care of the ventilator, given that she will never survive without it.

(This is the most "American" of the cases, and as I have seen before, most Africans consider withdrawing care a form of euthanasia, a terminology distinction which I discourage, since I don't think it helps them to discuss the issue with others.  It always highlights to me the difference in thinking about such a case and experiencing such a case.)

4. A 75 year old man presents with epigastric pain and severe anemia.  He is transfused and endoscopy shows an unresectable gastric cancer.  Before rounds the next day, the patient’s son comes and asks you if it is cancer and if it is treatable.  You explain what was found, and he asks you not to tell the patient, because it would cause him to despair.

5. You are the medical director at a hospital where there is one unit of O-neg blood left, and none at your referring blood supply hospital.  You have a 5 year old girl with severe malaria in respiratory distress with a hemoglobin of 2.5.  At the same time you have a postpartum lady with a hemorrhage, now controlled, mother of 5 children young children, who has a hemoglobin of 3 and a blood pressure of 70/30.

(This is one of the most common scenarios.  In fact, right after the discussion, someone came to interrupt the class to tell me we had a patient in an eerily similar situation.  However, I'm not sure there's a real good way to talk about it.)

6. A mother of 8 is hospitalized for a C-section for baby #9 at the same time that baby #8, age 15 months, weight 3.5 kg is hospitalized for severe acute malnutrition due to family food shortage and poverty.  The mother agrees to a tubal ligation, but the father refuses.  The mother asks you to do it and not tell the father.

(This generated the liveliest discussion, which was a lot of fun.  I had to cut it short.)

7. A 30 year old woman comes with severe anemia and respiratory distress after a femur fracture.  She needs blood and surgery to survive.  Your hospital has a policy of paying a deposit before surgery due to a high rate of repayment.  The patient cannot pay.  What to do?  The following week, the medical committee is meeting, of which you are the president.  Your hospital has not been able to pay salaries for the last 2 months.  Do you try and change the pre-payment policy?

(Also common and relevant, but pretty painful to talk about.)

8. A 40 year old mother of 3 children has HIV and is on ARVs (antiretroviral therapy).  She started the ARVs 18 months ago, and has been getting slowly better, despite a hospitalization for dysentery.  At this visit, she says that she visited a prophet on the border of Tanzania last week, who prayed for her healing from HIV.  She believes that she is now healed, and has stopped her ARVs.  She does not want to be retested, because she already knows by faith that she is healed.

(This one was harder to discuss than I anticipated, and maybe could be given more time and depth the next time around.)


Cindy said...

Thanks for sharing these scenarios. So thankful for the head-heart-hand integration and wisdom that you McCropders are bringing to the future medical leaders of Burundi.

Sarah Lorenz said...

Can you write a post about the blood shortage? I would be interested in knowing more about that.