The American Journal of Bioethics, 15(1): 63, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1526-5161 print / 1536-0075 online DOI: 10.1080/15265161.2015.975598
Case Summary
When a Patient Says “No” Kim Yen Thi Vu, Memorial Hermann–Texas Medical Center Arline Worsham, Memorial Hermann–Texas Medical Center VT is an 18-year-old Asian American male who presents into the hospital with a history of paraplegia secondary to a gunshot wound, neurogenic bladder, and pressure ulcers. Prior to admission, the patient complained of nausea and vomiting for 2 weeks. He also reports a history of urinary-tract infections, the last one a few months prior to his current admission. This patient is cared for at home by his older brother and parents. His brother is the primary caregiver for the patient and provides the patient with care for all his activities of daily living. Although supportive, the patient’s brother and parents have not been at the hospital. During his hospital course, the patient was found to have sepsis with a urinary-tract infection, multiple decubitus ulcers, and osteomyelitis of the right hip with his femur protruding through a large decubitus ulcer. The Infectious Disease Department was consulted and determined that, due to the extensive osteomyelitis, antibiotics alone will not adequately treat the infection, and recommended a surgery consult for possible resection of the bone. The primary team and the infectious disease team discussed the recommended surgery with the patient. After a long discussion, the patient refused surgery and insisted that he be discharged home prior to his upcoming birthday
the following week. He stated he did not like the hospital setting and wanted to return home as soon as possible. He also told a nurse he did not want amputation. During the next several days, members of the health care team had multiple discussions with the patient regarding the recommendation and necessity of surgery. The possible consequences of discharge without surgery were explained and included further bone destruction, possible systemic spread of infection to remote areas, and ultimately possible sepsis and death. After each discussion the patient, who was determined to have capacity, continued to refuse surgery and focused on returning home before his birthday. In addition, he did not allow the primary team to discuss his decision with his family. The primary and infectious disease teams have considered various treatment options, but the infectious disease team insists that antibiotics alone will not benefit the patient and may increase the risk for possible toxicity as a result of extended use. After several days of attempting to reach a resolution with the patient and the infectious disease team, the primary team is requesting an ethics consultation. How should the ethics consultant respond? &
Address correspondence to Arline Worsham, Memorial Hermann–Texas Medical Center, 6411 Fannin, Houston, TX 77056, USA. E-mail: [email protected]
ajob 63
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Case Summary
When a Patient Says “No” Kim Yen Thi Vu, Memorial Hermann–Texas Medical Center Arline Worsham, Memorial Hermann–Texas Medical Center VT is an 18-year-old Asian American male who presents into the hospital with a history of paraplegia secondary to a gunshot wound, neurogenic bladder, and pressure ulcers. Prior to admission, the patient complained of nausea and vomiting for 2 weeks. He also reports a history of urinary-tract infections, the last one a few months prior to his current admission. This patient is cared for at home by his older brother and parents. His brother is the primary caregiver for the patient and provides the patient with care for all his activities of daily living. Although supportive, the patient’s brother and parents have not been at the hospital. During his hospital course, the patient was found to have sepsis with a urinary-tract infection, multiple decubitus ulcers, and osteomyelitis of the right hip with his femur protruding through a large decubitus ulcer. The Infectious Disease Department was consulted and determined that, due to the extensive osteomyelitis, antibiotics alone will not adequately treat the infection, and recommended a surgery consult for possible resection of the bone. The primary team and the infectious disease team discussed the recommended surgery with the patient. After a long discussion, the patient refused surgery and insisted that he be discharged home prior to his upcoming birthday
the following week. He stated he did not like the hospital setting and wanted to return home as soon as possible. He also told a nurse he did not want amputation. During the next several days, members of the health care team had multiple discussions with the patient regarding the recommendation and necessity of surgery. The possible consequences of discharge without surgery were explained and included further bone destruction, possible systemic spread of infection to remote areas, and ultimately possible sepsis and death. After each discussion the patient, who was determined to have capacity, continued to refuse surgery and focused on returning home before his birthday. In addition, he did not allow the primary team to discuss his decision with his family. The primary and infectious disease teams have considered various treatment options, but the infectious disease team insists that antibiotics alone will not benefit the patient and may increase the risk for possible toxicity as a result of extended use. After several days of attempting to reach a resolution with the patient and the infectious disease team, the primary team is requesting an ethics consultation. How should the ethics consultant respond? &
Address correspondence to Arline Worsham, Memorial Hermann–Texas Medical Center, 6411 Fannin, Houston, TX 77056, USA. E-mail: [email protected]
ajob 63
Copyright of American Journal of Bioethics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
