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25 Nov 2018

1. Mary, age 37, is pregnant for the first time, and her doctor has ordered a series of routine screening procedures. Mary’s doctor probably will NOT order:

chorionic villus sampling.
amniocentesis.
sonogram.
AFP assay.

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Elin Hessel
Elin HesselLv2
28 Nov 2018

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Related questions

Mary, a 23 year old female was involved in a head on collision that lead to massive head trauma and neurological injuries. She is not defined as brain dead, however, after 3 weeks in the Medical Intensive Care Unit and neurological consultations there is grave concern for the patient. The medial team has come back with a prognosis that “meaningful recovery” is estimated to be less than 1%. At this point it appears that Mary would remain in a non-responsive (vegetative) state.

During this entire ordeal, Mary’s religious parents have been by her side and keeping track of everything going on. After consultation with Mary’s doctor and their priest, who is currently present for support, they decide it is time to remove Mary from tube feedings and off the ventilator. The parents feel that it is now “God’s will.” Later that day, while the priest is present and with family surrounding, they remove life support.

In preparation, the Medical Intensive Care Unit nurse notified the Organ Procurement Organization (OPO) to be on standby, with the expectation that soon after extubation, death would soon follow. Mary was always thinking of others and even though she never signed up with the online stated done registry, her driver’s license showed she was an organ donor represented by a “heart” on the front. Mary was carefree and did not have any healthcare directives but her driver’s license was enough to be considered a “first person consent.”

However, there is an issue. When the OPO rep arrives to discuss this with the family and explain that Mary had wishes to donate her organs, the parents are taken aback and upset at the suggestion. They explain that this was never discussed as a family and that they would not allow this to occur.

Even though Mary is not brain dead she qualifies as a donor under the hospital’s “Donation after Cardiac Death” protocol. In addition, this would be in accordance with the state’s newly revised “Uniform Anatomical Gift Act” which states that, “in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donor’s body or a part if the donor made an anatomical gift.

The OPO rep goes to the attending physician and explains the interaction with Mary’s parents. They discuss hospital policies and state law, which is on their side. They also begin examination of Mary for preparation for possible donation. Soon after Mary’s parents come looking for the doctor and an explanation as to why Mary has not been removed from the machines and “let God take over.”

Question 1) What should happen next? On what ethical and moral grounds? What about the law?

In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case.

Case One

Mary Stokes is in need of a kidney transplant, and her parents and siblings have been tested for compatibility. Her father is afraid of operations and knows that kidney trouble runs in the family. Before the test, Mary’s father tells the doctor that he does not want anyone, especially his wife, to know that he is compatible. He explains that if the family knows they will pressure him into being a donor. The father turns out to be the only one who is compatible. Mary asks the doctor, “Are you sure no one in my family is compatible?”

Is the father a patient and protected by confidentiality? Even if he is not a patient, is his explicit request, which was not refused, a protection of his confidentiality? If the matter is confidential, what can the physician say or do to protect the secret?

Case Two

Dr. Curious has a habit of wandering around the hospital and looking at the records of friends who are in the hospital. The nurses have tried to stop him, but he has retaliated by making their lives miserable and belittling them in public at every opportunity. The nursing administration has been notified but has done nothing, as it wants to avoid rocking the boat.

What are the nurses’ ethical obligations after they have done everything mentioned in the text? See Chapter 2 (Garrett). Is “not wanting to rock the boat” a sufficient excuse for the administration to do nothing further?

Case 1

John Smith, a patient with long-standing history of type 2 diabetes mellitus, has been feeling progressively weaker over the past few months. She has also been feeling generally ill, and has been gaining weight although she has not changed her eating habits. During her routine visit to her family doctor, some standard blood and urine tests are ordered as an initial evaluation. In addition, her previously diagnosed mild high blood pressure has gotten significantly worse. The physician is concerned when the testing shows an increase in levels of creatinine in her blood and microalbumin in her urine. The patient is referred to a nephrologist for further evaluation.

1) What disease condition is John Smith suffering from? Explain the pathophysiology and symptoms associated with this disease state?

2) Discuss the various laboratory tests done to diagnose this disorder.

3) Describe the biochemical phenomenon that is responsible for vascular complications associated with chronically elevated levels of glucose in the circulation.

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