Choose one scenario
Table of Contents
Case 1
Name: Mr. Sam Jones Age: 50 Marital status: Married with two children Occupation: Hardware store manager Pain issue: Chronic right ankle and foot pain
This is the second visit to this doctor. He transferred his primary care to this doctor because his previous doctor moved out of state. He had been seeing his previous doctor for over 10 years and had an excellent relationship with him. He is worried about having a new doctor. He presented last month (his first visit) with a copy of his old medical records, which included notes from his previous doctor and his orthopedic surgeon.
Two years ago, he fractured his right ankle and foot when he fell off a ladder while cleaning out the gutters. He had been drinking beer with friends earlier in the day while watching baseball, but he has not connected his accident to his alcohol use. His ankle/foot fracture required several surgeries with the placement of screws and plates to restore function. His orthopedist recently told him that his ankle and foot are "well-healed" but will likely always cause him significant pain and will never be “normal”. He was told that no additional surgeries are needed at this time.
His orthopedist also told him that his primary care doctor should take over the treatment of his ankle and foot pain. He has taken multiple medications over the past year for his pain including naproxen, acetaminophen, and tramadol. All of these medications were unhelpful.
The prescription monitoring program data shows NO history of previously prescribed controlled substances.
On physical examination his right ankle and foot are somewhat deformed from the fracture and surgeries, and he has very tender areas on the top and inside of his right foot. His left hip exam is completely normal.
You are witnessing an interview between the patient and his primary care doctor. The interview starts with the doctor having a conversation about how the patient’s pain is on the ibuprofen (Motrin) plus acetaminophen (Tylenol) taken 3 times per day that were prescribed at the last visit (1 month ago).
Discuss the potential risks and benefits of opioid analgesics for patient’s chronic pain? How would you go about providing a caring and ethical response? What are the implications of overprescribing such drugs for public health?
Case 2
You are attending an ethics meeting at a community health clinic in your role as an emergency medicine provider. Around the state, patients are believed to be flying into local airports from countries grappling with an Ebola outbreak. You and your team have been asked to weigh in on a potential scenario that may occur in your community:
Women, and possibly pregnant women may check in at the community health center (CHC) with symptoms of Ebola. Prior to transfer to one of the hospitals designated to take in Ebola patients, the CHC may need to hold the patient for a day or more. Due to lack of resources, the CHC has only one protective suit and it takes a professional 30 minutes to put it on. The CHC wants to create a policy for resuscitation if such a patient comes into the clinic and suffers a heart attack. Because it takes 30 minutes to put on the suit, anyone who suffers a heart attack could suffer severe brain damage.
The Chair of the committee seeks your input: Should you be forced to provide CPR without a suit? Should CPR be mandatory? Under what circumstances? Please explain the moral and ethical concepts applicable to your responses. What ethical principles are relevant to policy making and what policies would you suggest?
- Incorporate discussion from this article about whether hospitals should deny Ebola patients CPR as well as the reading above. Tim Lahey, Should Doctors Deny Ebola Patients CPR? Health Affairs 2014. https://www.healthaffairs.org/do/10.1377/hblog20141211.043189/full/
- Read this Bioethics article on responding to Ebola. Bioethics Forum: Responding to Ebola. Questions about Resuscitation (2014) https://www.thehastingscenter.org/responding-to-ebola-questions-about-resuscitation/
- Read also Komesaroff and Kerridge, Ebola Ethics and Question of Culture, Bioethical Inquiry (2014) https://www.healthaffairs.org/do/10.1377/hblog20141211.043189/full/
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