The paper analyzes the ethical medical practices identified in the case study involving a client with pelvic Ewing sarcoma who is at risk of losing fertility after a surgical operation involving the removal of ovaries. Ethics in medicine have been used to describe the case study events.
Ethical medical practices aim at ensuring that medical practitioners and patients adhere to the required healthcare practices by controlling their activities in the hospital. As such, principles of ethics in medicine have been established to necessitate these practices. In this case, the case study involving a patient with pelvic Ewing sarcoma depicts several situations that demand the application of ethical medical practices to solve them. As such, the following questions address ethical medical issues and practices in the case study:
As a medical practitioner, my initial response was based on the medical judgment of the patient’s condition while keeping in mind that she was above 18 years. Thus, my judgment was that she was a grown-up who should make her own medical decisions. The fact that her father was keeping her out of her own medical discussions indicates that ethical medical practices were being violated. According to medical ethics, the physician-patient-parent cycle should be maintained while making medical decisions.1 However, the patient’s father was hiding important information concerning her treatment which is not advisable. Besides, the scope of medical practitioners permits them to act as advocates for patients in cases where patients are denied their consent in making medical decisions. In this case, I felt like I should advocate for Miriam so that she can have her right to medical autonomy as an adult.
However, after taking some time to think about Miriam’s father’s wishes, I started developing second thoughts concerning her treatment plans. Firstly, her father insisted that we should not reveal to her that she will develop infertility after the surgical procedure since she may refuse to undergo the surgical procedure. Based on how the father explained himself, it was clear that he understood everything about her daughter. Thus, the chances of refusing to undergo treatment were high. Still, it is outlined in the medical ethics that parents should be given chances to decide for their adult children in difficult medical situations as they understand more about their children than how medical practitioners do. At this point, I had to reconsider the wishes of Miriam father since he understood her daughter better.
Before proceeding to treat Miriam without informing her about the consequences of the procedure, I would like to understand how his father will reveal the information to her that she is infertile. Knowing this is important because the patient may end up accusing medical practitioners, including me of dishonesty. In this case, the patient will have the right to take the medical team to the court of law as it is clearly outlined in the medical ethics that medical professionals should not hide any medical information from their clients.2 Therefore, it is essential to understand the approaches that will be used by Miriam’s parents so that she can avoid blaming the medical team for dishonesty and negligence.
The key stakeholders in ensuring that the patient recovers to a normal state after revealing information about her state of infertility include her parents, her Rabbi, and the medical team. Her parents believe that hiding information concerning infertility before the surgical procedure will make it easier for the intervention to be done. On the other hand, her Rabbi believes that people’s lives are not in their hands, and so Miriam’s life should be saved by all means. Lastly, the medical team believes that patient autonomy should come first and so she should be informed before the operation takes place. It is clear that Miriam’s parents and Rabbi prefer to see her alive while infertile than led her to die due to refusal to lose fertility. Although the other stakeholders have their own cultural reasons and beliefs as to why Miriam should not be informed, I still apply the key ethical principles in the medicine which include autonomy, dishonesty, negligence, and beneficence in making the final decision.
In the US and other countries in the world, children who are eighteen years and above are classified among adults. According to medical ethics, adults have the right to medical autonomy. As such, they should be allowed to make medical decisions for themselves. Based on this information, Miriam was at the right age to make informed decisions concerning her medical condition. Thus, it was not right to keep vital information concerning her condition from her. In most cases, gender does not apply while deciding who should be allowed to know his/her medical information. Both male and female can access their medical information if they have reached the appropriate age to make informed medical decisions. Thus, I will only keep life-threatening medical information from patients who are below eighteen years due to various reasons. Firstly, ethical principles in medicine give medical practitioners the mandate to hide such information from young children.3 Secondly, young people need assistance to make informed medical decisions, and so there is no need to reveal life-threatening information to them when their parents can as well help them in making medical decisions.
The statement, “cultural influences are making the problem worse than it has to be,” shows that the adolescent specialist disregarded culture as a contribution in the wellness of patients. According to me, the adolescent specialist was not right at all. Firstly, the culture of patients plays an integral role as far as medical decision-making is concerned.6 It is through it that people are assured of their wellbeing and survival. For example, in my culture, the circumcision of male children is considered to have health benefits. There are claims that circumcised men rarely contract sexually transmitted diseases as compared to uncircumcised men. Following this, parents ensure that male children are circumcised before they become adults. Although circumcision is a cultural practice, members of our community use it as a tool for wellbeing and survival.
In the case of Miriam’s culture, a lady who is infertile can only get married to an infertile man or a widower who has children, As such, Miriam had all reasons to be worried, considering that her marriage had already been arranged. Informing her that the surgical procedure will render her infertile could have disrupted her peace and desire to get married. Therefore, her father was right to argue that informing her before the surgical intervention could provoke her to avoid it. Still, informing her after the surgical operation that she was infertile could not change the cultural setup. In short, culture is vital in making medical decisions, and medical practitioners should be aware of the cultural impacts on the medical decisions made by clients.
It is true that autonomy is the most important ethical principle in the US and other parts of the world. Personally, autonomy helps me to analyze my own situations and decide on what I should do to make a change. Therefore, it contributes to the development of personal values. Due to the role of autonomy in people’s lives, American physicians have agreed that informed consent is a requirement before performing any procedure to patients. As such, medical autonomy has been classified among ethical principles in medicine.4 Still, there are cases whereby autonomy is not guaranteed for patients. For examples, if autonomy given to the patient has fatal outcomes. In such cases, medical practitioners and other concerned individuals can decide on what should be done for the patient.
As such, the case of Miriam required denial of autonomy in case she opted to avoid a surgical operation that would see her become infertile. Her life was more important. Besides, the size of the tumor showed that she was already infertile, and so deciding to avoid the surgical procedure could have only worsened the situation. In such cases, the medical team should have had a positive discussion aimed at saving the patients’ life, and not granting her autonomy to necessitate her own death. As such, laws and policies concerning autonomy and informed consent should be revisited so that limits can be set for patients to make decisions for their medical interventions.
I think waiting until the patient begins treatment so as to inform her about infertility is not a good idea. As shown before, medical professionals should act as advocates for patients by providing timely information to them. Besides, informing her while undergoing treatment can worsen the situation since she can choose to refuse the ongoing treatment. Such an action depicts the breach of patient autonomy and should be avoided. However, we can consider the fact that the patient’s culture lacks the idea of personal autonomy. In case the patient knows that she has no right to autonomy, the outcome will not be worse to the extent of involving the court of law.5 Therefore, the patient will react while knowing that her parents signed a medical consent for her as per their culture.
If Miriam died due to refusal to undertake treatment, I could have blamed the position and actions of the medical team. In medical care, there are situations whereby patients are denied self-autonomy. For example, a patient who is at risk of dying due to making poor medical decisions should not be allowed to do so. Medical ethics allow medical practitioners to take charge of patients’ health in critical situations so as to save a life. Since medical officers have adequate knowledge regarding what should be told to the patient, they should ensure that the truth said to the patient does not harm him/her. Therefore, the medical team could be blamed for telling the patient a life-threatening truth instead of taking care of her health situation first.
Rabbi advised Miriam that she could have children if God desired that she should have them. However, the physicians could not understand how this could happen since the treatment involved removal of the ovaries which are responsive for ova production in females. I think Rabbi was encouraging Miriam beyond biomedical thinking and knowledge. It not necessarily that one should conceive and give birth so as to have children. In this context, Rabbi was trying to instill faith in Miriam by advising her that God might bless her with another way to get children and live happily. In this case, we learn that people live beyond their physical bodies due to strong spiritual beliefs. Besides, a complication in the body does not mean that all is over since one has to continue to live with what is around him/her.