James is an FY1 doctor, 3 months into his job. He has just finished a 12-hour on-call night shift when he decides to go to his local supermarket to pick up some groceries on his way home. Whilst there, he hears someone shout for help. He rushes over to find a body lying on the […]
Dr Ruth Clarke has been working as a GP partner for the past 3 years. During this time the practice has had a change in staff; they have had to replace the practice manager, one GP retired and another emigrated to Canada. Despite advertising to fill their positions, there has not been any interest. Workload […]
Scenario 1 Don is a 54-year-old driving instructor who presents to the surgery with central crushing chest pain. An ECG demonstrates that he is having a heart attack. Whilst waiting for the ambulance he continues to deteriorate and goes into ventricular tachycardia. Staff begin CPR and shock him back into a normal rhythm, but he […]
Holly is 35 years old. She had been trying to conceive over the past 5 years and was successful after three cycles of IVF. At 23 weeks gestation, she was discovered unconscious at home by her husband. She was rushed to hospital but deteriorated further in the A&E department. She required intubating and was transferred […]
Given the medical situation, you believe your elderly patient, Tim, should not be for resuscitation because the harms of cardiopulmonary resuscitation (CPR) are significant for a person in his physical condition (it is likely that his ribs may break with compressions) and, even if successful at restarting his heart, it is likely that this will […]
Pearl has multiple sclerosis and has struggled with her condition for 20 years. Two years ago, in her early 50s, she wrote an advance decision. In it she states that she does not want to be resuscitated or receive any invasive treatments in the event that there is a deterioration of her physical health. The […]
On your first ward round you find that Mary’s condition has deteriorated overnight. She is tachycardic and tachypneic with a temperature of 38°C. You suspect she has developed bronchopneumonia. This is confirmed by a chest X-ray, and you decide that it would be best to start intravenous antibiotics and fluids. You discuss this with Mary’s […]
A palliative care consultant has been asked by a clinical colleague to speak to a woman in her 60s. Sue has a progressive neurological condition and she now has limited verbal communication, worsening mobility and some elements of dementia. Her life expectancy is around 4 years. Sue is frustrated by her condition and the prospect […]
Mrs. Smith has repeatedly requested all possible interventions and treatments. Driven not just by a desire to keep living, she has expressed a strong need to prove to her children that she will never give up fighting the cancer, equating giving up with abandoning her family. Mrs. Smith has regularly declined offers of psychological support. […]
This family has understood the explanation from the speech and language therapist that their mother is unable to swallow safely, and even though the clinical team would support the family with risk feeding, the family does not wish to cause any coughing or choking. Risk feeding acknowledges that there is a risk of choking and […]
Camille M. Renella, RN, CME, LNC
Clinical Medical Ethicist/Legal Nurse Consultant
Institute of Medicine Chicago (IOMC) Fellow
Executive Director