With a Medicare policy change, Lisa’s home health agency will no longer be able to provide her care. Her husband and sister are unable to provide the high acuity assistance she needs. What is each person’s responsibility when it comes to vulnerable patients who are not protected by the system? What are Lisa’s options for […]
Mike is a 92-year-old who was recently admitted to a long-term care facility after being discharged from the hospital after a stay for pneumonia. He is nonverbally refusing meals and with no obvious family members to relay his wishes, staff are finding it hard to determine what the next step should be in his care. […]
Peggy is a 79-year-old woman who had suffered from hypertension, diabetes and many strokes. She had an advance directive, which indicated that she did not desire any surgery, antibiotics, resuscitation or tube feeding. When it becomes very difficult for her to eat, requiring an aide for a couple of hours each meal, her daughter decides […]
Mary is diagnosed with bladder cancer but does not wish to have surgery. After refusing surgery twice, her doctor tells her that he cannot be her doctor any longer. What are the dilemmas that occur when a patient does not heed the advice of a doctor? What obligations do the patient and doctor have in […]
Mr. Smith is a 65yo, otherwise healthy male who wants doctors to turn off his pacemaker. Would turning off the pacemaker respect Mr. Smith’s rights and autonomy? Or, would it be physician-assisted suicide? What determines each decision? Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal […]
A 30-year-old woman is in the clinic, having been diagnosed several years ago with myelodysplastic syndrome (MDS, a blood disorder). There is a high chance that the disease will progress to acute myeloid leukemia (AML), with lower chance of survival, so physicians had started chemotherapy. What are other ethically complex treatment decisions does this case […]
KM is a 25-year-old patient who was diagnosed with Covid-19 and was admitted to the ICU. He is not brain dead, but after 4 weeks in MICU and several neuro consults, the prognosis for “meaningful recovery” is said to be less than 1%. KM has not regained consciousness and is apt to remain permanently in […]
You are a primary care physician who is assuming the care of a family. Upon review of the past medical history of the 1-year-old daughter, you find that she has had no immunizations although she received several well child examinations with their homeopathic caregiver. Her current medications include Chinese herbal supplements and the family follows […]
A 14-year-old boy is admitted to the Hematology-Oncology ward with acute lymphoblastic leukemia. He presented to the Emergency Department with pallor and dizziness and was found to have a hematocrit of 14.9%. The oncologist would like to start best available chemotherapy immediately. The adolescent patient agrees to this treatment but the legal guardians (aunt and […]
Each of two women had been advised by her physicians to have a gangrenous foot amputated to prevent the potentially fatal spread of infection. In both cases, the determination of the patients’ decisional capacity was a critical component in judging whether or not to honor their medical treatment decisions. In both situations, a person confronts […]
Camille M. Renella, RN, CME, LNC
Clinical Medical Ethicist/Legal Nurse Consultant
Institute of Medicine Chicago (IOMC) Fellow
Executive Director