Category: Acute Care

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  • 27. Case: Withdrawal of Life-Sustaining Treatment

    Mr. Windown, age 82, is admitted to a cardiology clinical unit with unstable angina. In addition to his coronary artery disease, Mr. Windown suffers from disabling generalized osteoarthritis, chronic and progressive obstructive lung disease, and diabetes with associated compromise of his vision and kidney function. The coronary angiography reveals significant blockages of Mr. Windown’s coronary…

    View Case Study: 27. Case: Withdrawal of Life-Sustaining Treatment

  • 25. Case: A Difference of Opinion?

    Mary is a 90-year old woman who has been in hospital several weeks. She has a COPD exacerbation, increasing difficulty swallowing, and pneumonia. She has said repeatedly she is tired of being in hospital and tired of fighting to breathe. She doesn’t want a feeding tube or her IV but wants to be allowed to…

    View Case Study: 25. Case: A Difference of Opinion?

  • 24. Case: Changing Care and Care-Giving

    Kevin Henderson is an 83-year old man who is hospitalized in an internal medicine clinical unit at the local hospital. Kevin has a variety of serious medical conditions including severe Alzheimer’s disease, diabetes, coronary artery disease and advanced chronic obstructive lung disease. He is slowly recovering from a difficult-to-treat pneumonia, which required treatment with intravenous…

    View Case Study: 24. Case: Changing Care and Care-Giving

  • 23. Case: Reaching the Limits

    Mr. Stanley, a divorced 55-year old journalist with a history of epilepsy, was admitted to the medical ICU after an unwitnessed (presumably prolonged) episode of status epilepticus at home. Investigations, including an MRI study, revealed that he had sustained watershed cortical infarcts and a diagnosis of severe anoxic encephalopathy was made. Mr. Stanley did not…

    View Case Study: 23. Case: Reaching the Limits

  • 20. Case: To Treat or Not to Treat

    Stan Miller, a retired widower, sustains severe burns covering 80% of his body surface in a house fire secondary to a propane gas leak. He is initially assessed in the ED of the local hospital where he is sedated and intubated without any pre-resuscitation discussion about the seriousness of his thermal injuries and his care…

    View Case Study: 20. Case: To Treat or Not to Treat

  • 18. Case: When the “Truth” is Painful

    Mrs. Sally Parrot, a 73-year old widow, has mild dementia of a presumed neurovascular type. She resides in her own small apartment in Serenity, a private continuing care community in Bedford, where she receives some assistance with housekeeping, meal preparation and organization of her medications. Sally is actively engaged in Serenity’s structured activities and, in…

    View Case Study: 18. Case: When the “Truth” is Painful

  • 10. Case: At a Crossroads…

    Sandra Livingstone, age 45, was admitted to the hospital with diffuse ischemic encephalopathy – a very significant, global brain injury – secondary to sustaining a massive stroke at home. It is now ten months after her admission. Ms. Livingstone is on an acute internal medicine unit where she has been living since her discharge from…

    View Case Study: 10. Case: At a Crossroads…

  • 9. Case: Right to Treatment

    A 54-year-old male patient has been treated for cancer for 2 years, but his illness has not responded to the major lines of treatment. He has been admitted to hospital with worsening nausea and vomiting, abdominal pain, and failure to thrive. A CT scan showed progression of disease as evidenced by new ascites along with…

    View Case Study: 9. Case: Right to Treatment

  • 8. Case: Who Should Decide?

    This case concerns a 35-year-old developmentally delayed female patient (functional age about 5 years old); her mother is her legal guardian. The patient tested positive for a BRCA gene mutation. Her mother is concerned that her daughter may develop ovarian cancer and wants her to have preventive surgery. Her physician does not believe this is…

    View Case Study: 8. Case: Who Should Decide?

  • 6. Case: To Feed or Not to Feed?

    You receive a call on the ethics line about a patient’s relative (next-of-kin and legal decision-maker) force-feeding her sister who is a patient on the unit (pushing food into the patient’s mouth and then holding her mouth closed, pinching her nose, etc. until she swallows). Apparently, this was not an uncommon approach to getting her…

    View Case Study: 6. Case: To Feed or Not to Feed?

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