Category: Substitute Decision-Making

  • 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…

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  • 22. Case: Double Effect?

    The following call comes in to the ethics line: “Hi. It’s Celine from Oncology. We have a patient here who is in the end stages of lung cancer and is in a lot of pain. The patient and his family are strongly Catholic. The patient’s pain doesn’t seem to be well-controlled. But the family won’t…

    View Case Study: 22. Case: Double Effect?
  • 21. Case: Balancing Concerns

    “Where’s the door to my bathroom? Can’t a man get some privacy?” “Uh oh, that’s Elias again. We’d better make sure he’s alright.” “How many times are we going to have to go through this with him? Maybe we should just put the bathroom door on again.” “The only problem is that on his ‘bad’…

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  • 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…

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  • 19. Case: Craig’s Right to Choose?

    Craig Renaldo is a 14-year old boy who was recently diagnosed with a right lower leg malignant vascular tumour. Staging investigations have been negative for distant metastases. Craig’s attending medical oncologist, Dr. Purvis, consults a pediatric orthopedic surgeon, Dr. Mendes, who recommends a below-knee amputation. Dr. Purvis concurs with this recommendation given the aggressive nature…

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  • 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…

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  • 16. Case: Shifting Gears

    Nedra has been fighting ovarian cancer for 3 years. When first diagnosed, Nedra had surgery followed by intensive chemotherapy. Although it initially looked like she might be moving into remission, things started to change about 6 months ago. Nedra started experiencing some bone pain and it was discovered that her cancer had metastasized. Although radiation…

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  • 15. Case: Acceptable Judgement?

    Sara Thornton, an unemployed 19-year old woman, lives with her 28 year old sister, Fran, and Fran’s boyfriend, Alan. Both sisters were diagnosed with bipolar I disorder in their mid-adolescence. They are both estranged from their alcoholic mother, the only living parent. Fran has learned to manage her illness reasonably well through lifestyle changes, participation…

    View Case Study: 15. Case: Acceptable Judgement?
  • 14. Case: I Want to Go Home!

    A widower (age 88) lives alone, but has family living nearby. Recently he had a stroke and regained consciousness after being admitted to hospital. He was deemed to have cognitive capacity. His adult children approached the physician in charge of his case along with the unit’s Nurse Manager and requested that the patient be placed…

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  • 11. Case: Truth-Telling

    The patient is an 89-year-old gentleman with moderate dementia and a history of COPD, swallowing difficulties, a CVA, and recent aspiration. The investigation of his aspiration uncovered a lesion in his lung- the physicians felt it was likely to be cancerous. Thoracic surgery verified that it was lung cancer and a determination was made that…

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