Case Study #3
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Boston University *
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Course
251
Subject
Medicine
Date
Dec 6, 2023
Type
docx
Pages
2
Uploaded by MegaHamster1653
Case Study #3
a.
Who, if anyone, in this scenario should be allowed to give informed consent to
treatment (or no treatment)? Why?
In this case, the patient shouldn’t be allowed to give informed consent to treatment. Since
he is a minor, he may not understand the full extent of the treatment and therefore cannot make
informed decisions on what the best outcome for his health is. However, describing the capacity
to which his mother is willing to go for invasive treatment may persuade the patient to lift
confidentiality and inform his mother about the ingestion of the drug.
The patient's mother also
has the right to informed consent since the patient is a minor and ultimately has the authority to
make the medical decision for treatment or not. She should be able to provide informed consent
on behalf of her son unless there is speculation that she is not making an informed decision with
her son's best interest in mind. However, with patient confidentiality in the way, it will be up to
the son to tell the truth in order for his mother to make a decision and give informed consent.
b.
Should the physician regard the 14-year-old as a mature minor? What would the
criteria be? What actions should the physician take if she regarded him as a mature
minor?
The physician shouldn’t regard the 14-year old as a mature minor being that he is only 14
years old. One of the criteria for a mature minor is being at least 16 years of age in America. The
mature minor doctrine allows adolescents who have the capacity to make decisions regarding
themselves medically. However, even though he was fully aware that he had taken these drugs
and had a full understanding of the consequences, during his visit he was “drowsy and
disoriented” meaning he wasn't fully competent so the physician treating him as a mature minor
wouldn't be morally right. If the physician regarded him as a minor, a step that the physician
should take is convincing the patient to talk to his mother about what he had done. As a mature
minor, his responsibility would be to choose what would be best for himself since he does have a
say on his autonomy as a mature minor.
c.
What actions would the physician likely take if she decided to set aside the issue of
informed consent and act only in the patient’s best interests? Could this create any
potential problems?
By setting aside the issue of informed consent, she would be acting on the patient’s
request to keep his secretive drug act confidential, which would maintain her promise to keep
confidentiality with the patient. This would result in the physician taking other means to try to
persuade the patient to open up to his mother about his secret. Adapting the interpretive model,
the physician should recognize that the patient’s values are conflicting and require further
development, which can be discussed in such a way that leads to what is valuable. She would be
an advisor or a counselor for the patient, attempting to use methods of counseling and
persuasion, while also keeping unqualified confidentiality with the patient. The potential issue
with this course of action is that if the model fails to persuade the son to tell his mother, then the
mother is still unaware of the true nature of the situation, and will continue to take other
unsuccessful measures to “figure out” what is wrong with her son. It is assumed that the mother
will continue with these inquiries since she “continued to be insistent that further tests be
performed, including a spinal tap.” It is also important to note that the symptoms of ingesting the
drug and contracting West Nile virus are very similar, so they are difficult to distinguish based on
the symptoms that the patient is experiencing, including a high blood pressure and temperature.
That said, if the physician does not tell the mother or persuade the patient to tell his mother about
him taking the drug, then it will be really difficult to figure out that his symptoms come from
something other than West Nile Virus.
d.
Should the physician break confidentiality and tell the mother? Why or why not?
Since the physician stated that all information given by the patient would be kept
confidential, it would not be ethically right to go against their word and tell the mother. There is
value in being able to trust your doctor and feeling comfortable enough to be honest with them.
According to Kipnis in every situation, there should be full honesty and 100 percent trust. If she
chooses to breach confidentiality that would be considered qualified medical confidentiality,
which Kipnis argues against. The physician also has no idea why the 14-year-old may not want
to tell their mother, there could be serious consequences that the minor is trying to avoid. Minors
are used to having local autonomy because usually their parents have a say in the things they do,
until they become a young adult. In this case, the 14-year-old youth seems to understand what is
causing their symptoms and knows that the drug they took is dangerous. What the provider
should do is act as a counselor and educator. However, if the patient's condition deteriorates, or if
there are any signs of severe medical complications then the physician can perhaps involve the
mother. As of now, the provider can persuade the patient to tell their mother voluntarily.
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