CASE 5: PROXY CONSENT FOR MEDICAL GAMBLE Norma Walker left her job when six months pregnant. Nine days after the baby was born she experienced severe headaches, fever, and a mild reaction to light. The next day, Sunday, she met with her obstetrician in the hospital emergency room. He found no abnormalities and felt strongly that further evaluation by an internist was imperative. Since Mrs. Walker did not know an internist, she and her husband were worried about finding a physician who would come to the emergency room on a Sunday morning. Dr. Stanley, a physician whom they both knew personally, happened to be in the emergency room at the time, and Mr. Walker asked him to assume care of his wife. Her obstetrician agreed. Dr. Stanley learned that the Walker's two-year old child had recently had viral meningitis, as had several other children and adults living near their home. When reached by phone, their pediatrician confirmed that two children had been given a lumbar puncture to have aseptic meningitis and had been treated conservatively at home. During the interview the Walkers expressed anger about the impersonal and unpleasant way Mrs. Walker had been treated by hospital personnel in the labor and delivery suite a week earlier. Mr. Walker was especially bitter and was certain she would have had better care at home. The results of the laboratory tests showed that Mrs. Walker probably had a just-beginning viral meningitis (for which the specific treatment is necessary), but may have had bacterial meningitis (a life-threatening illness requiring treatment with intravenous antibiotics). The test findings were carefully explained to the Walkers. Dr. Stanley stated that because of the circumstances, the chances of Mrs. Walker having viral meningitis were very high. But the result of the spinal fluid test raised the possibility of bacterial meningitis. The physician argued that, if he or his wife were the patient, he would play it safe and go into the hospital for two days of intravenous antibiotics until the spinal fluid culture was complete. Mrs. Walker felt too ill to think clearly - she would, she said, do whatever her husbands decided. Mr. Walker was determined to be involved in the decision. He was clearly concerned for his wife, but wasn't sure whether "playing it safe" was the best course of action. He appreciated the personal favor of the physician who had agreed to undertake her care on short notice and had given a detailed explanation of the medical evaluation. However, her recent hospitalization had left a bad impression. Also the couple had no insurance. Was the small chance really much of a gamble? Mr. Walker needed time to think and went for a walk. Upon returning, he announced his decision to take the gamble. He would take his wife home, fully aware of the risks and of Dr. Stanley's discomfort with his decision. Who ought to have made the decision about treatment in this case? Was Mr. Walker's decision justifiable?