coronary heart disease

The Case of Bob
County Hospital
Bob reports to the ER with sudden-onset chest pain, shortness of breath, and nausea. He has no prior diagnoses. He has not seen a physician in 3 years.

Bob is married, with 2 dependent children. His employer provides adequate health insurance and sick leave. He is of above average intelligence, and is a native speaker of English.

Reliable diagnostic tests indicate advanced coronary heart disease. If left untreated, the condition will likely prove fatal within months. The standard treatment is an immediate coronary artery bypass graft. With treatment, there is a high probability that Bob can return to normal activity. County Hospital is adequately prepared to provide this treatment.

The health care team has explained to Bob:

 Details about the recommended treatment
 The reasons for their recommendation
 The risks and benefits of treatment
 The risks and benefits of refusing treatment

There are no religious or cultural reasons for Bob to refuse treatment.
Bob does not have a health care advance directive.
Treating Bob would not limit the availability of treatment to any other patient.

Bob refuses treatment and asks to leave the hospital.

The health care team tells Bob that they would like him to stay and reconsider his decision.
Not all questions about what we should do are ethical questions.

Practical, non-ethical questions concern how we ought to act if we want some outcome or result.
Example: How do I get to Carnegie Hall?

Ethical questions concern how we ought to act (without qualification).
Example: Is it ever OK to tell a lie?
Some ethical questions involve right vs. wrong decisions.
Example: I’m at a restaurant and I left my wallet at home. Should I dine and dash?

Some questions involve ethical dilemmas (right vs. right decisions).
Ethical dilemmas are present when there are good reasons for more than one response to a situation and you can’t do both
o When your conscience (your gut/your intuition) tells you that what you are doing just doesn’t seem right but you are not sure that the other options are any better

What ethical dilemmas and questions
does Bob’s case pose?
What values are relevant to the case of Bob?
Respect for autonomy: HCPs have a duty to respect people’s right to decide how their own lives go.

Beneficence: HCPs (health care professionals) have an obligation to provide health-related benefit to their patients.


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