Case 1

Sophie has had her 20-week anomaly scan and has discovered she is expecting another biy. This is her
4th pregnancy. She already has 3 sons and she and her husband decided to have another child in the
hope of having a daughter. Sophie and her own mother had a very close bonding growing up, and she
had dreamt of recreating the mother-daughter bond with her own child. The desire had been mad
stronger due to recent death of her own mother.

You are her GP and when she comes to see you, she is visibly distressed. She confides that she has
already booked an appointment with a counselor. She does not want to continue her current pregnancy
as she does not feel she could give enough love to another son. She also tells you that her husband is
supportive of any decision she chooses to make as he too has a preference to have a daughter.

Questions:

What ethical principle(s) can be applied on the above situation? Justify.

What are the current laws in the Philippines about termination of pregnancy?

Does the potential father have any legal rights?

Case 2

Adele is a 39-year-old tax collector. She is 16 weeks pregnant with her first child. Following her first
trimester scan at 13 weeks she was informed that she was high risk for having a child with Down’s
Syndrome. She underwent further diagnostic testing in the form of amniocentesis which confirmed the
diagnosis. The couple is distraught as they had tried for a long time to conceive, but Adele does not
think she can cope with a baby with Down Syndrome. Despite counselling, Adele is sure she wants to
terminate the pregnancy. She visits her GP to a request for termination. However, the GP is a practicing
Roman Catholic with strong faith, and he does not wish to participate in abortion services.

Questions:

What ethical principle(s) can be applied on the above situation? Justify.

In what circumstances can a health care professional refuse to involve in a termination of pregnancy?

Are there any medical situations when conscientious objection can be used by a health care
professional?

Case 3
Seven year old Megan is on a school trip to Nangaromoan Beach when she slips on the edge of the
swimming pool and lands awkwardly on he r wrist. She is taken to the local accident and emergency
department by her teacher. Xrays reveal she has a nasty comminuted fracture of her radius, and the
orthopaedic team believes that it is going to need manipulation under anesthesia in order to achieve
satisfactory realignment. Your surgery consultant asked you to complete the necessary pre op checklist
and complete consent form. You try to explain to him that the parents are not present, but he reassures
you that the teacher can sign instead since she is an accompanying adult.

Questions:

What ethical principle(s) can be applied on the above situation? Justify.

What can consent to medical treatment?

What happens in an emergency?

Case 4

Adam is a 12 year old boy being treated for osteosarcoma of the arm in the pediatric oncology unit
where you are working as an intern. Although he initially responded well to treatment, he has suffered a
relapse and now has a widespread metastatic disease. His parents have been told about the relapse and
a further cycle of chemotherapy, with the hope of prolonging his life by a few months, has been
suggested. The chances of cure are negligible and the side effects likely to be very significant.

His parents have considered the options and decided they would like him to have further chemotherapy.
However, they are adamant that they do nt want adam to be informed that his cancer has spread or
that he is likely to die even with theadditional chemotherapy. They wish to protect him and are very
worried that telling him will cause him great distress. Your consultant has encouraged to discuss things
honestly with their children, even when the prognosis is terminal. However, his parents continue
making plans with him for the following year and telling him he needs further chemotherapy to get
better.

Questions:

What ethical principle(s) can be applied on the above situation? Justify.

Should Adam be involved in the decision about whether he has further chemotherapy?

What ethical principles should be considered when deciding whether to withhold information from a
patient?

Case 5
You are the Surgeon o Call. A patient comes in an cutely unwell with severe abdominal pain. He is
reviewed by your senior, who tell him he needs and operation to investigate the cause of his symptoms.
They ask you to obtain consent for laparoscopy and a laparotomy and proceed. When you see the
patient, he is still in pain and he tells you that he is aware he needs an operation but just wants them to
go get on with it. He says he does not want to know what risks there might be, “You do whatever is best,
doctor”.

Questions

Why is consent legally necessary?

What are the essentials of valid consent?

Is consent valid if the patient is not informed of risks because he does not want to know?