Clinical Skills – Ethics/Humanities/Health Law

Tutorial Notes for Thursday, Oct. 14, 2002

11- 11:40

Unlike the other sessions so far, this does not follow up on a Clinical Skills case. Instead, what this session does is set up a lecture on autonomy and paternalism that will follow your session starting at 11:45.

Fairly recently, the students had a class in which the idea of informed consent was presented, along with some discussion of why it matters. At the time, it was noted that sometimes our judgments about what is in a patient’s best interests do not match with the patient’s stated desires. I’ve attached to this are a couple of case that let them think about situations of that sort and about when, if ever, a paternalistic override of the patient’s desires is appropriate.

One case concerns Bethany Hughes, the Alberta teenager who rejected chemotherapy as treatment for her leukemia. Hughes, a Jehovah’s Witness, was forced by the courts, on behalf of Alberta child welfare authorities, to undergo the treatment and accompanying blood transfusions. The treatments were not successful. She died in September of this year. This will probably be a familiar case to most of them, but in case it is not the students will have received the same clippings that are attached to this.

The second reading is a passage from Margaret Laurence’s The Stone Angel. In this case, an elderly but arguably still competent woman is the object of paternalistic treatment from both her daughter and her physician. The students have been given this passage as well and it may be useful to have them talk about their reactions to the case.

It is quite likely that discussion of this case will take up the whole 40 minute we have scheduled. However, if it doesn’t, I’ve attached a third case description is attached, although the students haven’t received it. This case involves the possible involuntary commitment of a 60 year old woman with some psychiatric problems. It should be easy to get a discussion going of whether it is appropriate for the woman to be committed and what factors would need to be considered in making this decision.

Thanks for doing this. If you have any questions or concerns, you can reach me at 777-6720 or alatus@mun.ca

Andrew