ISD II – Musculoskeletal

Ethics/Humanities/Health Law

Short Paper Topics

Those of you who selected the option of writing short essays during the ISD I & II course should submit your next essay by May 30. Below are some possible topics.

1. The following case raises a number of difficult questions regarding the idea of informed consent (and, in particular, about decisions to refuse treatment). Write an essay which explores the ways in which this situation is problematic both ethically and legally. What should be done in such a case?

Tom is an 80 year-old man with diabetes, renal insufficiency, hypertension, coronary artery disease and severe peripheral vascular disease.

Two years ago, Tom had a left above the knee amputation. For the last three months, Tom has had an infection in the right lower extremity. Two weeks ago, he was admitted to hospital concerning this infection. At this time, a right below the knee amputation was recommended to him (since other treatment options had failed). Tom refused, saying that he had already lost a leg and saw no reason to live without any legs. Tom was discharged with a prescription for oral antibiotics although he was advised that this was not the optimal treatment.

Today, he was admitted to the hospital with a right lower extremity infection and sepsis. He was extremely confused and unable to communicate clearly. The orthopaedic surgeon brought in to consult on his case recommended that a right below the knee amputation be carried out. When his prior refusal of this procedure was brought up, the physician who discharged Tom the last time was consulted. He indicated that their conversation prior to discharge had concerned what the optimal way of treating the infection was, not the choice between amputation and death. The consulting surgeon is now of the opinion that Tom faces a real risk of dying if the amputation is not performed soon. Tom has no living relatives, nor a designated substitute decision maker, nor has he prepared an Advance Health Directive.

Note: A similar, although not identical, case is discussed in the article “Achieving Informed Consent When Patients Appear to Lack Capacity & Surrogates,” by Neil S. Wenger et al in Clinical Orthopaedics and Related Research 378 (2000): 78-82. This journal is available in the library.

2. Although the idea of informed consent has come to be thought of as one of the cornerstones of medical ethics, there are those who think that the goal of acquiring informed consent from patients is a futile one. Discuss this claim. Should informed consent have the status it does within medical ethics?

Note: For discussions of this issue, see “Informed (But Uneducated) Consent” by F.J. Ingelfinger, New England Journal of Medicine 287 (1972): 465-466 and “Abandoning Informed Consent: An Idea Whose Time Has Not Yet Come” by B.C. White and J. Zimbelman, Journal of Medicine and Philosophy 23 (1998):477-99.

You may also write on a topic of your own choosing provided it deals with one of the broad subjects covered in the ISD II course (i.e., neurology, gastroenterology, etc.). Please see either John Crellin or Andrew Latus to discuss a topic.