ISD II – Pediatrics

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. Discuss the following case. What ethical/legal issues are involved? How should the physician’s conduct be evaluated ethically speaking? How, if at all, could this situation be handled differently in order to avoid/minimize any ethical problems it poses? [Note: do not assume that Jesse can be easily persuaded that the surgery is a good idea.]

When Jesse Bowman was 9 years old a Wilms tumour was discovered on his left kidney. The kidney was successfully removed and with follow-up treatment the cancer appeared to be eradicated. Jesse had a full recovery and enjoyed an active life like any other boy his age.

Four years later, however, a spot is discovered on Jesse's other kidney. Another tumour is suspected. It is decided that surgery will be necessary to confirm the diagnosis. If, as his physicians suspect, it is another Wilms tumour, the removal of Jesse's remaining kidney will be necessary.

Jesse's condition and the need for an operation to confirm the diagnosis are explained to him. He appears to understand the serious implications of his illness.

Jesse agrees to go ahead with the surgery to confirm the diagnosis, but is adamant that his other kidney should not be removed: "I've seen those people on the machines" he says, "and I don't want to be like that!" His doctor tells him he doesn't have to worry about that yet: "At this point we just want to take a look to see what we're dealing with here."

Jesse's parents sign the consent form on his behalf. They inform the physician to do whatever he thinks is necessary. During the subsequent surgery a Wilms tumour is confirmed. Jesse's remaining kidney is removed.

2. As discussed in class, the B.H. case raises questions about the degree of autonomy that should be granted to a mature minor. Write an essay in which you address this issue. Should a mature minor be allowed to refuse lifesaving treatment or is the sort of paternalistic intervention that took place in B.H. ethically appropriate? Defend your answer.

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.