AETCOM CASES
Module 2.2 C: Describe and discuss the role of BENEFICENCE of a guiding principle in patient care.
Case 1. A 60-years-old female presented to the casualty ward with acute abdominal pain and fever. She
improved slightly with symptomatic treatment. The doctor wanted to hospitalize her but she begged to be
allowed to return home for bed rest saying that she was extremely fearful of hospitals and procedures. She
was diagnosed with acute appendicitis after full work-up and had to be operated.
1. What ethical Principle is involved here?
2. How would you respect this Principle?
Module2.2 A: Describe and discuss the role of NON-MALFICENCE as a guiding principle in patient
care
Case 2. A 22-years-old female patient with complaints of recurring back pain presents to a general
practioner. She was prescribed in accordance with the standard of care but did not improve. The practioner
realized that she needs on orthopedic referral but did not refer her for the fear of losing her to someone else.
He continued to treat her with a high dose of pain killers over the next eight months. Finally, the girl’s
friends took her to another doctor who diagnosed her with ill-managed slip disc & an addiction to pain
killers.
1. Which ethical principle is involved here?
2. How should you respect this principle?
Module 2.2 B: Describe and discuss the role of AUTONOMY and shared responsibility as a guiding
principle in patient care
Case 3. A 25-years-old woman who is 12 weeks pregnant lost her husband in an accident. The girl’s parents
want the doctor to convince the girl to abort the child so that she can remarry easily. The girl is adamant
about having the baby saying that her husband would have wanted it that way. The doctor is threatened by
the women’s family & offered a bribe to conduct an MTP.
1. Which ethical principle is involved here?
2. How would you respect this principle?
Module 2.2 E: Describe and discuss the role of JUSTICE as a guiding principle in patient care
Case 4. A 66-years-old Bangladeshi immigrant female with history of diabetes mellitus, hypertension &
vascular disease presented with c/o cough and wheezing. She could not speak Hindi or English. The
physician had a very strong view that people who come to India should learn to speak Hindi or local dialect.
She was turned away from care and had to be taken to a distant hospital, but died on her way there.
1. Which ethical principle is involved here?
2. How should you respect this principal?
Module2.2 D: Describe and discuss the role of PHYSICIAN in health care system
Case 5. Describe and discuss the role of PHYSICIAN in health care system.
Answer: The role of PHYSICIAN in health care system
1. Clinician who understands, provides preventive care with compassion
2. Leader & member of the healthcare team & system- capabilities to collect, analyze, synthesize &
communicate health data appropriately
3. Communicator with patients, families, colleagues and community
4. Lifelong learner- continuous improvement of skills and knowledge
5. Professional- committed to excellence, is ethical, responsive and accountable to patients, community and
profession
Module 2.5: Identify, discuss and defend medico-legal, socio- cultural and ethical issues as it pertains
to patient autonomy, patient rights and shared responsibility in healthcare.
Case 6. A 55-year-old male patient, Mr. Patel, is admitted to the hospital in Tumakuru with severe internal
bleeding requiring a blood transfusion to stabilize his condition. Mr. Patel is a devout follower of the Jain
faith, and his religious beliefs forbid the use of blood transfusions. His family supports his decision, but the
medical team, guided by the principle of beneficence, believes the blood transfusion is essential to save his
life. Mr. Patel refuses the transfusion, stating that he is willing to face death rather than violate his religious
principles.
1. Identify, discuss and defend medico-legal, socio- cultural and ethical issues as it pertains to patient
autonomy, patient rights and shared responsibility in healthcare
Answer: Medico-Legal Issues:
Informed Consent and Autonomy:
Mr. Patel's right to make autonomous decisions about his medical care, even if those decisions conflict
with medical recommendations, is a central issue.
Capacity to Consent:
The medical team needs to assess Mr. Patel's capacity to make informed decisions, meaning he
understands the risks and benefits of both the transfusion and its refusal, and can communicate his
choice.
Legal Framework:
The legal framework in Karnataka (and potentially other relevant laws) will determine whether Mr.
Patel's refusal to consent can be overridden, even in a life-threatening situation.
Criminal Liability:
If the medical team proceeds with the transfusion against Mr. Patel's wishes, there could be potential
legal ramifications.
Socio-Cultural Issues:
Religious Beliefs:
Jainism's prohibition on blood transfusions is a deeply ingrained cultural and religious practice.
Family Influence:
The role of family in medical decision-making can be significant, especially in cultures where family
values and opinions are heavily considered.
Communication and Understanding:
The medical team needs to understand and respect Mr. Patel's cultural and religious context, and
communicate effectively to ensure he understands the risks and consequences of his decision.
Cultural Sensitivity:
Healthcare professionals must be sensitive to the diverse beliefs and practices of their patients in
Tumakuru, which is a diverse region with varying religious and cultural traditions.
Ethical Issues:
Beneficence vs. Autonomy:
Balancing the healthcare team's duty to do good (beneficence) by saving Mr. Patel's life with his right to
self-determination (autonomy) is a core ethical dilemma.
Non-Maleficence:
The team also has a duty not to harm (non-maleficence), and proceeding with a transfusion against his
will could be considered a form of harm.
Justice:
Ensuring equitable access to healthcare and respecting all patients' rights, regardless of their beliefs, is a
matter of justice.
Shared Responsibility:
The responsibility for making the final decision rests with Mr. Patel, but the medical team has a duty to
provide information and support him in making an informed choice.
Defense and Resolution:
Respect for Autonomy:
While advocating for Mr. Patel's life, the medical team should prioritize his right to make his own
decision.
Clear Communication:
They should thoroughly explain the risks and benefits of the transfusion and explore alternative
treatments if possible.
Cultural Sensitivity:
The team should engage in open and respectful dialogue with Mr. Patel and his family to understand
their concerns and perspectives.
Legal Advice:
Consulting with legal counsel is crucial to understand the legal implications and responsibilities in this
situation.
Ethics Committee:
If a resolution cannot be reached, involving an ethics committee can provide guidance and facilitate a
more just and equitable decision.
Shared Responsibility:
Ultimately, Mr. Patel bears the responsibility for his decision, but the medical team must provide the
necessary information and support, while acknowledging their own responsibility in ensuring his well-
being.
