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17 July 2006 @ 09:49 pm
Out of curiousity...  
We were given some case studies for a medical ethic debate and I'm surprising myself by not having any strong feelings towards any of them. Hopefully that doesn't mean I have no sense of ethics! Anyway I'm throwing it open to the floor, what does everyone else think?

A patient aged 56 presents to you (as her GP/Family Doctor) requesting referral to the IVF unit for ovum donation IVF. Discuss the ethical issues involved. How might the following influence your decision.
  • She has no children.
  • She has 3 grown up children and 5 grandchildren.
  • She is willing to pay all costs.
  • If declined she may seek the same in Italy.

    A woman who has just given birth to a premature baby at 26 weeks has made inquiries about the chances of survival and of handicap. She judges the risk to be too high and requests that no attempt be made at life support. You are the Doctor attending the birth, what are the ethical issues you need to consider?
    (A fetus is considered viable after 24 weeks)

    You are a research scientist. You collected samples for HIV testing on the provision that the results be anonymous and confidential. The partner of a research subject approached you, she claims that her partner (the research participant) had deliberately infected her with HIV; she wants to know the result of the sample you analysed.
    Current Mood: thoughtfulthoughtful
    Broken Mnemonicimagechild on July 18th, 2006 02:40 am (UTC)
    see, I still don't know how I'm supposed to react unless you give me specific examples! post some examples, and I'll ethics you up!
    Maria: Smileria_kukalaka on July 19th, 2006 07:46 pm (UTC)
    Silly! :p
    noctuabundanoctuabunda on July 18th, 2006 09:32 am (UTC)
    A patient aged 56 presents to you...
    Okay, that one I just don't understand. IVF?

    A woman who has just given birth...
    Tough one. I'd say her wishes shouldn't be the first thing to think of. I mean, you're the one who studied medicine. You're the one who can really judge the risk. So if you think the baby has a good chance of leading a relatively uncomplicated life, try to save it (if necessary). On the other hand, I wouldn't want to give a handicapped baby to a woman who's clearly not able and/or willing to take care of that baby properly.

    You are a research scientist...
    If she already knows that, what does she need the result for? Why can't she just talk to her partner and get a test for herself Don't give that thing to her.
    Maria: D'OHria_kukalaka on July 19th, 2006 07:51 pm (UTC)
    IVF - Very simply, you give a woman some hormones to get her ovaries to produce eggs, take them out of her and put them in a 'test tube' then you mix in some sperm from her partner (or it can be donor sperm) and let the eggs fertilise and develop. Once you know they're doing ok, implant them in the woman's womb and it's the same as her being pregnant.

    I agree the second one is difficult. I wouldn't want to let a baby die if I know I can save it, but how can you go against the wishes of the mother who's responsibility it would be.
    zellieh: Text Watching from the dark Eyezellieh on July 18th, 2006 12:25 pm (UTC)
    Oh, these questions are interesting! Hmmm. Well, I have no training in ethics or medicine, but here are my feelings:

    I don't think any of those factors should be relevant, except maybe her age - are there still maximum age limits for women having IVF? If she's physically fit enough to cope with the IVF & pregnancy, and mentally fit to make the decision, then isn't it her decision to make? She's only asking for a referral, after all, and it's the IVF clinic's job to offer counselling & expert advice.

    26 weeks:
    If the fetus is considered viable at 24 wks, does that mean it counts as a patient in it's own right? If it does, then you'd have a duty to it as well as to its mother. In that case, you'd need to assess its health before deciding whether or not to refuse life support. There are a few preemies born that young that can be healthy - it could be one of them. BUT, if you 'save' the child against its mothers wishes, and it's handicapped, would she be able to take you (or your hospital) to court and claim damages? Or complain to the GMC?

    I know there was a criminal case where someone was convicted (of assault, I think) for knowingly giving their lover HIV. You might have a duty to report this to the police, or ask the lady to report it. BUT I don't think you're allowed to tell her the results, since you've signed a patient confidentiality agreement, although you could tell the police if it turns out to be evidence of a crime.

    I hope that helps. *g*
    Maria: CJ strengthria_kukalaka on July 19th, 2006 07:52 pm (UTC)
    Those are some interesting points to think about. Hopefully enough to let me babble randomly for 20 minutes ;) Thanks.