MMI - consent

[LizzyM]

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From my experience in MMI style boards and interviews, they don't expect you to know anything that isn't in the prompt. So if the prompt doesn't say it is a high risk surgery, you shouldn't assume that to affect your answer.

Any lay person would know that open heart surgery carries risks including the risk of death. There is really no point in putting that in the prompt otherwise. It could just say, "there is an alternative to a month of antibiotic treatment but it would mean that Jack, the donor, would require a lifetime of blood thinners which would preclude him from engaging in athletic pursuits."

This is a poorly written prompt and the malapropisms (or typos) only make it more difficult. (e.g. infested/ infected)

 

[lpp06]

Do nothing = Jack gets best quality of life. Mike will be dead in 2 days/ be in great agony to boost.
Surgery: Jack at great risk and will not be able to play sports. Mike = best quality of best coz identical twin 6/6
@Pusheen
Jack had some unknown infections. You can spend months to test it then Mike will be dead by then. They found a cyst (idk what is the correct term but you get the idea) in his heart so they can biopsy it and pinpoint the type of infection and use the right antibiotics to clean him. The problem is the size of the cyst indicates that it will take at least a month even if they have the correct antibiotics.

They have to get Jack ready in 2 days. So they decide to manually clean the cyst by open heart surgery and then flush his system with antibiotics to bring make him infection free. That was the prompt solution to the dilemma. Is it risky? No **** Sherlock. That is why the question of child abuse arose in the first place. Now if you are so so smart, can you propose a way to get Jack in shape in 2 days?
Caveat:
_No other donor available.
_The 4/6 core blood transplant will likely fail (let say they have done testing).

What is your reespone to the situation?

 

[Matthew9Thirtyfive]

Any lay person would know that open heart surgery carries risks including the risk of death. There is really no point in putting that in the prompt otherwise. It could just say, "there is an alternative to a month of antibiotic treatment but it would mean that Jack, the donor, would require a lifetime of blood thinners which would preclude him from engaging in athletic pursuits."

This is a poorly written prompt and the malapropisms (or typos) only make it more difficult. (e.g. infested/ infected)

Yeah I agree. I worded that poorly. All I meant was that you shouldn't use the unrealistic nature of the scenario as a way to avoid the underlying question.

 

[wizzed101]

Any lay person would know that open heart surgery carries risks including the risk of death. There is really no point in putting that in the prompt otherwise. It could just say, "there is an alternative to a month of antibiotic treatment but it would mean that Jack, the donor, would require a lifetime of blood thinners which would preclude him from engaging in athletic pursuits."

This is a poorly written prompt and the malapropisms (or typos) only make it more difficult. (e.g. infested/ infected)

Thanks for the feedback!
But if I did not spell out what and why things were done to impress upon the readers that there was really no other alternative, would they not just tend to propose yet another course of treatment? In other words, they could've thought that this was a test to see if they could detect a false dichotomy. Or are you suggesting that there will never be MMI questions that require you to seek an alternate solution other than what are provided?

 

[libertyyne]

This is my strategy:
Give the alternative solutions even if will be rejected by the interviewer. The following reasons:
1. Displays need for thoroughly evaluating all possible senarios.
2. Buys you more time to think about the problem and stakeholders.
3. You still end up giving the binary question's answer anyway.

I think the same applies for asking for opinions and advice from other stakeholders. Shows you are not rigid in your thinking. A team player. Know when you are outside your element. All positive attributes.

 

[LizzyM]

I am not, nor have I ever been, an applicant to medical school. With that caveat, I would say that to put Jack, a child who needs treatment for an infection, at even greater risk, including the risk of death, in order to save Mike, his twin from certain death, is unjust and treats the donor child as merely a means to an end.

I would think that the parents need to be told that Jack is not a suitable donor at this time. Jack has a treatable infection and prospects for a long and productive life. Unless a suitable donor can be found for Mike, he is going to die. That is unfortunate but putting Jack through a very risky procedure that does not benefit him is not in his best interest. If I were Jack's physician and advocate, I could not recommend that he undergo an open heart procedure as a prelude to bone marrow donation.

 

[lpp06]

Preface: I have not participated in an MMI

I would surmise that an ethical MMI question is intended to investigate a candidate's ability to sympathize with all parties involved and assess the implications of a decision.

So here, the question would want the interviewee to understand the parent's emotions and reasoning for rushing to a very important decision. This ultimately drives how you communicate your decision and/or guidance to the parents.

Sure you can offer alternatives, but you wouldn't be expected to know, at this point as a premed, the long term implications of mitral valve repair vs. replacement and mechanical vs. pig valve replacement (one requires blood thinners and the other does not).

 

[Pusheen]

@Pusheen
Jack had some unknown infections. You can spend months to test it then Mike will be dead by then. They found a cyst (idk what is the correct term but you get the idea) in his heart so they can biopsy it and pinpoint the type of infection and use the right antibiotics to clean him. The problem is the size of the cyst indicates that it will take at least a month even if they have the correct antibiotics.

They have to get Jack ready in 2 days. So they decide to manually clean the cyst by open heart surgery and then flush his system with antibiotics to bring make him infection free. That was the prompt solution to the dilemma. Is it risky? No **** Sherlock. That is why the question of child abuse arose in the first place. Now if you are so so smart, can you propose a way to get Jack in shape in 2 days?
Caveat:
_No other donor available.
_The 4/6 core blood transplant will likely fail (let say they have done testing).

Why are you so salty at me? Because I pointed out an issue with the prompt? I already said in a previous post that I wouldn't do the open heart surgery and I don't think Jack's surgeon would.

 

[wizzed101]

Why are you so salty at me? Because I pointed out an issue with the prompt? I already said in a previous post that I wouldn't do the open heart surgery and I don't think Jack's surgeon would.

So in other words, you knew nothing about the medical aspect of the prompt but kept berating it in the last 20 posts or so. And that is annoying. I hope you haven seen why the idea of an open heart surgery was proposed in the first place. Recap: it's probably because they were very smart. And this isn't my idea. Someone in the previous page had already pointed out where I got it from.

Sure you can offer alternatives, but you wouldn't be expected to know, at this point as a premed, the long term implications of mitral valve repair vs. replacement and mechanical vs. pig valve replacement (one requires blood thinners and the other does not).

For me at least, by proposing alternatives, you appear trying to avoid making a hard decision since I have presented it in a way that (hopefully) made it clear that there was no other alternative. I would have crossed you out, but it's just me :/ You have 2 choices and only 2. Pick one and tell me why.

 

[Lawpy]

I am not, nor have I ever been, an applicant to medical school. With that caveat, I would say that to put Jack, a child who needs treatment for an infection, at even greater risk, including the risk of death, in order to save Mike, his twin from certain death, is unjust and treats the donor child as merely a means to an end.

I would think that the parents need to be told that Jack is not a suitable donor at this time. Jack has a treatable infection and prospects for a long and productive life. Unless a suitable donor can be found for Mike, he is going to die. That is unfortunate but putting Jack through a very risky procedure that does not benefit him is not in his best interest. If I were Jack's physician and advocate, I could not recommend that he undergo an open heart procedure as a prelude to bone marrow donation.

I support this. Using Jack as a sacrifice to save Mike's life is cruel and unjust to Jack because Jack is being objectified as a necessary bone donor. As unfortunate as it may be, Mike would have to deal with the 4/6 marrow and suffer... or worse, die. But at least, Jack's quality of life will be good (and not used as a sacrifice).

I have criticized the uselessness and dangers of that surgery before and I stand by it.

 

[Pusheen]

So in other words, you knew nothing about the medical aspect of the prompt but kept berating it in the last 20 posts or so. And that is annoying. I hope you haven seen why the idea of an open heart surgery was proposed in the first place. Recap: it's probably because they were very smart. And this isn't my idea. Someone in the previous page had already pointed out where I got it from.


For me at least, by proposing alternatives, you appear trying to avoid making a hard decision since I have presented it in a way that (hopefully) made it clear that there was no other alternative. I would have crossed you out, but it's just me :/ You have 2 choices and only 2. Pick one and tell me why.

Look, I'm sorry people aren't playing along with your scenario like you want them to. Myself, Lawper, and LizzyM have pointed out why it doesn't lead to the dilemma that you want it to get to.
That is the problem here.

 

[Lawpy]

You have 2 choices and only 2. Pick one and tell me why.

I think this is a false dilemma, but even when going along with it, I oppose the surgery and refuse carrying it out. I rather have Mike suffer and die than Jack being used as a sacrificing scapegoat to potentially save Mike (no surgery in practice can guarantee such a perfect outcome, and an open surgery carries much more risk of errors than noninvasive forms).

 

[libertyyne]

I am not, nor have I ever been, an applicant to medical school. With that caveat, I would say that to put Jack, a child who needs treatment for an infection, at even greater risk, including the risk of death, in order to save Mike, his twin from certain death, is unjust and treats the donor child as merely a means to an end.

I would think that the parents need to be told that Jack is not a suitable donor at this time. Jack has a treatable infection and prospects for a long and productive life. Unless a suitable donor can be found for Mike, he is going to die. That is unfortunate but putting Jack through a very risky procedure that does not benefit him is not in his best interest. If I were Jack's physician and advocate, I could not recommend that he undergo an open heart procedure as a prelude to bone marrow donation.

I agree with the premise of your argument. I think what makes this prompt interesting is the consent issue. Imagine jack as an adult who is making this decision. Would your view of the scenario change? Would you allow jack to go through with his decision to undergo a risky procedure and spend a life time on blood thinners to potentially save his brother?

I think patient autonomy and validity of consent are the real questions here rather than the bad decison that has been made by the jack in my scenario or the parents in the scenario.

Do you deny jack the chance to donate because you think the calculus doesn't make sense? Or do you abide by jack's wishes.

 

[wizzed101]

Don't lump your answer with hers. You refused to do that open heart surgery because you thought the idea of a surgery itself was "stupid."

The dilemma here is that Jack and Mike were both minors. If they were adults, this would've been a non-issue. Risk? Liver transplant also carried great risk. If a parent agrees to give part of their liver to their child, will you also say no because because it was risky?

 

[Lawpy]

Don't lump your answer with hers. You refused to do that open heart surgery because you thought the idea of a surgery itself was "stupid."

The dilemma here is that Jack and Mike were both minors. If they were adults, this would've been a non-issue. Risk? Liver transplant also carried great risk. If a parent agrees to give part of their liver to their child, will you also say no because because it was risky?

No I said the surgery is unnecessarily high risk that would likely kill both kids. It's another reason that works well with what LizzyM said. My final answer remained the same either way: avoid the surgery at any cost.

Surgery being stupid is also true and further reinforces my opposition to it. Why endanger Jack when a much safer alternative is available? Electing to do surgery necessarily puts Jack as a high-risk sacrifice to save Mike, but there's no guarantee that even with the surgery, Mike would be cured.. or even alright.

 

[Matthew9Thirtyfive]

Don't lump your answer with hers. You refused to do that open heart surgery because you thought the idea of a surgery itself was "stupid."

The dilemma here is that Jack and Mike were both minors. If they were adults, this would've been a non-issue. Risk? Liver transplant also carried great risk. If a parent agrees to give part of their liver to their child, will you also say no because because it was risky?

Except that physicians have autonomy as well. A surgeon can refuse to do a procedure that is unnecessary if he deems the risks and long-term effects of the surgery do not justify the benefits, to include the possibility of being a donor to Mike (because that's not guaranteed).

That said, I posed this question to my wife, a pediatric oncology nurse, and she said she would absolutely do the surgery. Jack's life may be changed, but even if Mike survives, his life will be forever changed as well. That's a good point. The surgery does not ruin Jack's quality of life and give Mike a brand new lease on life. It's having two kids who will have decreased qualities of life, or one kid with a normal life and another kid who is dead.

 

[Matthew9Thirtyfive]

No I said the surgery is unnecessarily high risk that would likely kill both kids. It's another reason that works well with what LizzyM said. My final answer remained the same either way: avoid the surgery at any cost.

Surgery being stupid is also true and further reinforces my opposition to it. Why endanger Jack when a much safer alternative is available? Electing to do surgery necessarily puts Jack as a high-risk sacrifice to save Mike, but there's no guarantee that even with the surgery, Mike would be cured.. or even alright.

I don't think it says or implies that though. Open heart surgery is high risk, obviously. But the risk to Mike is much greater if the surgery is not performed, because there are no other donors and a 4/6 match will likely fail per the prompt.

By doing the surgery, you put Jack at risk to lower Mike's risk of death. It may not work, but it is a much better chance than nothing at all and a better chance than 4/6 (again, the prompt says that a 4/6 will put him in grave danger).

So is the risk of Jack's surgery greater than the risk of Mike's condition with a suboptimal transplant or no transplant at all? I'd say it depends on the surgeon, the relative risk for the particular procedure, and Jack's overall health.

 

[Pusheen]

It's having two kids who will have decreased qualities of life, or one kid with a normal life and another kid who is dead.

I don't think it's appropriate for parents to make that call. Sure, maybe they'd be happier with 2 sick kids instead of 1 healthy one, but kids aren't objects to be bartered with to ensure a better outcome for the parents.

 

[libertyyne]

I don't think it's appropriate for parents to make that call. Sure, maybe they'd be happier with 2 sick kids instead of 1 healthy one, but kids aren't objects to be bartered with to ensure a better outcome for the parents.

Do you prevent them from making the call to circumcise or not ?
How about vaccinate?
What about in living near a nuclear power plant?
Or smoking in the same house?
Or feeding them mcdonalds everyday?

 

[Lawpy]

I don't think it says or implies that though. Open heart surgery is high risk, obviously. But the risk to Mike is much greater if the surgery is not performed, because there are no other donors and a 4/6 match will likely fail per the prompt.

By doing the surgery, you put Jack at risk to lower Mike's risk of death. It may not work, but it is a much better chance than nothing at all and a better chance than 4/6 (again, the prompt says that a 4/6 will put him in grave danger).

So is the risk of Jack's surgery greater than the risk of Mike's condition with a suboptimal transplant or no transplant at all? I'd say it depends on the surgeon, the relative risk for the particular procedure, and Jack's overall health.

I think the risk of the heart surgery + bone marrow transfer is much greater than the risk of receiving a suboptimal bone marrow transplant. I can't rationalize how a surgery will lead to a 5/6 or 6/6 bone marrow outcome.

And how do the surgeons prevent sepsis? The bacterial infection was supposedly in the mitral valve of the heart.

 

[Pusheen]

Do you prevent them from making the call to circumcise or not ?
How about vaccinate?
What about in living near a nuclear power plant?
Or smoking in the same house?
Or feeding them mcdonalds everyday?

Those are different issues that must be examined individually and aren't as high risk

 

[libertyyne]

Those are different issues that must be examined individually and aren't as high risk

My point being that considering children can't make these decisions by themselves parents are given that autonomy. You deny the patient's autonomy by denying the parents autonomy in this instance.

 

[ATPsynthase123]

The twins' parents plan to consent to Jack's treatment without telling him, and even if they tell him, you have learned, they are unlikely to relent on the surgery regardless what Jack's consent. Again he is a minor, so technically, regardless of his feeling, he cannot consent to anything.
[/spoiler]

Someone found out who the favorite kid is lol

In all seriousness you go with what the parents say. For all ethical and legal purposes, Jack is a minor and unable make these decisions. You cannot override what the legal guardians say to honor the wishes of someone who legally isn't a person yet.

Jack gets the treatment and his brother gets his bone marrow.


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[libertyyne]

I think the biggest lesson from this thread is everyone will have a difficult time answering this question. So do the best you can and try to rationally decide. I don't think answering this one way or the other will lead to autoreject or accept.

 

[Lawpy]

Someone found out who the favorite kid is lol

In all seriousness you go with what the parents say. For all ethical and legal purposes, Jack is a minor and unable make these decisions. You cannot override what the legal guardians say to honor the wishes of someone who legally isn't a person yet.

Jack gets the treatment and his brother gets his bone marrow.


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The parents may be acting based on what the doctor (I guess that's the applicant in the scenario) presented to them. The problem is the surgery option is flawed and the parents were likely misled and reacted emotionally.

I think the biggest lesson from this thread is everyone will have a difficult time answering this question. So do the best you can and try to rationally decide. I don't think answering this one way or the other will lead to autoreject or accept.

I'm still stumped how a surgery is effective and can lead to 5/6 or 6/6 bone marrow outcomes. So I have no choice but to page the surgeons on board here: @mimelim @ThoracicGuy signal!

 

[Pusheen]

My point being that considering children can't make these decisions by themselves parents are given that autonomy. You deny the patient's autonomy by denying the parents autonomy in this instance.

Because I feel that it is a gross abuse of parental authority to do unnecessary open heart surgery and damage a child for life in hopes of saving the other child. That's just my opinion on it

 

[libertyyne]

Because I feel that it is a gross abuse of parental authority to do unnecessary open heart surgery and damage a child for life in hopes of saving the other child. That's just my opinion on it

So you won't dispense plan B , or listen to a Jehovah's witness's wishes to not receive blood if you feel that both are unnecessary wishes from the patients.

 

[Pusheen]

So you won't dispense plan B , or listen to a Jehovah's witness's wishes to not receive blood if you feel that both are unnecessary wishes from the patients.

What does that have to do with anything? You're making broad, unwarranted implications from a single decision

 

[libertyyne]

What does that have to do with anything? You're making broad, unwarranted implications from a single decision

Am i pusheen your buttons yet?

I joke, I am just taking your point of denying the patient autonomy based on your opinion and taking it to it's logical conclusions.

 

[Matthew9Thirtyfive]

I think the risk of the heart surgery + bone marrow transfer is much greater than the risk of receiving a suboptimal bone marrow transplant. I can't rationalize how a surgery will lead to a 5/6 or 6/6 bone marrow outcome.

Yeah, that's the flaw in the prompt. But you can't use that as an out. Ignoring that, Mike isn't getting the surgery. He's getting a 6/6 transplant or a 4/6 transplant. His risk is obviously lower with a 6/6 transplant.

Jack's risk is obviously greater with the surgery. But it says that he is an athlete, so he's most likely otherwise healthy. The risk of mitral valve repair at a center where they are done frequently is well under 1%. For example, at the Cleveland Clinic, the operative risk for asymptomatic patients (which is what the prompt indicates) is 0.1%. Additionally, the risk of reoperation is around 5% at 10 and 20 years.

So will Jack be a pro athlete after this procedure? Probably not, but he probably wouldn't have been anyway. The operative risk is pretty low, and the post op risk is relatively low.

Obviously you probably won't know the numbers off the top of your head, but I pretty much just assumed all of that. I would put the risk of Mike dying without Jack getting the surgery (again, suspending disbelief and assuming the surgery will make him a 6/6 match somehow) much higher than Jack's risk.

I would recommend the parents take Jack to a center where the procedure is done frequently like the Cleveland Clinic to minimize his risks and allow Mike the best chance at survival.

And how do the surgeons prevent sepsis? The bacterial infection was supposedly in the mitral valve of the heart.

Infective endocarditis on the mitral valve is usually due to defects in the valve. Standard treatment is 2-6 weeks of IV abx, but if the valve is damaged, surgery might be necessary anyway. The patient will be given IV abx anyway, but during the case they will lavage the cavity and heart with an antibiotic flush.

 

[Pusheen]

Am i pusheen your buttons yet?

I joke, I am just taking your point of denying the patient autonomy and taking it to it's logical conclusions.

Oh, I see what you're trying to say. I think that the parents have less autonomy over the child than over themselves. E.g. If mom wanted to do the risky surgery on herself to save her kid, I'd be more ok with it. Making your child do it is way more problematic

 

[Lawpy]

What does that have to do with anything? You're making broad, unwarranted implications from a single decision

Am i pusheen your buttons yet?

I joke, I am just taking your point of denying the patient autonomy and taking it to it's logical conclusions.

Necessary Pusheen gif

 

[libertyyne]

Oh, I see what you're trying to say. I think that the parents have less autonomy over the child than over themselves. E.g. If mom wanted to do the risky surgery on herself to save her kid, I'd be more ok with it. Making your child do it is way more problematic

Ahh and here it is. This is the issue I was trying to say was at the heart of this thing in the post above when I quoted LizzyM.
The counter to this line of reasoning is
1. Parents are the legal gaurdians.
2. Where do you draw the line? What do parents get to decide and what don't they?
3. Who makes the decision if the parents can't and the child can't? Is it a committee is it the state ? Is it a bunch of white coats?
4. What if there are distinct cultural differences in what risk is appropriate or not?

That line of reasoning opens up a can of worms. That I feel unqualified or unwilling to answer. Therefore questioning the capacity and capability of the pare t's by involving cps , and psych consult. And if they still can making sure that the child understands as best as he can before going forward with the procedure is the correct course in my mind.

 

[wizzed101]

Again, for the last time. The 6/6 match is genetic. You cannot make a 4/6 -> 6/6. Jack's was 6/6 before he got the infection.

The goal has always been clearing the infection in 2 days. And yes, no mediocre and/or sane people would propose open heart surgery to clear infection.

 

[Lawpy]

Again, for the last time. The 6/6 match is genetic. You cannot make a 4/6 -> 6/6. Jack's was 6/6 before he got the infection.

The goal has always been clearing the infection in 2 days. And yes, no mediocre and/or sane people would propose open heart surgery to clear infection.

But does infection + surgery maintain 6/6 outcome? Will Jack really be 6/6 after the surgery?

 

[Lawpy]

Yeah, that's the flaw in the prompt. But you can't use that as an out. Ignoring that, Mike isn't getting the surgery. He's getting a 6/6 transplant or a 4/6 transplant. His risk is obviously lower with a 6/6 transplant.

Jack's risk is obviously greater with the surgery. But it says that he is an athlete, so he's most likely otherwise healthy. The risk of mitral valve repair at a center where they are done frequently is well under 1%. For example, at the Cleveland Clinic, the operative risk for asymptomatic patients (which is what the prompt indicates) is 0.1%. Additionally, the risk of reoperation is around 5% at 10 and 20 years.

So will Jack be a pro athlete after this procedure? Probably not, but he probably wouldn't have been anyway. The operative risk is pretty low, and the post op risk is relatively low.

Obviously you probably won't know the numbers off the top of your head, but I pretty much just assumed all of that. I would put the risk of Mike dying without Jack getting the surgery (again, suspending disbelief and assuming the surgery will make him a 6/6 match somehow) much higher than Jack's risk.

I would recommend the parents take Jack to a center where the procedure is done frequently like the Cleveland Clinic to minimize his risks and allow Mike the best chance at survival.



Infective endocarditis on the mitral valve is usually due to defects in the valve. Standard treatment is 2-6 weeks of IV abx, but if the valve is damaged, surgery might be necessary anyway. The patient will be given IV abx anyway, but during the case they will lavage the cavity and heart with an antibiotic flush.

are you sure youre a premed and not a surgery chair pretending to be a premed for lolz

 

[ATPsynthase123]

Again, for the last time. The 6/6 match is genetic. You cannot make a 4/6 -> 6/6. Jack's was 6/6 before he got the infection.

The goal has always been clearing the infection in 2 days. And yes, no mediocre and/or sane people would propose open heart surgery to clear infection.

But if the parents consent to do it, then you must do it. You do not disregard patient/guardian autonomy because you don't think it right. Sadly this is a decision they are at liberty to make for their child.


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[libertyyne]

Necessary Pusheen gif

I have been saving that line ever since I saw her /his username. I am glad I got to use It.

 

[Pusheen]

Ahh and here it is. This is the issue I was trying to say was at the heart of this thing in the post above when I quoted LizzyM.
The counter to this line of reasoning is
1. Parents are the legal gaurdians.
2. Where do you draw the line? What do parents get to decide and what don't they?
3. Who makes the decision if the parents can't and the child can't? Is it a committee is it the state ? Is it a bunch of white coats?
4. What if there are distinct cultural differences in what risk is appropriate or not?

That line of reasoning opens up a can of worms. That I feel unqualified or unwilling to answer. Therefore questioning the capacity and capability of the pare t's by involving cps , and psych consult. And if they still can making sure that the child understands as best as he can before going forward with the procedure is the correct course in my mind.

Sure, I'm not claiming to have the universal answer by making my decision. I can only have an opinion for a specific case, which is the point of the MMI. I think we all know what the underlying issue is. 😉

 

[Lawpy]

But if the parents consent to do it, then you must do it. You do not disregard patient/guardian autonomy because you don't think it right. Sadly this is a decision they are at liberty to make for their child.


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This is news to me. Can anyone confirm this?

Paging SDN ethical philosophers: @efle @Lucca

 

[Pusheen]

This is news to me. Can anyone confirm this?

Paging SDN ethical philosophers: @efle @Lucca

This is almost certainly not right

 

[ATPsynthase123]

This is almost certainly not right

Not what I was taught in bioethics.

What gives the physician the right to disregard the parents wishes if:

A) the parent is 100% mentally competent

And

B) the patient is a child and thus unable to make decisions for him/herself?

That is a lawsuit waiting to happen.

The best a competent physician can do is list the options to the patient/guardian and let them decide the best course of action with the physicians guidance.

In a short term emergency situation, the patient may be disregarded, but in any other situation you owe it to the patient to give them full autonomy. If we do not do that, what is to keep us from backsliding into the days of the Tuskegee experiments or when we disregarded all patient wishes because "im the doctor and I know what you want better than you do".

So let's pose a slightly different scenario. You are a doctor who discovers colon cancer in an 60 year old dementia patient. His designated guardian expresses wishes to sign a DNR and discontinue treatment because she doesn't want her dad to suffer anymore. You instead disregard her wishes and perform the bowel resection. Not only is this a breach of the guardians wishes, it is an utter desecration of the patients autonomy when he signed his legal guardianship over to his family member.

Ideally there are work arounds, but in cold reality, you go the route of disregarding the guardian and you will be almost guaranteed to face legal action.


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[Lawpy]

Not what I was taught in bioethics.

What gives the physician the right to disregard the parents wishes if:

A) the parent is 100% mentally competent

And

B) the patient is a child and thus unable to make decisions for him/herself?

That is a lawsuit waiting to happen.

The best a competent physician can do is list the options to the patient/guardian and let them decide the best course of action with the physicians guidance.

In a short term emergency situation, the patient may be disregarded, but in any other situation you owe it to the patient to give them full autonomy. If we do not do that, what is to keep us from backsliding into the days of the Tuskegee experiments or when we disregarded all patient wishes because "im the doctor and I know what you want better than you do".

So let's pose a slightly different scenario. You are a doctor who discovers colon cancer in an 60 year old dementia patient. His designated guardian expresses wishes to sign a DNR and discontinue treatment because she doesn't want her dad to suffer anymore. You instead disregard her wishes and perform the bowel resection. Not only is this a breach of the guardians wishes, it is an utter desecration of the patients autonomy when he signed his legal guardianship over to his family member.

Ideally there are work arounds, but in cold reality, you go the route of disregarding the guardian and you will be almost guaranteed to face legal action.


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Except the parents have likely been misled by the options presented, meaning that the doctor is at fault for even presenting the surgery option as something comparable to the 4/6 marrow. And the fact that the parents were insisting on the surgery being done shows that they were acting emotionally and were trying their best to get both kids saved and not lose any of them.

I blame incomplete information.

 

[Pusheen]

Not what I was taught in bioethics.

What gives the physician the right to disregard the parents wishes if:

A) the parent is 100% mentally competent

And

B) the patient is a child and thus unable to make decisions for him/herself?

That is a lawsuit waiting to happen.

The best a competent physician can do is list the options to the patient/guardian and let them decide the best course of action with the physicians guidance.

In a short term emergency situation, the patient may be disregarded, but in any other situation you owe it to the patient to give them full autonomy. If we do not do that, what is to keep us from backsliding into the days of the Tuskegee experiments or when we disregarded all patient wishes because "im the doctor and I know what you want better than you do".

So let's pose a slightly different scenario. You are a doctor who discovers colon cancer in an 60 year old dementia patient. His designated guardian expresses wishes to sign a DNR and discontinue treatment because she doesn't want her dad to suffer anymore. You instead disregard her wishes and perform the bowel resection. Not only is this a breach of the guardians wishes, it is an utter desecration of the patients autonomy when he signed his legal guardianship over to his family member.

Ideally there are work arounds, but in cold reality, you go the route of disregarding the guardian and you will be almost guaranteed to face legal action.


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There is a difference between refusing treatment and requesting a risky and unnecessary operation that significantly decreases quality of life when it is not necessary. In your scenario, that would be someone requesting that their grandparent get a bowel resection when the cancer could be treated by radiation. And they are requesting the resection because they want insurance perks

 

[aalamruad]

A 9 year-old is mature enough to understand the implications of his decision if information is presented in age appropriate manner.

Lol no


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[LizzyM]

I left for a few hours and things got busy here!

Parents have legal responsibility to make decisions for their minor children given the expectation that they will act in the best interest of the child. However, here we have a conflict of interest as we are asking them to make treatment decisions for both children where the best interest of each child is in conflict with the best interest of their twin.

The parents' "wishes" are not the be all and end all. We don't give antibiotics to a child with a cold because the parents wish to have their child treated with antibiotics. The parents get to choose from among the clinically appropriate options offered to them. I am arguing that the open heart surgery for the purpose of quickly curing an infection is higher risk than a month of antibiotics and the only reason to accept that higher risk is for the benefit of another, not the benefit of the recipient of the surgery. In fact, the surgical approach will lead to a condition in the donor child requiring a lifetime of drug therapy but some are taking that as an acceptable trade-off to attempt to save his twin's life.

The other option is to have a guardian ad litem appointed who represents the best interest of that child.

 

[Matthew9Thirtyfive]

are you sure youre a premed and not a surgery chair pretending to be a premed for lolz

Lol I wish.