Just to begin with, I would like to note that aneurysm is a terrible disease which can easily lead to death of not well treated. This particular illness always occurs especially when a particular blood vessel such as the artery or the cardiac muscle swells or if the walls of the blood vessels are weak. This implies that as the blood pressure builds up, the weak points of the blood vessels bulges outwards or swells as this disease grows, an individual is exposed to the risk of rupture. This in turn may lead to severe hemorrhagic and then eventually sudden death.
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The case involves Mrs. G who has aneurysm in her brain that, if untreated by surgery, will lead to blindness and probably death. The surgery recommended leads to death in 75% of all cases. Of those who survive the operation, nearly 75% are crippled. Mrs. G has three small children. Her husband has a modest job, and his health insurance will cover the operation, but not the expenses that will result if she is crippled.
When informed of this, Mrs. G. is in great emotional turmoil for a week or so until she makes her decision. She refuses treatment, because she does not like the odds. There was, after all, only a one chance out of sixteen for a real recovery. In addition, she could not come to grips with exposing her family to the risk of having a mother who would be a burden and not a help.
Question
Can a patient with serious obligations, such as a family, refuse treatment? What odds of recovery would be good odds?
Before, the author answer this question, it is prudent to note that the answer to this question can either be yes or no depending on the outcomes associated with the consequences of either accepting treatment of avoiding treatment. For instance, if refusing treatment would lead to death, then it is advisable that an individual accepts treatment. On the other hand, if accepting treatment would lead to death or any other calamity which might prevent an individual from carrying out family obligations, then it would be in order for such a person to refuse to accept payment. .
The situation in which Mrs G. Is in is very tricky one. This is because either accepting or refusing treatment might lead to death or crippleness which in turn might hinder an individual from carrying out his day to day family obligations. However, the chances of surviving even if Mrs G. Accepts treatments is very minimal if the data available concerning the past surgeries which have been done to the very same patients who suffer from such disease is anything to go by. For instance, the surgery recommended has once led to death in 75% of all cases. However, of those who survived the operation, nearly 75% are crippled. This implies that if Mrs G. Accepts to go through the same operation, then his chances of surviving are very minimal.
It is therefore recommended that Mrs G. Refuses the treatment and go for the available alternative which would ensure successful operation or instead look for another secure alternative which can be used to cure that disease without undergoing surgery like endovascular coiling. In conclusion, I would like to affirm that the patient have the right to refuse treatment if the chances of surviving after such treatment is very minimal. So Mrs G Is in order to refuse treatment.
Calcific aortic stenosis is one of the severe causes of the aortic valve disease. The condition is known to increase with advancement in age. This implies that increase in age increases the chances of an individual being attacked by calcific aortic stenosis. Some of the risk factors associated with calcific aortic valve disease include: hypertension, diabetes mellitus, raised serum creatinine cigarette smoking among others.
This case concerns Mrs. S., an 85-year-old housewife who becomes aware of breathlessness and is easily fatigued. The patient is known to have experienced a heart murmur for two years. She consents to come to a research hospital for cardiac catherization, which confirms the presence of severe, calcific aortic stenosis with secondary congestive heart failure.
Because of the unfavourable prospect for survival without surgical intervention, the recommendation at the combined cardiac medical-surgical conference is for an operation. The physician explains the situation to Mr. and Mrs. S. and recommends aortic valve replacement. It is noted that the risk of surgery is not well known for Mrs. S,'s age group, and that early mortality is usually around 10 percent, with 80 percent achieving good functional results after three years. Her lack of an obvious disease makes her a relatively good candidate for a successful surgical outcome, despite her age.
Therefore, it is prudent to note that Mrs. S apparent denial of her condition may not in any way make informed consent impossible. This is because, the decision regarding her condition was never made by one person but by a combined medical-surgical conference. The group opted for operation if her life was to be saved. Furthermore, the available records show that surgery is likely only to lead to early mortality of 10% with 80%percent achieving good functional result after three years. This implies that surgical operation will be appropriate if her life is to be saved considering the fact that the medical-surgical conference found that she was at a severe condition. Therefore, delaying operation might lead to the advancement of this disease to critical condition.
According to me, the physician is ethically right in reducing her anxiety concerning her apparent refusal of treatment. Actually, the physician believes that treatment is medically recommended if her life is to be saved. The physician has the sole responsibility to save life. Therefore, he is ethically right to try as much as he can to reduce the anxiety of the patient so as to remove any doubt concerning the outcomes of the treatment. Furthermore, the available records show that the chances of surviving are very high if the patient is subjected to treatment recommended by the physician. The physician should therefore use any means available to convince the patient to accept treatment in order to prevent the advancement of this disease to critical stage.
References
Ethical responsibilities of Health Care Leadership. Accessed on 23rd June 2013 at http://www.wha.org/data/sites/1/emergencyPrep/EthicalResp_HCLeadership_8-08.pdf. Ashcroft, R. E. (2007). Principles of health care ethics (2nd ed.). Chichester, West Sussex, England: John Wiley & Sons.
Sporrong, S. K., Arnetz, B., Hansson, M. G., Westerholm, P., & Hoglund, A. T. (2007). Developing Ethical Competence In Health Care Organizations. Nursing Ethics, 14(6), 825-837.
Morrison, E. E. (2008). health care ethics. critical issues of the 21st century , 14.
Limentani, A. E. (1999). The Role Of Ethical Principles In Health Care And The Implications For Ethical Codes.. Journal of Medical Ethics, 25(5), 394-398.
