What would you do?

From Dr. M's lecture today on Medical Ethics:

Case 1: Audience response question

Newborn with Trisomy 21(Down syndrome) transferred from hospital A to hospital B. Unable to keep food down, vomiting solid and liquid foods. Duodenal atresia (small intestine malformation), complete blockage beyond stomach. Surgical recommendation to relieve obstruction.

Parents refuse, citing:
• poor future quality of life for child
• additional drain on family’s resources away from other children
• the child is “as God made him” and it is God’s will that the child should be allowed to die on its own without intervention

What would you do?
a. Refuse to accept the parents wishes: repair the small intestine
b. Apply for court appointed guardianship so that an operation can be performed to save the child’s life.
c. Send the child to die at home with its parents
d. Transfer the child back to die in the initial hospital (hospital A)
e. Leave the child at hospital B to die under the care of the house staff and nurses
f. Administer lethal doses of medication to the child to end its life quickly as an alternative to starvation and dehydration.


Case 2: Audience response question

25 year old military pilot involved in motor vehicle accident with father, both engulfed by flames. His memory of scene of accident:

"I was burned so severely and in so much pain that I did not want to live even in the early moments following the explosion. A man who heard my shouts for help came running down the road, I asked him for a gun. He said, 'Why?' I said, 'Canʼt you see I am a dead man? I am going to die anyway. I have got to put myself out of this misery.' In a very kind and compassionate caring way, he said, 'I canʼt do that.”

Patientʼs father dies en route to hospital. Throughout his hospitalization and rehabilitation, he asks his doctors and nurses to end his life because he is in unbearable pain and knows that he is blind and deformed.

What would you do?
a. Respect the patient’s wishes and administer a lethal dose of morphine and barbiturates
b. Consider the patient incapable of requesting withdrawal of care and continue regardless of patient wishes
c. Consider the patient incapable of making informed decisions and defer to closest relative: his mother
d. Request psychiatric consultation to declare the patient incompetent to make decisions regarding his own care
e. Transfer the patient to another burn treatment facility


Please include your reasoning for your answer(s).