Academic journal article The Hastings Center Report

Great Moments in Medical Ethics Teaching

Academic journal article The Hastings Center Report

Great Moments in Medical Ethics Teaching

Article excerpt

"I have an ethical problem with one of my patients," said Dr. Russell toward the middle of the weekly ethics conference. Dr. Russell is extraordinarily alert at all times (not always the case among the ICU house staff and medical students, who are often running on less than half a night's sleep and use the ethics conference to catch a few Zs). He is not only alert; he also appears to be intensely interested in everything that happens, everything that everyone says, although he does not himself talk much. But he makes a lot of eye contact.

I invited Dr. Russell to tell me about his problem and he proceeded to describe his case:

"The patient is a fifty-one-year-old woman with metastatic breast cancer. She has been kept alive for the past five months primarily with experimental treatments, but there's really nothing left for her to try. She's been in the unit for three days now and she drifts in and out of consciousness, but even when she's conscious, she's minimal."

"Yes," I said encouragingly, letting him know I was listening, doing my own eye contact.

"Well," he continued, "she has this boyfriend, this fiance. They've been together for seven or eight years. And she has this son who is some kind of fugitive...drugs, apparently. He's some kind of no-goodnik. And she has an ex-husband who is going into her house while she's in the hospital and walking out with furniture and stuff

"Yes," I said, a little less encouraged. This case is beginning to sound like a daytime soap.

"Well, the patient and the fiance were going to get married. He says that was really important to her-that she knew she was going to die but she wanted them to be married before she died. Except they hadn't done it yet. So he comes in here every day with this marriage license that he wants her to sign. And also, she wrote a new Kill. Well, an attorney wrote the will, but I guess he didn't get it done as fast as he was supposed to and she was supposed to sign it last Friday, but that was the day she came into the hospital, so she never got to sign it. So, actually, he comes in here with both these papers that he wants her to sign. He showed them to me and she left everything to him in the will. The fiance comes in real regular and he's always really concerned, and really hopeful, and he says, `I think she's a lot better today, don't you? …

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