The three duties of a physician are: first the
preservation of health, second the cure of dis-
ease, and third the prolongation of life.
• Case Study—Decisions of Life or Death
Matthew J. is 62 years old and has a wife and three grown children. Two years ago he was diagnosed as having stage 1 Alzheimer's disease and was informed of this diagnosis. He has just recovered from a mild heart attack, and his cardiologist has told him that he requires cardiac bypass surgery if he is to live. He has refused the surgery, stating, "There is no point in living." The consulting psychiatrist confirms that Mr. J. is clinica ly depressed in addition to having Alzheimer's disease, and believes that Mr. J. cannot make a rational decision.
• Case Study—Administration of Drugs
Shirley W. is a 74-year-old patient with Alzheimer's disease who lives in a nursing home. Over the past few months she has become increasingly difficult to spoon feed because she spits, pushes the spoon away, and refuses to eat. When admitted to the home, while still coherent and clear-minded, Mrs. W. had asserted that she did not want her lift prolonged by artificial means. The physician orders feeding by a nasogastric tube, which Mrs. W. frequently pulls out. In response to complaints from the nursing staff, the physician prescribes tranquilizers for Mrs. W. to make her "more manageable."
• Case Study—Confidentiality
Dave S. is taken to his family doctor by his wife and grown daughter to find out why he has become so irritable. He admits to angry outbursts for no apparent reason. He also says that he has trouble remembering and is finding it increasingly difficult to add and subtract. After extensive testing, the diagnosis is confirmed: Mr. S. has probable Alzheimer's disease. The doctor tells him about the diagnosis and gives him a broad outline of what to expect. Mr. S. takes the news calmly, then states that under no circumstances does he want his wife or daughter informed.
• Case Study—Patient Wishes vs. Societal Norms
Martha J.'s children have complained to the nursing home administrator that on their last three weekly visits, they have found Martha in her room dressed only in her slip.