Case Studies

Bioethics Case Studies
Case studies are an important tool in bioethics, especially in practical bioethics where the focus is on real issues in real life and real time. Case studies provide a roadmap for decision-making in future cases, help drive the development of new analysis and thought about complex medical and moral dilemmas, and are an effective way to bring bioethics alive for students, healthcare providers, administrators, attorneys and, even in some situations, patients and families. Most of the case studies collected here were written by staff of the Center for Practical Bioethics. Many originally appeared in the Center’s former Bioethics Forum magazine.

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The Role and Importance of Case Studies in Bioethics

One of the central tasks of bioethics is to identify ethical problems in healthcare and then apply moral principles to help resolve those problems.

 

Good Death or Assisted Suicide?

Mr. Perry wants doctors to turn off his pacemaker. Would doing so respect Mr. Perry’s rights and autonomy? Or, would it be physician-assisted suicide?

 

Helping the Care Team Help Patient Patti

Patti, a 52-year old woman with history of asthma, chronic obstructive pulmonary disease, hepatitis C and substance abuse, presented to the emergency department after cardiac arrest at home with subsequent return of spontaneous circulation. When Patti’s husband didn’t respond to attempts to contact him, with no advance directive, it was deemed more helpful to support the care team’s communication efforts and to provide an ethics perspective with procedural recommendations and “what if” options.

 

The Case of the Careless Caregiver

 
Before Grace’s dementia progressed, she could be found where ever a group had gathered and her laughter could be heard above the others. 
 
 

“It’s Too Much - First My Daughter, and Now This”

 
Fiona’s twenty-two-year old daughter was killed in a car wreck. Fiona took custody of her two grandchildren and worked as a housekeeper in a private home while the children were in school. Fiona had no health insurance. She earns too little to buy an individual plan and too much to qualify for Medicaid. When she started bleeding, she just kept buying napkins to absorb the blood.

 

Managing Pain, A Family Affair

 
Mrs. W is a sixty-year-old African American woman with a recent diagnosis of breast cancer with metastases to the bone and lung. She has been married thirty-two years and has three adult children. Over the last month, she has experienced increasing pain that has not been effectively controlled by her physician. She has now been referred to hospice, primarily to get her pain under control.
 
 

I Know What You’re Thinking…

 
An African American male patient, age forty-two, was admitted to a skilled nursing unit after surgery for head and neck cancer with lymph involvement, newly diagnosed. Extensive excision of the tumor had been done, and the patient had a newly placed tracheostomy and feeding tube.

 


Walking the Pain Management Tightrope

Providers and family members alike must tread carefully when caught between a patient’s crankiness and a family’s report that the patient’s pain is not being managed.

 

Our (Pregnant) Daughter Didn’t Want This . . .


Twenty-nine year old Janet and her husband Jack were driving home from her ob-gyn appointment when tragedy struck. Another driver, elderly and distracted by an incoming text message, ran a red light and T-boned Janet and Jack’s Mini-Cooper. Both young people sustained severe injuries.


One Small Cut that Killed

One day, a patient comes to see her complaining of ankle pain on his right leg. The patient is a farmer and says that he fell while he was taking care of his chickens in the chicken coup. He has some cuts and bruises on either leg, complains of a swollen right ankle, but appears to be fine otherwise. Dr. Contadina instructs him to purchase an air cast at a pharmacy along with some ibuprofen and to take it easy.


My Patient’s Dying

I had never seen it before. I had no experience on which to base my unsettling suspicions. And yet, it was unmistakable. My patient, Ms. P, was dying right in front of me.



CASE of Family Opposition to Organ Donation 
Despite First Person Consent


JD is a 25 year old patient who sustained massive head trauma and neurological injury in a motorcycle accident. He is not brain dead, but after 4 weeks in MICU and several neuro consults, the prognosis for “meaningful recovery” is said to be less than 1%. JD has not regained consciousness and is apt to remain permanently in a vegetative state.


Abortion Rights and/or Wrongs


Kate is a 17 year old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care and then abused in that system. 



 

A Family Divided


A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “yes” and “no,” and his responses are inconsistent. 



 

A Sister for Joshua


There are such emotional overtones to this case that it might be helpful to use Immanuel Kant’s recommendation: What if everybody performed the action with the same purpose in mind?

 



Mr. Jay’s Case


The doctor explained that for Mr. Jay attempting resuscitation following a pulmonary arrest was not likely to succeed. The doctor further explained that even if resuscitation restarted his lungs, Mr. Jay would require aggressive care in an intensive care unit. Given these prospects, Mr. Jay told his doctor he would prefer that resuscitation not even be attempted.



 

Could This Happen at Our Hospital?


What should physicians and families do when the patient they are attending is in the dying process? The answer may not be easily categorized, but one thing is certain: the failure to communicate will always have grave consequences.



 

Alice’s Frail Mother


Alice watched her mother’s long slide into alzheimer’s type dementia, certain that her mother’s careful attention to advance care planning would be able to prevent her worst nightmares. . .

 



Barney Says, “No!”

Almeda’s nurses and attending physicians want her long-time friend Barney to help them determine the direction her treatment should take now that she needs dialysis. She’s already on a ventilator, a feeding tube, and receiving high doses of antibiotics. She would be better, Barney thinks, if she could watch TV a little. . .


 

Artificial Nutrition and Hydration

A 49-year-old male came into the cardiac care unit with an inferior wall myocardial infarction, and shortly thereafter coded. Resuscitation attempts succeeded; however, over the course of a few days he went into multi-system failures. This case study explores whether the provision of artificial nutrition and/or hydration is a medical treatment, and in what situations should artificial nutrition and/or hydration be offered?
(From End-of-Life Ethics: A Case Study Approach)

 

Is More Better in Oncology?

 

A Young Boy Is Losing Weight

 

Jennie  – To Tube Feed or Not (PDF)


TJ – Clinical Research Involving Children (PDF)


Landmark Legal Cases – A Study Guide for Ethics Committees (Part I)


Landmark Legal Cases – A Study Guide for Ethics Committees (Part II)


Empacho – A Gastrointestinal Folk Illness in Latino Communities (PDF)


What are the Limits of a Community’s Right to Know? (PDF)


Freda – Nursing Staff in Moral Distress When Patient’s Wishes Not Followed (PDF)


George - DNR for Adult with Down Syndrome (PDF)


Grace H. - Why Are They Doing All This (PDF)


Herman - Rejecting Doctor’s Orders (PDF)


Sepsis in a Newborn (PDF)


Jimmy - Out of Hospital DNR for School-Aged Child (PDF)


John - Refusal to Eat in a Long-Term Care Facility (PDF)


Mary - The Role of Literacy in Making Wishes Known (PDF)


Megan and Ken - Confidentiality of a Diagnosis (PDF)


Melinda and Matt - Ethical Indicators of Futility in Critically Ill New Mother (PDF)


Beth - Personal vs. Organizational Ethics in Experimental Treatment (PDF)


Ophelia - Conflicting Values in the Placement of Violent Teenager with Mental Disability (PDF)


Pat - Unprepared to Talk about Dying (PDF)


Sheila and Nick - Sheila Shares Her Boyfriend’s Experience at the VA (PDF)


Teresa - Patient Vulnerability from a System’s Failure to Protect (PDF)


Mary Jo Hoffman - The Wanted, Unwanted Doctor (PDF)


Theresa - I Don’t Pray. I Paint. (PDF)


Jennie M - Pros and Cons of Tube Feeding Woman Not in Danger of Imminent Death (PDF)


Treating Immigrant Populations   Cultural Competence in Health Care (PDF)


Omer - Who Should Talk to the Family and What Should They say? (PDF)

 

Russell – Adults with Disabilities as Essential Partners in Their Healthcare

 

Case Study: James vs. the Board of Education, Robert L. Potter

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