The Case of a 20-Month-Old Boy

Ethical analysis is both a science and an art. As a science, it is not purely theoretical but practical in the sense that one is searching for the right and the good in specific circumstances. As an art, ethical analysis needs to be practiced; it is a skill that can be acquired only by repeatedly performing the unique investigation into the right thing to do. Ethics committees, in particular, practice analysis on mock cases that illustrate different aspects of health care treatment options. Our readers are encouraged to analyze the following case, using the questions as a guide. 

Your clinic is located in a largely Hispanic area of the city. You have often treated children whose illnesses have been called empacho by their parents. As Dr. Lee Pachter explains: Empacho is a folk illness that has been described in various Latino ethnic groups, including Puerto Ricans, Mexicans, and Central Americans. [It has] been described as a condition wherein food or other matter gets stuck to the walls of the stomach or intestines, causing an obstruction. It is thought to be caused by dietary indiscretion, often by eating too much food or spoiled food, inappropriate combinations of food, or eating at the wrong time period. (Pachter 1994).

A 20-month-old Puerto Rican boy was admitted to the inpatient unit for failure to thrive after a weight loss of 1.6 kilograms, associated with a decrease in appetite. Social history was significant and that the mother had limited support and had been out of work for two months because of a back injury. Physician examination showed a thin child without any signs of organic pathology.

The child was admitted to the inpatient unit for dietary and behavior observation. On questioning, the mother expressed the opinion that a possible cause of her child's weight loss and poor appetite was his eating some pork a few weeks earlier. She believed that the pork was spoiled and caused empacho in her son. She was so certain about this that she and her husband were planning to send for her husband's mother, a santiquadora, i.e., a folk therapist or healer— who would come to perform the treatment that cures empacho. In the meantime, she had brought the child to your clinic.

Pachter, Lee, 1994.  “Culture and Clinical Care.”
JAMA 271:690-694

 

QUESTIONS TO CONSIDER IN ANALYZING THIS CASE:

• Assumptions are important in ethical analysis. If you do not believe there is such an illness as empacho, how do you relate to the parents of this child?

• What is the ethical dilemma (the class of opposing goods) that you see in this case?

• What treatment would you suggest and how would you relate the reasons for the treatment to the parents?

• Could you justify supporting the decision to bring the grandmother to the United States to apply her remedies? What information would you want to have first?

• Discuss other cultural/ religious positions that affect your ordinary delivery of health care. What are the important points to consider when you meet such positions?

Center for Practical Bioethics

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