WBR0760: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Ethics
|MainCategory=Ethics
Line 8: Line 8:
|MainCategory=Ethics
|MainCategory=Ethics
|SubCategory=Head and Neck
|SubCategory=Head and Neck
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
Line 20: Line 21:
|MainCategory=Ethics
|MainCategory=Ethics
|SubCategory=Head and Neck
|SubCategory=Head and Neck
|Prompt=A sick-looking 7 year old girl is brought to the emergency department (ED) in respiratory distress. The physician quickly inquires about her condition. Her mother informs the physician that the entire family lived in India and only recently settled in USA. The girl has not received any vaccinations since she was born. On physical examination, the physician notes the girl sitting in a tripod position; she is breathing laboriously and is drooling. The diagnosis of acute epiglottitis is made. The girl suddenly turns blue and collapses. The physician has no choice but to perform an urgent tracheostomy. The mother intervenes saying that the family's religious beliefs prevent the girl from having any surgical procedure. What must the physician do in this case?
|Prompt=A sick-looking 7-year-old girl is brought to the emergency department (ED) in respiratory distress. The physician quickly inquires about her condition. Her mother informs the physician that the entire family lived in India and only recently emigrated to USA. The girl has not received any childhood vaccinations. On physical examination, the girl is in acute distress; she is sitting in a tripod position. Her breathing is laborious, and she is drooling. The diagnosis of acute epiglottitis is promptly made, but the girl suddenly turns blue and collapses. The physician rapidly perform an urgent tracheostomy. The mother intervenes, saying that the family's religious beliefs prevent the girl from having any surgical procedure. What must the physician do in this case?
|Explanation=A minor is any individual less than 18 years of age. Generally, a minor's parents have the right to refuse medical care for their child. But in the case of an emergency involving a minor, patient care must not be compromised despite family refusal. The physician in such emergency life-or-death cases must perform whatever it takes to save the minor's life regardless of the parent's decisions. The physician must not waste time calling for help or inquiring about legal issues in such emergency situations. On the contrary, physicians are protected by law to perform urgent care to minors. Although it is ideal if the physician has the time to explain to the family the purpose of the procedure and why it is important, in this case time is crucial to save the patient's life and it is thus not proper to dwell into discussions.
|Explanation=A minor is any individual of less than 18 years of age. Generally, a minor's parents have the right to refuse medical care for their child. But in the case of an emergency involving a minor, patient care must not be compromised despite family refusal. In emergency life-or-death situations, the physician must perform whatever it takes to save the minor's life regardless of the parent's decisions. The physician must not waste time calling for help or inquiring about legal issues in such emergency situations. On the contrary, physicians are protected by law to provide urgent care for minors.
 
|AnswerA=Respect of the family's belief and stop the urgent tracheostomy
For competent adults with decision-making capacity, however, the law does not allow physicians to perform procedures if they do not wish to, including emergencies. A classical example is refusal of blood transfusion among Jehovah's Witnesses.
|AnswerAExp=In life-or-death emergency situations, a minor's urgent care must not be withheld under any circumstance.
 
|AnswerB=Perform the urgent tracheostomy despite the family's decision
Educational Objective:
|AnswerBExp=Since urgent tracheostomy is the a mandatory life-saving procedure for this minor, the procedure should not be withheld. regardless of the family's beliefs.
In life-or-death situations, a minor's emergency care must not be withheld under any circumstances.
|AnswerA=Stop the urgent tracheostomy in respect of the family's beliefs
|AnswerAExp=In life-or-death emergency situations, a minor's urgent care must not be withheld under any circumstances.
|AnswerB=Perform the urgent tracheostomy despite the family's beliefs
|AnswerBExp=Since urgent tracheostomy is the only option left for this patient, who is a minor, to survive, it should be performed regardless of the family's beliefs.
|AnswerC=Call the patient's father to make sure he approves of the mother's decision
|AnswerC=Call the patient's father to make sure he approves of the mother's decision
|AnswerCExp=The physician must not waste time calling other family members while the patient is at risk of death.
|AnswerCExp=The physician must not waste time calling other family members while the patient is at risk of death.
|AnswerD=Call the ambulance to transfer the patient to another medical center
|AnswerD=Call the ambulance to transfer the patient to another medical center
|AnswerDExp=Physicians must not escape urgent cases at hand. Also, the patient might die while calling the ambulance and waiting for their arrival.
|AnswerDExp=Physicians must not escape urgent cases at hand. Also, the patient might die while calling the ambulance and waiting for its arrival.
|AnswerE=Get a second physician opinion on the matter
|AnswerE=Get a second physician opinion on the matter
|AnswerEExp=A second opinion is not necessary in this emergent life-or-death care for the minor.
|AnswerEExp=A second opinion is not necessary in the urgent care of minors.
|EducationalObjectives=In life-or-death situations, a minor's emergency care must not be withheld under any circumstance.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=urgent, tracheostomy, minor, life, death, religion, religious, belief, beliefs, law, epiglottitis
|WBRKeyword=Tracheostomy, Minor, Religion, Religious belief, Epiglottitis, Ethics
|Approved=No
|Approved=Yes
}}
}}

Revision as of 23:44, 6 March 2015
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Ethics
Sub Category SubCategory::Head and Neck
Prompt [[Prompt::A sick-looking 7-year-old girl is brought to the emergency department (ED) in respiratory distress. The physician quickly inquires about her condition. Her mother informs the physician that the entire family lived in India and only recently emigrated to USA. The girl has not received any childhood vaccinations. On physical examination, the girl is in acute distress; she is sitting in a tripod position. Her breathing is laborious, and she is drooling. The diagnosis of acute epiglottitis is promptly made, but the girl suddenly turns blue and collapses. The physician rapidly perform an urgent tracheostomy. The mother intervenes, saying that the family's religious beliefs prevent the girl from having any surgical procedure. What must the physician do in this case?]]
Answer A AnswerA::Respect of the family's belief and stop the urgent tracheostomy
Answer A Explanation AnswerAExp::In life-or-death emergency situations, a minor's urgent care must not be withheld under any circumstance.
Answer B AnswerB::Perform the urgent tracheostomy despite the family's decision
Answer B Explanation AnswerBExp::Since urgent tracheostomy is the a mandatory life-saving procedure for this minor, the procedure should not be withheld. regardless of the family's beliefs.
Answer C AnswerC::Call the patient's father to make sure he approves of the mother's decision
Answer C Explanation AnswerCExp::The physician must not waste time calling other family members while the patient is at risk of death.
Answer D AnswerD::Call the ambulance to transfer the patient to another medical center
Answer D Explanation AnswerDExp::Physicians must not escape urgent cases at hand. Also, the patient might die while calling the ambulance and waiting for its arrival.
Answer E AnswerE::Get a second physician opinion on the matter
Answer E Explanation AnswerEExp::A second opinion is not necessary in the urgent care of minors.
Right Answer RightAnswer::B
Explanation [[Explanation::A minor is any individual of less than 18 years of age. Generally, a minor's parents have the right to refuse medical care for their child. But in the case of an emergency involving a minor, patient care must not be compromised despite family refusal. In emergency life-or-death situations, the physician must perform whatever it takes to save the minor's life regardless of the parent's decisions. The physician must not waste time calling for help or inquiring about legal issues in such emergency situations. On the contrary, physicians are protected by law to provide urgent care for minors.

Educational Objective: In life-or-death situations, a minor's emergency care must not be withheld under any circumstance.
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::Tracheostomy, WBRKeyword::Minor, WBRKeyword::Religion, WBRKeyword::Religious belief, WBRKeyword::Epiglottitis, WBRKeyword::Ethics
Linked Question Linked::
Order in Linked Questions LinkedOrder::
Retrieved from "https://www.wikidoc.org/index.php?title=WBR0760&oldid=1075855"