WBR0760

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
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 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?]]
Answer A	AnswerA::Stop the urgent tracheostomy in respect of the family's beliefs
Answer A Explanation	AnswerAExp::In life-or-death emergency situations, a minor's urgent care must not be withheld under any circumstances.
Answer B	AnswerB::Perform the urgent tracheostomy despite the family's beliefs
Answer B Explanation	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.
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 their arrival.
Answer E	AnswerE::Get a second physician opinion on the matter
Answer E Explanation	AnswerEExp::A second opinion is not necessary in this emergent life-or-death care for the minor.
Right Answer	RightAnswer::B
Explanation	[[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. 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. Educational Objective: In life-or-death situations, a minor's emergency care must not be withheld under any circumstances. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::urgent, WBRKeyword::tracheostomy, WBRKeyword::minor, WBRKeyword::life, WBRKeyword::death, WBRKeyword::religion, WBRKeyword::religious, WBRKeyword::belief, WBRKeyword::beliefs, WBRKeyword::law, WBRKeyword::epiglottitis
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