Case 1 Norma Walker left her job when six months pregnant.

Nine days after the baby was born, she experienced severe headache, fever and a mild reaction to light. The next day, Sunday, she met with her obstetrician in the hospital emergency room. He found no abnormalities and felt strongly that further evaluation by an internist was imperative. Since Mrs. Walker did know an internist, she and her husband were worried about finding a physician whom they both knew the personally, happened to be in the emergency room at the time, and Mr. Walker asked him to assume care of his wife. Her obstetrician agreed Dr. Stanley learned that the Walkers two year old child had recently had viral meningitis, as had several other children and adults living near their home. When reached by phone, their pediatrician confirmed that two children had been proven by lumbar puncture to have aseptic meningitis and had been treated conservatively at home. During the interview the Walker had been treated by hospital personnel in the labor and delivery suite a week earlier. Mr Walker was especially bitter and was certain she would have had better care at home. The result of laboratory test showed that Mrs. Walker probably had a just beginning viral meningitis (for which no specific treatment is necessary), but may have had bacterial meningitis (a life-threatening illness requiring treatment with intravenous antibiotics). The test findings were carefully explained to the Walkers. Dr. Stanley stated that because of the circumstance, the chance of Mrs. Walker having viral meningitis were very high. But result of the spinal fluid test raised the possibility of bacterial meningitis. The physician argued that, if her or his wife were the patient, he would play it safe and go into the hospital for two days of intravenous antibiotics until the spinal fluid culture was complete. Mrs. Walker felt too ill to think clearly-she would, she said, do whatever her husband decided. Mr.walker was determined to be involved in the decision. He was clearly concerned for his wife, but wasnt sure whether playing it safe was the best course of action. He appreciated the personal favor of the physician who had agreed to undertake her care on short notice and had given a detailed explanation of the medical evaluation. However, her recent hospitalization had left a bad impression. Also the couple had no insurance. Was the small chance really much of a gamble. He would take his wife home, fully aware of the risk and of Dr. Stanleys discomfort with his decision.

Kasus 1 A 42 year old man with end-stage AIDS is admitted to the MICU with overwhelming sepsis and pneumonia. He is placed on pressors dan intubated. His partner of 8 years states that the patient was adamant that he would never want extended ventilator support. He doesnt have a healthcare proxy. His only living family is his mother, whom he has been estranged from for 15 years. That evening, the patients mother arrives and asks that every possible measure be used to treat her son.