One Small Cut that KilledBy Lindsay Bohonik

Dr. Contadina is a primary care physician in a Metropolitan area at a large, not-for-

profit, integrated health care system. On average, she sees several patients a day from
a variety of backgrounds who come in with an assortment of conditions, injuries, and
ailments.

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 a 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. Dr.
Contadina returns to seeing other patients and Joe goes home.

Three days later Joe is admitted to the emergency room. He has low blood pressure, a
fever, extreme shaking, an irregular heartbeat, and is very agitated. After removal of
the air cast, the nurses notice a cut that has become infected on his left leg (the
opposite of the leg with the swollen ankle). Joe’s condition continues to worsen and he
eventually goes into Septic shock. After two days in the ICU, Joe dies of complete
organ failure.

The family wants answers, and so far all they know is that he came in with one small cut
and suddenly died. The hospital is pressuring Dr. Contadina to apologize in hopes of
mitigating some legal trouble. Dr. Contadina is afraid that if she admits that there was
any chance she made a mistake, that she’ll be in bigger trouble- both legally and
professionally. She is very afraid of what her colleagues and patients will think if she
admits that she made an error.
Questions for discussion

As the administrator of the hospital, what do you do? Do you require that Dr. Contadina
apologize to the patient’s family and explain to them what went wrong? What are the
risks to doing so? Does Dr. Contadina have an ethical obligation to admit error? What
are the possible benefits to admitting fault? What could the hospital and/or Dr.
Contadina (or any physician) have done differently? Was this a preventable mistake?

Court Decision:

This is adapted from a similar case (McCourt v. Abernathy, 457 S.E.2d 603 [S.C.1995]),
and the recent movement towards hospitals and physicians accepting greater
responsibility for medical errors.

• Evidence has recently indicated that there are two main reasons for why patients sue:
1) Because they feel like they have been wronged or disgraced and, 2) To get answers
about what happened. For many patients and/or families, pursuing legal action is the
only way in which they can get information regarding what happened.1

• Thus, there has been an indication that if patients feel that their physician expresses
remorse over the mistake, and they are explained to why it happened, it can
potentially reduce liability.

Exploring in Ethics:

Dilemma – what action will Dr. Contadina do? Will she apologize with the family and
explain what happen to patient which has a medical error? Or just keep it herself and
don’t admit the medical error. To disclose or not to disclose the information?

Autonomy and Right to Self Determination

Concepts of autonomy and right to self-determination acknowledge patients’

right to make their own choices and to take actions based on their personal views.

The doctor who operates the patients haven an ethical obligation to inform the
family of what happen to the patient (Deontology). They have the rights to demand to
have full disclosure of an error. So, that the family could decide on what action should
they take. If the family had not informed about the truth, the problem will be bigger,
and it was an investigation about the malpractice of the doctor who operates the
patient.
 Virtue ethics also support these principles because a physician must follow
standards of best care which are designed to protect patients.

Uncertain Resolution:

Errors will never disappear from a medical practice. Its aim to ensure that they occur as
rarely as humanly possible. Dr. Contadina must inform about the medical error that
happen to the patient. So that some corrective action should be taken in every case.
The family is asking for it and the doctors must give it to them.

License doctors as a work culture in which healthcare providers at all level of the
organization are committed to core values and behaviors that emphasize safety over
competing goals.

Disclosure of medical errors can be a very individual issue because sometimes only
person knows about it. Beyond our job duty to the patient or the hospital, we have a
responsibility to ourselves to practice and responsible and honest medicine.

“Remember, there is nothing you can do to change the past but you can use its lessons
to improve your future.”
The Case of Mr. Perry and his Pacemaker

Tarris Rosell, PhD, DMin

Rosemary Flanigan Chair at the Center for Practical Bioethics

Mr. Perry (not his real name) was 83 years old and had several medical problems. He
had spent the past several months in and out of hospitals and rehab. Prior to that, he
lived independently in a small Midwestern town. Widowed many years ago, he
subsequently enjoyed the company of a lovely lady friend who lived down the street
from the Perry home. He had five adult children and numerous grandchildren.

Life should have been relatively good for this octogenarian. But life was not good. Not
anymore. “My body is all worn out. I’m worn out. Don’t want to do this anymore, Doc.
They say I can’t go home and be safe. And I’m NOT going to a nursing home. No way!
Just stop that little gadget that shocks me and the part that keeps my heart going. I
want them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it.
Please.”

Tired of Fighting

Mr. Perry had a cardiac resynchronization therapy defibrillator (CRT-D) implanted a few
years ago. It included an electrical pacing component for heart rhythms, on which the
patient was 100% dependent. The defibrillator had shocked him, more than once, just
before he came to the hospital E.R. with this request. That was the last straw for Mr.
Perry. No more shocks for him. No nursing home or rehab or hospitalizations or
medications. And no more mechanical pacing either. “I’m tired of fighting.”

Deactivating an internal defibrillator is one thing. The patient’s cardiologist didn’t need
an ethics consultation for that decision. “If he doesn’t want to be shocked again, that’s
his decision. And if it went off again after he’d requested it stopped, that could be a
kind of torture,” she reasoned. Deactivation happened quickly after admission from the
Emergency Department. A “Do Not Attempt Resuscitation” order was placed in the
chart.

But the pacemaker, also? He wanted it stopped. Ought we do so? Would that be
ethically respectful of this patient’s autonomy? Or would it be physician-technician
assisted suicide?

“If we stop the pacemaker, Mr. Perry, you will die within a few minutes.”

“Yes, I know. I’m tired of fighting. Please.”

Exploring ethics:

Dilemma: Is a good death or assisted suicide? Doing what the patient wants which is
stop the machine and he will die with a few minutes?

One of the ethical principles is the ethical decision making. Autonomy calls for the
patient to be the decision maker, that is having the right to self-determination.

The physician’s role for the dying patient must always be to advocate for approached
that promote good care for the patient at the end of life. It should not violate of what
the patient’s decision and just be respected it.

One might reasonably ask whether Mr. Perry choose morally right or wrong. Even it is his
autonomous decision, it is possible that he made a wrong decision. That’s why a
physician must guide his patient until the end of his life.

Conclusion:

A physician must be in the side of permissibility and respect for a patient’s autonomy.
They have no right to decide for a patient but just assist them to promote good care at
the end of life.
 Mapua University

Department of Arts and Letters

Final Project

Cases in Bioethics and Engineering

Submitted by:

Leader: Mañalac, Noli

Boyore, Ralston Khevin

Castañeda, Benedick

Dizon, Mika

Lupac, Aeron Dayle

Umandap, Rolan

Submitted to:

Prof. Marilou Evangelista

GED107 / A7

October 11, 2019

 Table of Contents
Bioethics 1

One Small Cut that Killed 1

Court Decision 2

Exploring Ethics 3

Uncertain Resolution 4

The Case of Mr. Perry and his Pacemaker 5

Exploring Ethics 7

Uncertain Resolution 8

Engineering 9

NSPE, BER Case 96-4 9

Exploring Ethics 10

Uncertain Resolution 11

Case Study F-11: Conflict of Interest in Building Inspection 12

Exploring Ethics 13

Uncertain Resolution 14