Ethical Issues: The Case of Mr. B

Mr. B

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Mr. B is a 70 year-old male patient from Venezuela with past medical history of diabetes, high cholesterol, hypertension, severe renal disease on hemo-dialysis who presented to the hospital after he fell. Mr. B denied any other symptoms. Of note, patient also has dementia which has been progressive over the past several months.

Mr. B does recognize his family and is able to interact and communicate with others; however, he has become verbally and physically aggressive with his wife. Mr. B lives with his wife of many years, and has 2 sons who are very close to him. Mr. B has no insurance and is undocumented. Mr. B was admitted to the hospital for observation, and also because during initial evaluation, his chest x-ray revealed a lung mass.

Mr. B has been admitted to the hospital and is being treated for pneumonia (lung infection), and is receiving hemo-dialysis. Also, he requires a nurse assistant to sit with him at all times due to agitation. Mr. B undergoes many tests to diagnose the etiology of the lung mass. The results of Mr. B’s report from a CT scan of the chest, an MRI of chest and abdomen indicate that he has lung cancer with metastasis to bone. Multiple attempts have been made to try to biopsy the mass, all unsuccessful. Some nodes are noted around his aorta and on the liver.

A Metastasic cancer diagnosis, but it is very likely. His wife and children wish to have this cancer diagnosed; because “yo quiero saber para rezar que ocurra un milagro” (I want to know so I can pray that a miracle happens). Also, the family thinks that Mr. B should continue dialysis. An ethics consultation is called to evaluate the situation.

Questions for Discussion

Questions for Discussion

1. Should Mr. B continue hemodyalisis?  If so, who will pay for it?

2. Should Mr. B be offered more invasive procedures to diagnose this cancer, knowing that his prognosis is very poor?

3. Who is the decision maker?

4. The ethics consultation team must make a decision…

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