Question

Jimmy, who is 17 years old, is seriously injured in a car accident. Taken to a nearby hospital, he is given emergency treatment by Dr. Smith, who judges that the boy’s right arm will have to be amputated below the elbow because it has been crushed beyond repair. Two other physicians are consulted and agree that the amputation should be done immediately to protect Jimmy’s life.Jimmy is unconscious as a result of a concussion, without the indications of a problem on the CT scan of the brain. He is also medicated for possible pain to allow the suturing of a head wound that was bleeding profusely. Attempts to contact the boy’s parents in a neighboring town are unsuccessful. Dr. Smith amputates the boy’s arm.

1) Should the physicians have waited for Jimmy to wake up to obtain informed consent? 2) Is the pain medication necessary, even if it may slow the recovery of the brain function? 3) Is this case an emergency exception? Why or why not? 4) What other ethical issues to do you see with this case?

Answer 1

Answer:

1. No, the physician is need not to wait to obtain informed consent from the Jimmy.In emergency situation, if the patient is unconscious, incompetent or no surrogate is available, the consent should be "persumed" rather than obtained,if emergency treatment save his life and prevent disability.The principle of beneficence is required to act on behalf of patient when his life is on danger. If the parents are there,the can give the permission for the treatment.

2.The person should not take any analgesics in the initial stages of concussion. It will act like a mask and cover the symptoms of concussion,which could allow someone to return to normal life.Once the concussion is diagnosed mild analgesics can administer to reduce headaches. Short term use of drugs helps for recovery. While long term use of opioid analgesics will affect the brain function and will ultimately leads to opioid addiction.

3.It is an emergency life threatening situation where the patient has concussion and he is unconscious. He has severe injury on his right arm which requires amputation and he needs high priority emergency care.

4.*Ethical issues on treatment policies

* Multidisciplinary team approach for further treatment

*Long duration of treatment and time required to return normal activities

* Risk for dependence to opioid analgesics

*Impact on relationship in long term treatment

*Physical impairment by amputation