Task 2

In this section, we’re going to focus more deeply on the potential conflict between the physician’s cultural and religious beliefs and the Medical cultures’ requirement to provide services required by the patient.

The CMA Code of Ethics advised physicians to “Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.” However, the human rights Code does not allow for “decisions to restrict medical services offered, to accept individuals as patients or to end physician-patient relationships that are based on moral or religious beliefs”.

Speaking for the College of Physicians and Surgeons, Kathryn Clarke insists that, “All we’re doing is reminding physicians that they have to comply with the law. The Human Rights Code is the law, and it’s not new. We just want to alert physicians as to their obligations under the law.” The college considers itself to be asking physicians to do three things:

  • to communicate clearly
  • to treat patients with respect
  • to provide information about accessing medical care—services that patients have a legal right to access

Here’s what you need to do:

Step 1:

Ethical, legal and practical considerations are part of making an informed decision in complex medical cases. Review the following case:

Paul Cook, age 13, advanced bone cancer. The tumour above his knee has already spread to his leg and doctors are worried it may spread to his lungs soon, at which point the cancer will inevitably cause death within 1 year. The medical team suggests amputation of the leg as soon as possible to prevent the cancer from spreading further. The estimated success rate of immediate amputation combined with chemotherapy is 65%.

Paul’s parents do not want the amputation. They are Christian fundamentalists who seriously doubt in conventional medicine and want to send Paul to a private alternative medicine clinic in Costa Rica which apparently does cancer treatment in the form of specialized diet, herbs, and shark cartilage. These treatments are obviously evaluated as useless by the medical team and will most certainly cause Paul to die at the clinic. Paul shares his parent’s view and does not want to lose his leg. He’s a remarkably intelligent and well-spoken young boy who fully understands his own predicament. No one questions his parents’ unconditional love for him and the fact that they sincerely think they are trying to save their son’s life in the name of their faith.

Social services demands Paul be taken out of his parent’s custody and that he goes through with the amputation and chemo.

Who should decide on Paul’s well-being – the State or himself and his family? Do the doctors have a responsibility to intervene against the family’s wishes if it means saving his life, or respect the family’s wishes and fundamental values?

Step 2:

Research the ethical, legal and practical considerations relevant to an informed decision in this case.

Step 3:

Script the explanation you would provide to Paul and his parents about his ongoing care (and who would be responsible for decisions about his health care). Go to the Group Forum and post your explanation in the Deepening Understanding – Task 2 topic.

Step 4:

Read the responses from other participants and comment on the responses of your online colleagues as you wish.

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