November Response
Martin Albi is a 65-year-old man living with ALS. His disease is advanced; he uses a wheelchair for mobility and has difficulty speaking. His wife, Anne-Marie, who has been his primary caretaker for the last 23 years, often speaks for her husband due to these difficulties. She is a devout Catholic and credits her ability to care for her husband and her optimism to her faith. You recently discovered a mesenchymal stem cell trial that has showed promise in slowing the deleterious effects of ALS. You presented this study to Mr. Albi in the hopes that Mr. Albi would consent to be a member of the study. He showed great interest in the study but could only express that he would like you to discuss the study in the presence of Mrs. Albi when she returns from getting coffee from the hospital café. When Mrs. Albi returns, you excitedly explain to her the proposed benefits of the treatment. However, as soon as you mention stem cell treatment, Mrs. Albi immediately declines, citing the faith that she and Mr. Albi share. She forbids you from discussing or proposing any treatment related to stem cells to her or her husband. This decision is not consistent with Mr. Albi’s previous enthusiasm to pursue a stem cell-based treatment.
There were no comments added to the responses. The most popular answer was (C) Wait for another opportunity to speak to Mr. Albi alone and try to convince him to accept the treatment. The treatment would benefit him and extend his life. He should be able to choose his own treatment and you know that Mrs. Albi isn’t going to budge. Preventing the patient harm while protecting his autonomy is most important (patient autonomy/ beneficence). As we can see here, there arises an ethical dilemma between respecting the autonomous desires of the patient versus avoiding damage to the relationship that the patient has with his wife. Another ethical dilemma that arose is the declination of promising treatment as a result of Mrs. Albi’s religious values.
January Question
A 12-year-old female presents to your clinic for their regular well-child examination. You recommend the following immunizations: Tdap, first HPV vaccine, and the first meningococcal vaccine. The mother consents to all vaccinations except for the HPV vaccine. She states that her child is not sexually active. You then proceed to inform both the mother and patient that per the CDC, it is recommended that 11- to 12-year-olds get two doses of HPV vaccine to protect against cancers caused by HPV. Ideally, females should get the vaccine before they become sexually active and are exposed to HPV. The mother continues to decline the HPV vaccine and says that she has the final say in her child’s well-being.
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Nancy Lopez was born and raised in Los Angeles, California. She graduated from the University of California, Irvine, with a degree in biological sciences with a minor in medical anthropology. She received a Master's in global medicine from the University of Southern California. She has a special interest in rural and public health. In her free time, she enjoys dancing, hiking, snowboarding when the sunny Arizona weather is permitting, and spending time traveling.