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Public HealtH ScienceS ` PUBLIC HEALTH SCIENCES—ETHICS Public HealtH ScienceS ` PUBLIC HEALTH SCIENCES—ETHICS SectiOn ii 269

Ethical situations (continued)
SITUATIoN APPRoPRIATE RESPoNSE
A patient requires a treatment not Never limit or deny care because of the expense in time or money. Discuss all
covered by his/her insurance. treatment options with patients, even if some are not covered by their insurance
companies.
A 7-year-old boy loses a sister to At ages 5–7, children begin to understand that death is permanent, that all life
cancer and now feels responsible. functions end completely at death, and that everything that is alive eventually
dies. Provide a direct, concrete description of his sister’s death. Avoid clichés and
euphemisms. Reassure the boy that he is not responsible. Identify and normalize fears
and feelings. Encourage play and healthy coping behaviors (eg, remembering her in
his own way).
Patient is victim of intimate partner Ask if patient is safe and has an emergency plan. Do not necessarily pressure patient to
violence. leave his or her partner, or disclose the incident to the authorities (unless required by
state law).
Patient wants to try alternative or Explore any underlying reasons with the patient in a supportive, nonjudgmental
holistic medicine. manner. Advise the patient of known benefits and risks of treatment, including
adverse effects, contraindications, and medication interactions.
Physician colleague presents to If impaired or incompetent, colleague is a threat to patient safety. Report the situation
work impaired. to local supervisory personnel. Should the organization fail to take action, alert the
state licensing board.
Patient is officially determined to Gently explain to family that there is no chance of recovery, and that brain death is
suffer brain death. Patient’s family equivalent to death. Movement is due to spinal arc reflex and is not voluntary. Bring
insists on maintaining life support case to appropriate ethics board regarding futility of care and withdrawal of life
indefinitely because patient is still support.
moving when touched.
A pharmaceutical company offers Reject this offer. Generally, decline gifts and sponsorships to avoid any appearance of
you a sponsorship in exchange for conflict of interest. The AMA Code of Ethics does make exceptions for gifts directly
advertising its new drug. benefitting patients; gifts of minimal value; special funding for medical education
of students, residents, fellows; grants whose recipients are chosen by independent
institutional criteria; and funds that are distributed without attribution to sponsors.
Patient requests a nonemergent Provide accurate and unbiased information so patients can make an informed decision.
procedure that is against your Explain to the patient that you do not perform the procedure but offer to refer him/
personal or religious beliefs. her to another physician.
Mother and 15-year-old daughter Transfuse daughter, but do not transfuse mother. Emergent care can be refused by the
are unresponsive following a healthcare proxy for an adult, particularly when patient preferences are known or
car accident and are bleeding reasonably inferred, but not for a minor based solely on faith.
internally. Father says do not
transfuse because they are
Jehovah’s Witnesses.
A child presents with injuries Contact child protective services and ensure child is in a safe location. Physicians are
inconsistent with parental story. required by law to report any reasonable suspicion of child abuse or endangerment.

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