group seven (7)

8/6/2019 Group Seven (7)

1/25

Group seven (7)


2/25

Introduction

Our presentation is about an erotic dancer

who survived surgery on abdominal aorticaneurysm without her consent which she

later sued the hospital for millions of dollars.


3/25

Objectives

To educate members on the nature of

abdominal aortic aneurysm To find out the ethical issues in relation to the

case


4/25

Overview of the case

A woman enters the emergency room with stomach pain. She undergoes aCT scan and is diagnosed with an abdominal aortic aneurysm, a weakeningin the wall of the aorta which causes it to stretch and bulge (this is verysimilar to what led to John Ritter's death). The physicians inform her thatthe only way to fix the problem is surgically, and that the chances of

survival are about 50/50. They also inform her that time is of the essence,and that should the aneurysm burst, she would be dead in a few shortminutes. The woman is an erotic dancer; she worries that the surgery willleave a scar that will negatively affect her work; therefore, she refuses anysurgical treatment. Even after much pressuring from the physicians, sheadamantly refuses surgery. Feeling that the woman is not in her correctstate of mind and knowing that time is of the essence, the surgeons

decide to perform the procedure without consent. They anesthetize herand surgically repair the aneurysm. She survives, and sues the hospital formillions of dollars.


5/25

What is abdominal aortic

Most aneurysms occur in the aorta. The aorta is themain artery that carries blood from the heart to therest of the body. The aorta comes out from the leftventricle of the heart and travels through the chest and

abdomen. Abdominal aortic aneurysm (also known as AAA,

pronounced "triple-a") is a ballooning of the abdominalaorta exceeding the normal diameter by more than 50percent.

Approximately 90 percent of abdominal aorticaneurysms occur below the kidneys, but they can alsooccur at the level of the kidneys or above the kidneys


6/25

What is abdominal aortic

Experts recommend that men who have ever

smoked (at least 100 cigarettes in theirlifetime) and are between the ages of 65 and

75 should have an ultrasound screening to

check for abdominal aortic aneurysms.


7/25

Signs and symptoms

Most abdominal aortic aneurysms (AAAs) develop slowly over years andhave no signs or symptoms until (or if) they rupture. Sometimes they tendto cause no symptoms, although occasionally they cause pain in theabdomen and back (due to pressure on surrounding tissues) or in the legs

(due to disturbed blood flow). The major complication of abdominal aortic aneurysms is rupture, which

can be life-threatening as large amounts of blood spill into the abdominalcavity, and can lead to death within minutes.

A doctor can feel a pulsating mass while examining a patient's abdomen.When symptoms are present, they can include:

Deep penetrating pain in your back or the side of your abdomen Steady gnawing pain in your abdomen that lasts for hours or days at a

time

Coldness, numbness, or tingling in your feet due to blocked blood flow inyour legs


8/25

If an AAA ruptures, symptoms can include sudden, severe pain inyour lower abdomen and back; nausea and vomiting; clammy,sweaty skin; lightheadedness; and a rapid heart rate when standingup. Internal bleeding from a ruptured AAA can send you into shock.Shock is a life-threatening condition in which the organs of the body

do not get enough blood flow.

The bleeding usually leads to a hypovolemic shock withhypotension, tachycardia, cyanosis, and altered mental status. Themortality of AAA rupture is up to 90%. 6575% of patients diebefore they arrive at hospital and up to 90% die before they reach

the operating room. The bleeding can be retroperitoneal orintraperitoneal, or the rupture can create an aortocaval oraortointestinal (between the aorta and intestine) fistula.


9/25

Types of aortic aneurysm

The two types of aortic aneurysm are thoracicaortic aneurysm (TAA) and abdominal aorticaneurysm (AAA).

An aortic aneurysm that occurs in the part ofthe aorta running through the abdomen is anabdominal aortic aneurysm. Three in fouraortic aneurysms are AAAs.

An AAA can grow very large without producingsymptoms. About 1 in 5 AAAs rupture.


10/25

A picture of AAA


11/25

Causes of AAA

Cigarette smoking: Greater than 90% of people who develop anAAA have smoked at some point in their life.

Genetic influences: The influence of genetic factors is highlyprobable. The high familial prevalence rate is most notable in maleindividuals.[10] There are many theories about the exact geneticdisorder that could cause higher incidence of AAA among malemembers of the affected families.

Atherosclerosis: The AAA was long considered to be caused byatherosclerosis, because the walls of the AAA are frequentlyaffected heavily. However, this theory cannot be used to explain theinitial defect and the development ofocclusion, which is observedin the process.[6]

Other causes: Other causes of the development of AAA include:infection, trauma, arteritis, cystic medial necrosis (m. Erdheim).


12/25

Diagnosis

An aneurysm may be found by chance during a routinephysical exam. More often, an aneurysm is found by chanceduring an x-ray, ultrasound, or computed tomography (CT)scan performed for another reason, such as chest or

abdominal pain. If you have an abdominal aortic aneurysm (AAA), the

doctor may feel a pulsating mass in your abdomen. Arapidly growing aneurysm about to rupture can be tenderand very painful when pressed. If you are overweight orobese, it may be difficult for your doctor to feel even alarge abdominal aneurysm.

If you have an AAA, your doctor may hear rushing bloodflow instead of the normal whooshing sound when listeningto your abdomen with a stethoscope.


13/25

Treatment of AAA

Treatment recommendations for aortic aneurysms are based on thesize of the aneurysm. Small aneurysms found early can be treatedwith watchful waiting.

If the diameter of the aorta is small - less than 3 centimeters (cm) -and there are no symptoms, watchful waiting and a follow-up

screening in 5 to 10 years may be all that is needed, as determinedby the doctor.

If the aorta is between 3 and 4 cm in diameter, the patient shouldreturn to the doctor every year for an ultrasound to see if theaneurysm has grown.

If the aorta is between 4 and 4.5 cm, testing should be repeatedevery 6 months.

If the aorta is larger than 5 cm (2 inches around or about the size ofa lemon) or growing more than 1 cm per year, surgery should beconsidered as soon as possible.


14/25

Treatment of AAA

Two main types of surgery to repair aortic aneurysms are openabdominal or open chest repair and endovascular repair.

The traditional and most common type of surgery for aorticaneurysms is open abdominal or open chest repair. It involves amajor incision in the abdomen or chest. General anesthesia isneeded with this procedure.

The aneurysm is removed and the section of aorta is replaced withan artificial graft made of material such as Dacron or Teflon. The

surgery takes 3 to 6 hours, and the patient remains in the hospitalfor 5 to 8 days. It often takes a month to recover from openabdominal or open chest surgery and return to full activity. Openabdominal and chest surgeries have been performed for 50 years.More than 90 percent of patients make a full recovery.


15/25

Ethical Issues

What is Ethics

It is the standard of behaviour that tells us

how human beings ought to act in the many

situations in which they find themselves:

friends, parents, children, citizens,

businesspeople, teachers, professionals, and

so on.


16/25

Ethical Issues

Ethical bases for the physicians actions

Consequentialist Determine good or bad action simply by

looking at the ratio of goodness or badness

the action produces. This theory can beapplied to justify the ethical bases on which

the surgery was performed.


17/25

Ethical Issues

Situational ethics:

the moral action is the one that produces the

greatest amount ofC

hristian love of all thealternatives available.

Looking at the available alternatives to the

physicians, the best alternative to

demonstrate Christian love for the patient is

to perfom the surgery


18/25

Ethical Issues

Utilitarianism is based on the idea that ethical

behaviors are those that result in the greatest

amount of benefit for the largest number of

people (Mill, 1863).

The utilitarian believes that what benefits the

larger number of people is morally right. Thus,

the ladys survival is a benefit to the society.


19/25

Ethical Issues

Kants categorical imperatives:

Act in such a way that the action you take could be

a universal law or rule of behaviour under the

circumstances

The actions of the physicians though against

the autonomy of the patient was one that

other health workers could learn in theirattempt to save life.


20/25

Ethical Issues

The TVTest:

Ask, Would I feel comfortable explaining to a

national TV audience whyI

took this action?


21/25

Ethical Issues

Other related issues to the physicians actions:

Yes, they could have contacted her relationssince they feel the woman was not in her

correct state of mind.

However, since it was an emergency and acritical situation, any further delays could have

resulted in her death. Secondly they could have asked the patient to

sign a document that she refused treatment


22/25

Ethical IssuesP

atients autonomy and surgeons beneficence: Sometimes patients are not able to make decisions about their medical

care. This applies to newborns, young children, people in persistentvegetative states, and people with psychiatric or psychological conditionsthat disrupt ordered thought.

In general, physicians are bound to respect patient wishes as a matter ofrespect for person. However physicians also owe a duty of beneficence(doing good ) toward patients. It is certainly not in patients best intereststo be abandoned by medicine because they cannot make decisions forthemselves. Both ethics and the law accept the idea that others may makedecisions for patients who are unable to do so. For adults, this is generallyreferred to as (surrogate decision making). For children, their mothers andfathers enjoy parental privilge when it comes to making medicaldecisions

The court will look at the proportionality or limited responsibility theory;i.e. what we intend, how we carry out our intentions and what happens


23/25

Ethical Issues

what will you do if were one of the health

workers?

We could have taken the surgeons position to

save thelife of the patient (beneficence) and

also have communicated to her relations.


24/25

So What do you also

think?


25/25

Lessons Learnt

Surgeons shouldnt take away patients

autonomy unless all avenues have beenexhausted

group seven (7)

Documents