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Garrett p. 56 Case Study 2 (Mrs. S)-

Reference: APA

Garrett, T., Baillie, H., & Garrett, R. (2013). Health care ethics: Principles and problems (6th ed.). Upper Saddle River, NJ: Prentice Hall.

Case Study - 2. Mrs. S., a 85-year-old housewife, becomes aware of breathlessness and is easily fatigued. She is known to have had a heart murmur for two years. She consents to come to a research hospital for cardiac catheterization, which confirms the presence of severe, calcific aortic stenosis with secondary congestive heart failure.

Because of the unfavorable prospect for survival without surgical intervention, the recommendation at the combined cardiac medical-surgical conference is for an operation. The physician explains the situation to Mr. and Mrs. S. and recommends aortic valve replacement. It is noted that the risk of surgery is not well known for Mrs. Ss age group, and that early mortality is usually around to percent, with 8o percent good functional results after three years. Her lack of other obvious disease makes her a relatively good candidate for a successful surgical outcome despite her age.

Mrs. S. appears to understand the discussion and recommendation, but requests deferral of the decision and shows signs of denial of the problem. She has no other medical problems, her husband is in good health, and their marriage appears happy. They are financially secure and enjoy a full set of social and recreational activities. She returns on three subsequent occasions for simple, supportive attention. The physician decides not to employ psychiatric assistance or other measures to reduce her denial and begins to use conversation to reduce her anxiety associated with her decision.

Does Mrs. Ss apparent denial of her condition make informed consent impossible? Is the physician ethical in reducing her anxiety about her apparent refusal of treatment when the physician believes treatment is medically indicated?

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