Case Study

CASE STUDIES

Case Study 1

Henry has been practising as a physiotherapist for 8 years. He works in an inner-city medical centre

along with orthopaedic surgeons, a podiatrist, a rheumatologist, a radiologist, and a massage therapist.

Henry has been treating Jim, a 73 year old man, following bilateral knee replacements. After 3 months

of therapy, Jim has shown little improvement in mobility; his wife tells you that Jim is not following his

exercise program at home. Henry has a waiting list of patients who need his assistance; for this reason,

he decides to discontinue Jim’s treatment. Instead, he suggests that Jim see the massage therapist.

Later that week, the practice manager, Sally, calls a meeting with Henry to discuss his decision to

discontinue Jim’s treatment as she believes that such measures could undermine the reputation of the

practice. She warns Henry that if he discontinues treating patients, they will go elsewhere. Later, Henry

raises his concerns with the practice manager over the well-being of one of the surgeons. He tells Sally

that the surgeon frequently arrives to work smelling of alcohol, including on those days on which he

performs surgery. Sally offers to speak with the surgeon, assuring Henry that he does not need to

intervene in this matter. Weeks go by and the surgeon continues to arrive at work in the same

condition.

Select only one case study from the list below and address the following points:

1) Identify the ethical issues at stake in your chosen case study

2) Establish a clear ethical perspective on the issues

3) Recognise an alternative perspective to your own

4) Discuss the ethical issues from the perspectives of:

 The requirement to respect human dignity and human rights;

 your future profession’s codes of ethics/ professional conduct & professional

standards;

 one ethical theory you have studied in this unit; &

 the principles of health care ethics

5) Make recommendations for professional practice

Case Study 2

Camilla works on a surgical unit in a large, inner-city hospital. One morning shift, she is assigned to care

for Sam, a 21 year-old man who was admitted during the night for investigation of acute abdominal

pain. His medical history includes multiple admissions to the emergency department for treatment of

(among other things) drug-related psychosis. At the beginning of her shift, Camilla attempts to check

Sam’s vital signs but is unable to do so as he is very agitated, attempting to push her away. He is also

calling out and unable to answer her questions rationally. Camilla asks the medical team to review Sam

as she is concerned about not being able to monitor his condition effectively. She is also concerned for

her own safety and that of her colleagues. The medical team arrives to find Sam pulling out his IV

cannula and verbally abusing Camilla. They order that Sam be placed in physical restraints and

document as much in the notes.

Camilla is concerned that this approach will only exacerbate Sam’s agitation and that, ultimately, he will

injure himself and/or other patients and staff. She expresses her concerns to the nurse in charge of the

shift (Julia) who advises her to apply the restraints and focus on caring for the other patients she has

been assigned. Julia states: “patients like Sam are a waste of our time. Besides, we haven’t got enough

staff rostered on today to be worried about him”.

Case Study 3

Jane works as a midwife in an inner-city hospital where she runs an ante-natal clinic twice a week; on

other days, she works on the labour ward. Jane is aware that one of the women attending the ante-

natal clinic (Tiffany) is alcohol dependent and lives with a physically abusive partner; Tiffany has been

admitted to the emergency department on several occasions with multiple injuries, including fractured

ribs, bruising to her face and, on one occasion, a fractured mandible. Jane refers Tiffany to the hospital

social worker who, in turn, refers her to the drug and alcohol services; she has attended the D&A clinic

only once and continues to abuse alcohol on most days. Eventually, Tiffany gave birth to a seemingly

healthy baby. Her partner visited a few hours later and became verbally abusive. Jane became

concerned about discharging Tiffany home; in particular, she worried over the well-being of the baby.

However, Tiffany insisted that they would be ‘alright’ and discharged herself only a few hours following

delivery.

Case Study 4

Cindy is a social worker on an adolescent mental health unit. She has been working with a 15 year-old

client, Ben, who was admitted as an outpatient following a suicide attempt 3 months ago. On one

occasion, Ben tells Cindy that he is involved in a sexual relationship with a 30 year old man; he explains

that he is happy with this arrangement even though he worries that his parents will find out. Cindy

continues to see Ben each week but has not mentioned Ben’s situation to other team members; she

believes that she will be able to help Ben arrive at a decision, independently, to terminate the

relationship. Besides, she finds it rewarding to work with clients like Ben who, she believes, really need

her help.

Case Study 5

Luke is a speech pathologist who specialises in working with patients who have sustained a traumatic

brain injury (TBI). He works with a team of health care professionals attached to a neurology

department of a metropolitan teaching hospital. One of his clients, Tom, suffered a TBI in a motor

vehicle accident. He has shown no real progress over the last 9 months; his cognitive function, as well as

his speech and language impairments remain unchanged. Tom’s dysphagia persists such that he

continues to need artificial feeding via a PEG tube. Luke believes that weekly treatment visits should

stop; he believes that the sessions are exhausting and frustrating for Tom. He also knows that is difficult

for his wife to accept Tom’s condition and believes that continuing treatment is deceptive inasmuch as it

encourages a ‘false hope’ on her part. The other team members wish to continue treatment even

though they agree that Tom is unlikely to improve. While Luke cares about Tom’s well-being, he is also

aware that there is a waiting list for his services.

Case Study 6

Alex, an ‘early career’ epidemiologist, has been employed by the Australian Institute of Health and

Welfare (AIHW) to work on a cohort study; the project has involved comparing the morbidity rates of

the refugee population with the general non-indigenous population. Data was collected from public

hospitals and general medical practices where large numbers of refugees attended. The research

proposal was approved by the relevant ethics committee in accordance with the NH&MRC guidelines.

Towards the completion of the study, it became evident that the use of health services by the refugee

population was significantly higher than that of the general population. Moreover, refugees were

significantly more likely to consult health services in relation to mental health conditions, especially

post-traumatic stress disorder (PTSD) and psychoses. These findings were discussed on ‘talk back’ radio

and other media outlets in ways that alienated and offended refugees; for instance, some

commentators were angry that, as taxpayers, they had to pay for medical care of newly-arrived refugees

while, at the same time, “our own diggers” were neglected on return from active service. Department

heads within the AIHW were considering, in future, to censor research findings they thought likely to

undermine social cohesion. However, Alex disagreed; he believes that hiding such evidence is both

deceitful and undermining of public health objectives.

Case Study 7

Ibrahim works in a laboratory on a major cancer research project. The findings of the research are

showing great promise; a breakthrough has been reached which will, most likely, produce both reduced

mortality rates and improved quality of life for people with prostate cancer. The research project has

advanced to the point where trials can commence on human participants. In the course of Ibrahim’s

work, however, he discovers that some results have been manipulated. While he has full confidence in

the effectiveness of the treatment, he suspects that the manipulation has been done in order to ensure

that funding continues for the project. Specifically, Ibrahim is aware that the financial and time

constraints are placing undue stress on the Principal Researcher to produce positive results. At the

same time, he is sure that, with more time, positive results will eventuate anyway.

Case Study 8

Sam and Natalie, both senior paramedics, attempted to resuscitate a 78 year old man who had suffered

a cardiac arrest at home. After 45 minutes, resuscitative efforts were discontinued due to lack of clinical

response. Immediately afterwards, a student paramedic, Jim, who had accompanied Sam and Natalie on

the call-out, asked if he could re-intubate the patient for practice purposes. Jim argued that, as the

man’s wife would not really understand what he was doing, no-one would be harmed. However, Sam

and Natalie thought it inappropriate, but were unable to explain to Jim why they objected to his

proposal. Jim reluctantly agreed not to re-intubate the man but asked, instead, if he could take a

photograph of the deceased man to upload on to his clinical experience portfolio.