PROFESSIONAL

RELATIONSHIPS
CASE 1
C.T. 60 Yr.Old , f, married,gravida 1
para1 was admitted because of
body weakness and depression for
the last 6 mos. which she
attributes to marital and family
problems because of an absentee
husband and emotionally and
financially problematic only son.
She is a very religious woman, a
daily mass goer. She requested her
sister to request their parish priest
to visit her.
During the visit C.T. told the priest about
her problems and requested for the
sacrament of reconciliation. The priest
after administering the sacrament
prayed with her to get well and be able
to go home soon. The next day the
attending psychiatrist called up the
priest and asked what he said to his
patient. He told him that C.T. will be
better off if she sees him only. The
doctor considers separation from her
husband as the solution while the priest
disagrees that the marriage be ended.
The priests goal is to help
resolve the difficulties, which
he thinks began when the
husband was asked to retire
one year and a half earlier.
The psychiatrist inhibited the
priest to visit C.T. again as his
presence will undermine her
medical treatment.

Case 1
Questions:
1. Should the priest return to see
C.T. inspite of the psychiatrists
ban?
2. Does C.T. have the right to
choose her counselor?
3. Do patients belong to any
professionals?
Discuss the different ethical
issues involved.
CASE 2
E.P.,a nurse in the intensive care unit
takes care of Lola, a 70 yr. old with
terminal colon cancer who is suffering
from pain which has been increasingly
difficult to control. The attending
physician has ordered moderate doses
of morphine. The family was told that at
these doses it may depress respiration
and therefore may possibly hasten
death. Lola and her family have
accepted her condition. All the members
of the team except E.P. see no problem
in giving her an increasing dose of
morphine.
CASE 2
E.P .believes that the morphine
may hasten Lolas death thus she
cannot in good conscience, give
the injection. The attending
physician regards her refusal as a
serious form of disobedience. One
night Lola became very restless
and unable to sleep and was on
severe discomfort and was asking
for the injection ,E.P. refused even
with the pleading of her daughter.
Questions:
1. Do nurses have the right to
refuse medical orders?
2. Do they have the right to
ignore the wishes of the
patient and the family on
grounds of conscience?
Discuss the ethical issues
involve in this case.
Dr. R.V. an anesthesiologist
friend of yours have been using
prohibited drugs and you have
noticed him to be withdrawn,
irritable and distracted recently.
You have heard rumors that he has
made a serious error in calculating
a medication dosage but the error
was discovered before the drug
was dispensed.
You talked to him as a friend and
raised your concern about him.
You encouraged him to undergo
detoxification and addiction
treatment program but he declined
saying that he can handle it by
himself. Unfortunately his
personality changes persist and
even though he assures you that
he is drug free you strongly
suspect that his drug abuse
continues.
When you directly confronted
him with your suspicion, he
cuts off all further contact
with you. You want to
intervene but are uncertain
how to proceed. You believe
that you should raise your
concern to a body that can
handle this problem.
Questions:
1. Are you justified in doing so on the
basis of your current information?
2.Should his admission of drug abuse
during your professional contact be kept
confidential?
3.What are the moral and legal
implications of breaking confidentiality?
4. Discuss the ethical issues in this case

C.T. , a 65 yr. old female came to you because of
persistent abdominal pain and fever two weeks
after she was discharged. She underwent total
abdominal hysterectomy and bilateral
oophorectomy for uterine myoma. You advised her
to go back to her gynecologist for a better
assessment of her condition but she refused and
insisted to be treated by you. On examination
there was tenderness and so you requested for
some workups including an abdominal X-ray which
showed a foreign body probably a needle. The
radiologist called you up to inform you of the
findings and since you know the gynecologist you
called her up and told her the X-ray result. The
gynecologist apparently called up the radiologist
and requested him not to report the foreign body.
What are the ethical issues involved in
the case?
Should you accept the patient? Justify
your answer.
Are you going to tell her the truth? Or
will you just suggest an exploratory
abdominal surgery without telling her
what her case is all about.
Will it be ethical for the radiologist to
give in to the request of the previous
gynecologist not to disclose the
presence of a foreign body?
Justify your answers on the basis of the
principles and virtues that you have
learned.
Mr. B is a 28 year old bisexual
who was found to be HIV positive.
He has no symptoms. Dr. T.M.
informed him that although he
does not have AIDS there was
between 5 to 35% probability that
he would develop the disease
within the next 5 years. He was
told that he can possibly infect
others through sexual contact , by
sharing needles or by donating
blood and blood products. He
revealed that since he is a
bisexual he must have gotten it
through one of his homosexual
encounters.
He also said that he is
engaged. Dr. T.M. advised him
to tell her fiancee about it but
he refused for it will ruin their
marriage plans.
Should Dr. T.M. inform the
fiancee of Mr. Bs test result
or should he protect the
confidentiality of the
professional relationship?
Justify your answers.

Case 6
M.S. an elementary school teacher
consulted you for hemoptysis. You
are the school physician. You
requested for chest X-ray which
showed PTB, active with cavities.
Sputum exam showed positive for
PTB. She requested you not to inform
the school authority as she has used
all her sick leave benefits and she is
supporting her invalid mother if she
will apply for leave it will be without
pay. What are you going to do?
Discuss the ethical issues in the
case.

CASE 7
An 82 yr old male with dilated
cardiomyopathy and Chronic myelogenous
leukemia was admitted because of body
weakness. His attending physician is a
cardiologist. As an out patient he has three
physicians attending to him : a
hematologist, infectious disease specialist
and electrophysiologist.
On admission the AMD referred him to all
the three consultants. On the fourth
hospital day when he felt some
improvement he requested his AMD to ask
his other physicians to sign out due to
financial problem. If you are the AMD what
will you do? Are you ethically obliged to
refer the patient to all the three
consultants?Discuss the ethical issues in
this case.
CASE 8
You are the head of the
diagnostic section in your
hospital. With your other doctor
friends you organized a
diagnostic clinic nearby where
you send most of your patients.
To be able to entice more
referrals you have sent letters
to the doctors offices informing
them of referral fees you will be
giving for every referral they
will be sending. Is this practice
ethical ? If not, why? Justify
your answer.