Case #7
Principles in Practice

Case Goals
  • Assess patient capacity for decision-making
  • Demonstrate understanding of patient autonomy
  • Balance competing ethical principles appropriately

    • Goals

  • Assess patient capacity for decision-making
  • Demonstrate understanding of patient autonomy
  • Balance competing ethical principles appropriately
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    Greetings! I am Dr. Alfred Schmurtz III, and today we shall explore one of the most fundamental challenges in medical practice - when ethical principles collide. Our case today is titled "Principles in Practice" and involves Michael Thompson, a 41-year-old gentleman who has recently been diagnosed with stage 1 (T1N0M0) renal cell carcinoma. The radiologist found this incidentally on imaging done for back pain, and subsequent workup confirmed the diagnosis. You are the oncologist seeing him for the first time in clinic. Your job will be to navigate the complex ethical landscape of patient autonomy, beneficence, non-maleficence, and justice as you provide care for this patient. We will begin by meeting Mr. Thompson in your office and when you have finished your conversation with him you may send him home. Why don't you ask him what he knows about his diagnosis so far?

    Case Complete!

    High Yield points about this case:

    • Stage 1 renal cell carcinoma has a 5-year survival rate of over 95% when treated appropriately with surgery.
    • The four core medical ethics principles are autonomy, beneficence, non-maleficence, and justice.
    • The principle of autonomy requires that patients with capacity can refuse any treatment, even life-saving ones.
    • Patients have the right to make decisions that physicians consider medically inadvisable - the 'right to make wrong decisions.'
    • Autonomy may only be limited if the patient's decision poses an immediate and identifiable risk to another person.
    • Non-maleficence means 'do no harm', which includes respecting a patient's informed decision to refuse treatment.
    • Beneficence requires physicians to act in the patient's best interest, which includes informing them when their choice conflicts with medical recommendations.
    • Ethics committees are rarely needed for competent patients making informed decisions about their own care.