Read the scenarios:discuss the scenarios.Be sure to provide your analysis and arguments

Case A

Hapless Hospital employs Dr. Frank Aterror, a surgeon who in the past has sexually assaulted female patients.Suppose that he sees a thousand patients a year, half of them female and has allegedly assaulted two women over five years, making the individual risk for an individual female patient 2/2500, or .0008, or .08%.Should every female be informed of the risk of sexual assault?

Case B

Hapless Hospital has a staff surgeon, Dr. Rye, who is an alcoholic.He is an excellent surgeon when he is not impaired by drinking, but because he is a chronic alcoholic it is hard to predict when he may violate his aftercare (part of on going rehabilitation) and become impaired.Should Dr. Rye be required to disclose to patients that he is an alcoholic??

Case C

You volunteer for a nonprofit organization that provides services to the homeless through a community center called Emmaus House.While you are there, the director of the center comes rushing up to you and tells you there is an emergency.He wants your help because you are a student of health services management and taking a legal course.

Mr. Jack Lark, a homeless man who comes frequently to the center, is complaining of chest pains and shortness of breath.He has had these episodes in the past and, in fact, went to the public hospital very early this morning because of them.The doctor at the public hospital examined Mr. Lark and concluded that he was not having a heart attack but rather suffering from influenza.You and the director get Mr. Lark into your car and take him to the nearest hospital, which happens to be Hapless, a private hospital.Mr. Lark is guided to a cubicle where the emergency room physician examines him.The doctor then tells you that they are going to transfer him to the public hospital, twenty minutes away.What do you do?

Assume that Mr. Lark is admitted to the public hospital but dies within the week.If suit was brought on Mr. Lark's behalf, what would have to be proven to be successful?Is there a claim against the doctor?

Case D

Mr. Smith was transferred from the Coronary Care Unit to a semi-private room in Hapless Hospital.He decided to leave the hospital because he did not like his new accommodations or having a roommate.When he tried to leave, several staff members returned him to his room and restrained him in bed while they tried to contact his doctor.During this time, he escaped from the restraints and exited through the third story window.He was severely injured in his fall to the ground.

The involved staff and administration of Hapless Hospital are concerned about their potential risk and that of the hospital if a lawsuit is filed.Should they be?? Why or why not?Please explain your answer.

Case E

Mr. Karl,an otherwise healthy 62-year old man, arrived at Hapless Hospital emergency room by ambulance.He had serious stab wounds to his chest and back, and he was loosing blood quickly.The emergency technician on the ambulance explained to the emergency room physician that he was called to Howdy Podner Bar by the owner, who telephoned to report a fight and request an ambulance.He said that Mr. Karl complained that he had been knifed by his son and that Mr. Karl was uncooperative but too weakto successfullyoppose ambulance attendants on the four block drive to the hospital.Mr. Karl's wife, who wascalled byanother patron at the bar, arrived at the emergency room at the same time as Mr. Karl.

When an emergency room physician explained to Mr. Karl that he required several units of blood, Mr. Karl absolutely refused to accept that form of treatment.He said that he understood the consequences of not receiving blood under the circumstancesthat death would be likely, if not inevitable.However, he explained that his Jehovah's Witness faith did not allow him to consent to a blood transfusion.In any case, he explained, religion or not, he "had his own reasons" for not wanting to survive this stabbing, and he did not want any blood.His wife, who is also a Jehovah's Witness, begged the doctor to provide the blood and save her husband's life.She explained that her husband was misinterpreting Jehovah Witness doctrine, which permitted a blood transfusion in certain circumstances.In fact, she argued, their faith does not provide that he not be givenblood;it merely requires that he not actively give his consent to receiving blood.She pointed out that they had been married for 35 years and that she knew he wanted the transfusion, but he felt obligated by his religion to appear to oppose it.Physicians treated his wounds but did not provide any blood.

Mr. Karl was maintained in the emergency room.He continued to object to any form of blood transfusion, but after several hours of blood lossbecame less coherent.He began to cry about the guilt he suffered from stabbing his son, and he began talking about the Lord's revenge upon evil men.When he was approached by physicians, he merely screamed obscenities as loudly and raucously as his weakened condition would permit.

About 10 hours after he arrived at the emergency room, Mr. Karl was afflicted with an apparent stroke and slipped into unconsciousness.He then was moved to the intensive care unit.He lost breathing capacity and he was placed on a respirator by the ICU physician.Shortly after his move, his three daughters arrived, confirmed what their mother had said earlier and begged that their father be given all available treatment, including blood.His only son, with whom he had been fighting earlier in the evening, was arrested and remained in jail.

Within the next several hours all bleeding ceased, and he remained in stable condition.Given the consequences of the stroke, his physicians concluded that there was virtually no hope that Mr. Karl would regainany cognitive abilities.Intravenous nutrition supplementation was commenced, then replaced by a naso-gastric tube through which nutrition was passed directly to his stomach.

After her father had spent two weeks in intensive care, one of the daughters requested that her father's respirator be removed.The doctors explained that they had several options.The respirator could be removed at once, which would surely lead to her father's death.He could be "weaned" from the respirator, with respirator support removed slowly (and reinstated when necessary), a process which would not result in his immediate death, but would likely shorten his life substantially.He could be "terminally weaned," which would be the same as the weaning process except that the support would not be reinstated, even if it were necessary.Finally, he could be maintained on the respirator.Mr. Karl's wife and daughters determined that he should be removed from the respirator in whatever manner the physician thought proper, and he was successfully "weaned" from it.A week later, Mr. Karl's wife asked that his feeding tube be removed.She said "He always said that the worst thing that could happen to him was to be a vegetable."In addition, his family physician reported that he had once talked to Mr. Karl about living wills and that Mr. Karl had asked for a living will form, although he had not filled it out.Two of the three daughters agreed with their mother that the feedingtube should be removed, but one strongly objected, saying that she believed it would be wrong, from a moral and religious point of view, to do so.

Mr. Karl's wife and children are his only heirs.He has always been particularly close to the daughter who does not want his feeding tube removed.His family physician reports that during a previous hospitalization for an ulcer, Mr. Karl depended heavily upon his wife, to whom he has been happily married for 35 years, and left every treatment decision to her.The current medical and hospital charges of about $5,000 a day are paid by Mr. Karl's insurance (80%) and his family (20% coinsurance obligation).The family resources will be exhausted in another few weeks when the maximum annual payout on the insurance policy will have been met.After that, his health care will be paid by Medicaid.

What treatment would have been appropriate at each point in Mr. Karl's hospitalization?How should that have been decided?What judicial consequences could (or should) each medical decision have?Would you answer differently if you were Mr. Karl?A member of Mr. Karl's family?One of his creditors?The hospital administrator? The doctor?The hospital ethics committee?