Case 3 and 4

Kamilah Bt Maketar
C111 12 826
23/02/2016
Case no 3
You are a general practitioner and a mother comes into your office with
her child who is complaining of flu-like symptoms. Upon entering the
room, you ask the boy to remove his shirt and you notice a pattern of very
distinct bruises on the boy's torso. You ask the mother where the bruises
came from, and she tells you that they are from a procedure she
performed on him known as "cao gio," which is also known as "coining."
The procedure involves rubbing warm oils or gels on a person's skin with a
coin or other flat metal object. The mother explains that cao gio is used to
raise out bad blood, and improve circulation and healing. When you touch
the boy's back with your stethoscope, he winces in pain from the bruises.
You debate whether or not you should call Child Protective Services and
report the mother.
1. Should we completely discount this treatment as useless, or could
there be something gained from it?
-As a physician, we should respect the ethnicity belief in some
people culture. Besides, it will go against the autonomy of the
parent on how they believe they should be raising their kids.
2. When should a physician step in to stop a cultural practice? (if
someone answer when it harms the child remind that there I some
pain in many of our medical procedures, for example having ones
tonsils removed)
-The physician should really stop a cultural practice when it brings
harms to the child. By meaning of bringing harms are; as for the
doctor knowledge, when the cultural practice will cause the
permanent damage and disable the children when performed. In this
case, I dont think this practice is bringing a great harm. It is enough
that the parent being advised for a sterilize and a safer procedure.
3. Should the physician be concerned about alienating the mother and
other people of her ethnicity from modern medicine?
-No. As a physician, we should treat people equally in accordance
with medical ethics principles; justice, no matter what their races,
culture and social economy.
4. Do you think that the physician should report the mother?
No, I dont think that the physician should report the mother. It is still
the rights of a parent to care for her child in the manner that she
sees fit. This is how the

Case no 4
A woman was diagnosed with motor neurone disease (the same
disease that Stephen Hawking has) 5 years ago. This is a condition that
destroys motor nerves, making control of movement impossible, while the
mind is virtually unaffected. People with motor neurone disease normally
die within 4 years of diagnosis from suffocation due to the inability of the
inspiratory muscles to contract. The woman's condition has steadily
declined. She is not expected to live through the month, and is worried
about the pain that she will face in her final hours. She asks her doctor to
give her diamorphine for pain if she begins to suffocate or choke. This will
lessen her pain, but it will also hasten her death. About a week later, she
falls very ill, and is having trouble breathing.
1. Does she have a right to make this choice, especially in view of the
fact that she will be dead in a short while (say six hours)? Is this the
choice extension of her autonomy?
-Yes, she definitely has the right to make this choice. It is her
autonomy in deciding what she want the best for her treatment.
However, as a physician, we should advise her on making the best
decision as her mind is virtually unaffected.
2. Is the short amount of time she has to live ethically relevant? Is
there an ethical difference between her dying in 6 hours and dying
in a week? What about a year, and how do you draw this distinction?
-there is totally an ethical difference for her dying time. We should
always encourage the patient to keep on hoping that if she lives
longer, they might discover a new treatment to help cure the
disease. By that, the matter of her dying time is really bring an
ethical difference as this will give her the rights of living.
3. Is the right for a patients self-determination powerful enough to
create obligations on the part of others to aid her so that she can
exercise her rights? She clearly cannot kill herself. She cant move,
but should someone be FORCED to help, or to find someone to help
her?
-Of course. As a health care provider, we should always make the
patients autonomy as the highest priority. If she is determined to
continue on living despite whatever the disease are, we should help
her with all our might. By this, she would be able to practice her
rights on living.
4. Should the money used to care for this woman be taken into
account when she is being helped? Do you think that legalizing
euthanasia could create conflicts of interest for the patient/ or the

doctor? Will people feel that they need to end their lives earlier to
save money?
-The government should take into account to provide such a
foundation or a centre for euthanasia cases like this where people
can donate or volunteer. When there are people needing the help,
they should be sponsored by this foundation. So, they will be no
problem as for the money used to care for this woman.
-No, I dont think one should end their lives earlier to save money.
Everyone has the rights on continue living despite what the cost is
5. If you were the physician, what would you do? Note: if you would
pass her off to another doctor knowing he or she would do it, does
this free you from your ethical obligations?
-If passing her to another doctor clearly will not free me from my
ethical obligations. If I were handling this case, I would offer to her
another option or alternative that she can choose to provide comfort
to her. Even if it is her autonomy to choose for the drugs, but I has
still got the non-maleficent on the principle of medical ethics to be
obliged.