Case 1

Mr B, 50 yrs old consulted his ophthalmologist, Miss M, due to swelling affecting his eyelid.

Miss M examined him and diagnosed a papilloma. She documented no corneal or tear was

observed. The excision surgery was recommended. The consent was obtained; the risks of

bruising, infection, scarring and repeat surgery were warned to Mr B.

Shortly after surgery, Mr B reported to Miss M due to a severe pain on the same eye. The cornea

abrasion was diagnosed by Miss M, another operation was recommended to correct the problem.

2 weeks post operation, the upper eyelid closed, swollen and sever pain. Mr B decided to consult

another surgeon, Dr K, who diagnosed cornea opacity, reduced vision and increased pain. “The

recurrence of your problems could be attributed to the first operation, which I thought the wasn’t

necessary but could be the option , and the operation was not done expertly, the aftercare was not

up to standard” said Dr K.

Mr B made a claim against Miss M for negligence, failed to provide adequate aftercare,

unnecessary operation and he wasn’t given thorough information.

a. Discuss the ethical dilemma in this case.

b. Do you think there were any benefits to the operation?

c. Do you think there was negligence?

d. Is there non maleficence?

Case 2.

Mrs G visited his GP, Dr P, for the low backpain. His GP told him the pain could be due to

physical exhaustion of his low back due muscles. Dr P prescribed pain killers and advised

him to do massage to his low back muscles. However, Mrs G asked for injection as her pains

get better on injection than pills. Reluctantly, Dr P injected diclofenac injection on right

buttock and gave her some pills to drink. 3 days later Mrs G started to feel the pain on

injection site followed by the numbness of the right leg and foot. She returned to Dr P who

assured her that the pain will disappear and could be not related to the injection she was

given.

The numbness progress until she could no longer feel her limb. She decided to see a second

opinion from another Dr who told him that was Sciatic nerve injury and she might no longer

be able to walk again with her right limb.

She sue Dr P for negligence claiming that, Dr P was initially reluctant to give her injection

that means he knew the side effects which could happen to her but failed to address them, she

isn’t even sure what was she given.

a) Discuss the ethical dilemma in this case.

b) Do you think there was ethical misconduct?

c) i. List and

ii. Discuss the ethical misconduct if there are any.

Case 3.

Mrs T claim to Dr L, the Gynecology & Obstetrician who operated her 18 years ago for

the possible misconduct. She had elective caesarian section. The baby was delivered

normal but after 1 month a scar appeared on the daughter’s right side of the face, owing

to the minor cut wound during operation. Her daughter, 18 years old now, failed to

progress to the beauty contest due to the scar.

Mrs T claim that the operation was unnecessary, she wasn’t informed and given choice of

the procedure and the Dr L didn’t do what other doctor ought to do.

Dr L didn’t remember the case, there are no records of the patient, but the hospital

administration confirmed that, Dr L was the surgeon in charge of the operation.

a. Discuss the ethical dilemma in this case

b. i. Was/were there any misconduct(s)? if Yes, (ii)list them and (iii) discuss why do

you think so.

Case 4.

Juma H. Ally and Juma S. Ally were two male patients admitted in the same ward, but scheduled

for different operations. H was supposed to go for brain operation while S was scheduled for

knee operation.

The routine procedure was; the nurse in the ward was supposed to put the labeled plaster on the

patients’ right arm. In the label, the name, the age and the operation to be done was supposed to

be clearly written. Moreover, the patients’ file is supposed to have the same label. These were

done at the ward a day before the operation.

On the operation day, both patients were supposed to be taken to the operation theatre at 7am,

however there were emergencies which delayed the operations till 9am. By 9am, the escorting

nurse (who was supposed to take the patients to the theatre) finished his duties; a new one came

to pick the 2 patients and the other 2.

When the operation started, the brain surgeon was called for emergency and the new one had to

come to take his place. The patients were operated. The surgeons found the normal brain and

knee!!

The Brain patient was operated for the knee while the brain of the knee patient was opened and

operated!! A mistaken identity!! The hospital was sued by both patients.

Do you think there was ethical misconduct in this case? If Yes, List and explain them

If you could be in a medical team, what otherwise could you have done?

Case 5.

Miss G had severe anaemia due to excessive menstruation. Dr T decided to transfuse her. The

grouping and cross matching was done and a blood group A+ was sent to the ward for

transfusion.

The transfusion began, Miss G told the nurse she knew she is blood group A-. The nurse

immediately stopped the transfusion , by that time about 5 drops were transfused. She contact the

lab technician who said he will cross check but the transfusion should continue.

The nurse allows the transfusion to continue until after 3 minutes when the lab technician called

her to confirm indeed Miss G is group A-. by that time, about 15 drops were transfused to the

patient.

The nurse then took miss G blood for possible complications (transfusion reaction), all tests

shows negative for reactions. She was then discharged without detrimental effects.

Mrs G later on made the claim to the hospital, claiming the pain, suffering, and emotional stress

among other suffering due to wrong transfusion.

Discuss the ethical dilemma in this case.

Discuss the possible misconduct.

Case 6.

Mr R had severe knee pain; he underwent a knee replacement surgery which was initially

successful. 3 months later he complained of difficulty in flexing his knee. His surgeon, Dr P told

him he developed fibrotic changes within the joint. He sent him to physiotherapy for exercises of

the joint, the decision which didn’t please Mr R. He decided to seek second opinion from a

consultant orthopedic surgeon, who diagnosed the problem , wasn’t fibres but he plate from the

knee plate Dr P put on Mr R.

Mr R then claim against Dr P, stating that Dr P placed the wrong plates which made his

condition worse. He incurred a lot of costs, pain, and the pointless manipulation of

physiotherapists for something he thought was wrongly inserted on his knee.

Discuss the ethical dilemma in this case.

Discuss the possible misconduct.

Case 7.

Miss Y was seen at the hospital M8 due to labor pains. She was 38 weeks. The nurse in-charge

examined her and diagnose her to have false labor. She was then discharged home and told to

return when the labor pains intensify. After some hours, the abdominal pains worsen; she

decided to go to the other hospital B8. Reading the notice from the previous hospital visit, the

nurse at B8 did not even examined her, she told her it is too early, she have to go home and wait,

otherwise she would stay in the hospital for too long.

Miss Y decided to return home, the pains initially subsided but she started having vaginal

bleeding.

Upon arrival at hospital M8, the doctor diagnosed the rapture uterus and a dead fetus due to a big

baby. The surgery was done, the dead fetus was removed and a uterus was removed due to

severe rapture.

She later sues hospital M8 and B8.

Do you think there were/was misconduct? List them if there are any and discuss.

Case 8.

Miss O visited her GP, Dr T, due to flu. Her GP diagnosed tonsillitis. He gave her, among other

medication, penicillin. 3 days later, Miss O returned to her GP with severe rash which involved

the mucous membrane of her eyes, oral cavity and vagina.

Her GP noted the problems and asked her to continue with her medication, “The skin problem

will disappear, the medications are important for your tonsillitis” he said.

Miss O decided to see other practitioner who told her that he suffered from the Steven’s Johns

Syndrome, a fatal reaction due to penicillin. He stopped the penicillin and managed her

accordingly.

Discuss any misconduct in this case.

Case 9.

A Motswana lady, Miss W, visited her friends in Liberia before Ebola outbreak. She returned

home in the middle of the outbreak. While arriving at the airport, she was screened and found to

have fever and her passport showed that she visited Ebola epidemic areas. The health team at the

airport decided to keep her on guarantee for the next 21 days.

She was later found to have no infections and released.

She claimed to her authority that the action were against her rights and grossly misconduct.

Discuss the medical-ethical dilemma in this case.

Mention and discuss the rights violated in this case.

Case 10.

While pregnant, Miss R, visited her GP who did the ultra sound at 12 weeks. The scan revealed

the well progressive pregnant. The GP advised her to do another scan at 7 months. At 8 months

Miss R did another scan which revealed a normal pregnancy. She delivered at 9 months to the

abnormal baby having a phocomelia. After some consultation with other experts, she was

informed that the condition could be (not necessarily) due to some medication given during

pregnant, the condition could be diagnosed during pregnancy by scan, if at all it was done

properly.

Miss R claim that, her GP gave her some medications which caused the problem and he failed to

diagnose the condition twice while pregnant, if the condition could be diagnosed earlier she

could opt for medical abortion.

Discuss (if there is/are) misconduct(s) in this case.

Case 11.

Miss R delivered the low for age baby at the hospital. Despite being low for age, the baby was

doing fine initially. However, she was told to stay in hospital for some weeks for observation of

her baby at neonatal ward. No more information was given.

In the neonatal ward, Miss R noted the nurse touching the navel of her baby; she became

suspicious that she could be contaminating her baby simply because she didn’t see her changing

the gloves or washing the hands.

The baby was doing fine, until after 7 days when he developed the yellow discoloration of the

skin, eyes and mucous membrane. Also there was fever, rigors, unable to breastfeed and

lethargy looking baby.

The Dr in-charge diagnosed septicemia, and he said could be due to the infections of the navel,

possibly contamination. The baby later developed some complications which made her to stay

more in hospital and costly treatment.

She later claimed to the hospital that the nurse contaminated her baby.

Discuss the misconduct(s) in this case.

Case 12.

HIV discordant couple ( a woman was HIV+) consulted their GP for advice; they wanted to have

the child. The Dr assured them that, simply because they are on medication the chance of getting

the infected child is minimal if the mother will take the medication as advised.

No more information was given/recorded.

During one of the visit, the pregnant lady asked her doctor about the information on the leaflet of

her ARVs, that the safety of the medication in pregnancy is not proven. However the doctor

assured her that there will be no problem.

The lady gave birth to the congenitally malformed child and claim to the Dr for misconduct(s)

during the pregnancy which will torture her psychologically, financially and socially.

Discuss the misconduct(s) in this case.

Case 13.

Miss W gave birth to the baby having neural tube defects. When inquiring about the condition,

she was informed probably was due to deficiency of folic acid during pregnancy, something

mandatorily given to all pregnant women on their first visit to the clinic.

She doesn’t remember to be told about the folic acid. When she cross checked the clinic card,

nothing was written that she was given the medication. And nothing was documented in ultra

sound she did at 28 weeks.

She claims that the condition of her child was the fault of the hospital.

Discuss the misconduct(s) in this case.

Case 14.

Ms X was seen by Dr T, she mentioned she missed her period for 2 months, she suspected she

was pregnant and don’t want the baby (in the country where abortion is legalized). A pregnancy

test (urine) was done by Dr T which proved positive, but the ultra sound didn’t show gestational

sac.

Dr T gave her cytotec pills to induce abortion. 2 days later, Ms X came back to Dr T complained

of bleeding and severe abdominal pain, the ultra sound shows the rapture of the right fallopian

tube. The surgery was done; the right fallopian tube was removed.

Some years later, Ms X brought a claim to Dr T and the clinic that despite she wanted abortion

which was her rights of choice, the Dr done some misconduct that made her right tube to be

removed and now she no longer conceives because the left tube was long blocked.

Discuss the misconduct(s) of Dr T if there are/is any.

Case 15.

Mr K had progressive loss of vision for years. He finally saw Dr P, who diagnosed the glaucoma,

the eye disease due to raise the pressure inside the eye which might lead into blindness, the

disease can be corrected by surgery.

Dr P gave him some medication. 3 months later, the condition worsens, Mr K returned to Dr P,

who gave him another treatment.

After 6 months of no recovery, Mr K decided to see Dr M who is eye specialist. After

examination, Dr M discovered the glaucoma and the condition could no longer be managed

because he came late to see him. “If you could be here 3-6 months ago, this condition could be

100% cured”, said Dr M.

3 months later Mr K became blind.

Mr K claim to Dr P for misconducts when managing him.

Discuss the misconduct(s) of Dr P if there are/is any.

Case 16.

Mr P had severe abdominal pain. Dr Z, diagnosed the acute appendicitis. The surgery was done

and the drain (a small tube inserted into the abdomen to control/reveal the bleeding if there is any

was inserted). He was discharged after 3 days, Dr Z removed the catheter before Mr P was

discharge from the hospital.

3 days later, Mr P was returned to the hospital with distended painful abdomen and he was pale.

The ultra sound revealed intra abdominal bleeding/fluid. The explorative surgery was done to

reveal the problem. He was bleeding and had pus all over the organs, he died 2 days later.

The cousin to Mr P consult the second opinion, they were told that in a standard way, the drain

was supposed to remain for 7 days, and if that procedure would have been followed, Dr Z would

discover the bleeding earlier and necessary measures could have been taken.

Discuss the misconduct(s) of Dr Z if there are/is any.

Case 17.

Mrs. B was diabetic, hypertensive and had kidney failure. She was comatose at the referral

hospital. Before her condition worsens, she asked her family not to suffer due to her; they

should let her die in peace in case she became very sick.

When she was comatose, assisted by cardio respiratory machines for 1 month, her husband

reluctantly asked the doctor to let her wife die in peace; however this is disputed by one of his

daughter. This is despite the efforts of the medical team to revive Mrs. B condition.

a. Discuss the medical-ethical dilemma.

b. What would you suggest the Dr should do? And why?