Subject Administration Health/Medical/Hospital Administration

Question

Organize the basic concepts, principles and information using the "four-topic" method to help distill the case down to its essence.
1. Introduction Identify and briefly define the major theme of the case (confidentiality and truthfulness, death and dying, maternal/fetal conflict or social justice)
2. Medical Indications should explore diagnosis, treatment goals, acute/chronic condition, possibilities of success, etc.
3. Patient Preferences should explore mental capacity, informed consent, advance directives, etc.
4. Quality of Life should elaborate on prospects for return to normal life, physical, mental, and social deficits, palliative care, etc.
5. Contextual Features should explore legal, cultural, religious, and familial issues).
6. Conclusion: Please include references from the readings, links, other literature and/or personal experience to support the answers to the questions posed in the case study and your final decision/solution to the dilemma.

Case:
Ms. W is a nineteen-year-old unmarried woman pregnant for the third time, having previously had an abortion when fifteen, and a daughter now ten months old.
She was admitted to the hospital in the twenty-sixth or -seventh week of gestation and placed on intravenous medications (magnesium sulfate) to stop her preterm labor.
Two days later, Ms. W asked her physician, Dr. C, to discontinue the medications because she was "tired of being in the hospital and the medications and the fetus were too painful and uncomfortable."
Dr. C explained that the potential risks of premature delivery include: respiratory immaturity, intraventricular hemorrhage, neurologic handicaps, and even fetal death.
He advised her to continue the medications for two to three more weeks to give the fetus more time to mature.
These critical weeks would enhance the fetus's chances of survival (from 50 percent at twenty-six weeks' gestation to 90 percent at thirty week's gestation) and decrease morbidity, reducing the risk of chronic lung disease (from 50 percent at twenty-six weeks to 20 percent at thirty weeks' gestation) and neurologic handicaps later on in life.
Ms. W continued to refuse treatment, and a psychiatry consult was obtained.
Ms. W was found to be extremely immature, emotionally labile and unrealistic, to have a very poor social situation (battered by family members), to have sometimes had suicidal ideas, to have used illegal drugs in the past (but not recently) and to have a longstanding personality disorder (histrionic personality).
Meanwhile she continued to refuse the medication to stop labor and threatened to leave the hospital.
Dr. C contemplates three options: Respect Ms. W's wishes and risk delivering a very premature fetus who may expire or may survive and be handicapped secondary to prematurity and its complications; refuse to abide by her wishes, but transfer care to a physician who is willing to do so; refuse to abide by her wishes and try to obtain a court order to force Ms. W to undergo treatment.
What should Dr. C do?

Solution Preview

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Medical Indications.
This case discusses a single mother Ms. W of nineteen mother of a ten month old, having had an abortion at the age of fifteen. She was admitted to the hospital at either twenty six or twenty seven weeks gestation intravenous medications (magnesium sulfate) in effort to halt her preterm labor. Studies of infants delivered at 24, 25, and 26 respectively revealed a survival rate of 43%, 74% and 83% respectively (Kilpatrick, Schlueter, Piecuch, Leonard, Rogido, and Sola, 1997)....

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