scholarly journals Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

2021 ◽  
Vol 9 (C) ◽  
pp. 267-272
Author(s):  
Taufik Suryadi ◽  
Sarjani Sarjani ◽  
Kulsum Kulsum
Keyword(s):  
Case Report ◽  
Pregnant Women ◽  
Ethical Dilemma ◽  
The Elderly ◽  
Double Effect ◽  
Prima Facie ◽  
Termination Of Pregnancy ◽  
Ethical Principles ◽  
Ethical Considerations ◽  
Pediatric Pulmonology

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

scholarly journals Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1303
Author(s):  
Taufik Suryadi ◽  
Kulsum Kulsum
Keyword(s):  
Case Report ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Clinical Medicine ◽  
Ethical Dilemmas ◽  
Prima Facie ◽  
Ethical Principles ◽  
Recurrent Bleeding ◽  
Stroke Patients ◽  
Double Effect Principle

Background: Ethical dilemmas can occur in any situation in clinical medicine. In patients undergoing neuro-anesthesia for surgical procedure evacuation of intracerebral hemorrhage with a history of hemorrhagic stroke, anticoagulants should not be given because they can cause recurrent bleeding. Meanwhile, at the same time, the patient could also be infected with coronavirus disease 2019 (COVID-19), one of treatment is the administration of anticoagulants. Methods: A case report. A 46-year-old male patient was admitted to hospital with a loss of consciousness and was diagnosed with intracerebral hemorrhage due to a hemorrhagic stroke and was confirmed positive for COVID-19. Giving anticoagulants to patients is considered counterproductive so, an ethical dilemma arises. For this reason, a joint conference was held to obtain the best ethical and medicolegal solutions for the patient. Results: By using several methods of resolving ethical dilemmas such as basic ethical principles, supporting ethical principles, and medicolegal considerations, it was decided that the patient was not to be given anticoagulants. Conclusions: Giving anticoagulants to hemorrhagic stroke patients is dangerous even though it is beneficial for COVID-19 patients, so here the principle of risk-benefit balance is applied to patients who prioritize risk prevention rather than providing benefits. This is also supported by the prima facie principle by prioritizing the principle of non-maleficence rather than beneficence, the minus malum principle by seeking the lowest risk, and the double effect principle by making the best decision even in a slightly less favorable way as well as the medicolegal aspect by assessing patient safety and risk management.

Ethics in palliative care

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Double Effect ◽  
Ethical Principles ◽  
Ethical Considerations ◽  
Withdrawing Treatment ◽  
Justice As Fairness ◽  
Respect For Autonomy ◽  
Principle Of Double Effect ◽  
Medical Disciplines

Ethical principles are the same in palliative medicine as they are in other medical disciplines. Clinical decisions at the end of life, however, may involve ethical considerations and judgements that are particularly complex and on whose outcome much may depend. This chapter reviews basic ethical principles, including beneficence, non-maleficence, respect for autonomy, and justice as fairness, as well as ethical principles specific to palliative care. It evaluates the principle of double effect and the ethical considerations when withholding and withdrawing treatment, alongside a discussion of euthanasia.

scholarly journals Ethical and Medicolegal Considerations in the Termination of Pregnancy Due to Lethal Congenital Anomalies in Banda Aceh, Indonesia

2020 ◽  
Vol 8 (C) ◽  
pp. 167-171
Author(s):  
Taufik Suryadi ◽  
Kumalasari Kumalasari ◽  
Kulsum Kulsum
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Gestational Age ◽  
Ethical Dilemma ◽  
Congenital Anomalies ◽  
Termination Of Pregnancy ◽  
Joint Decision ◽  
Contextual Features ◽  
Medical Indications

BACKGROUND: The aim of the following paper is to present the case termination of pregnancy indicated by lethal congenital anomalies based on ethical and medicolegal consideration. The method used to resolve this ethical dilemma is based on clinical ethics theory with systematic consideration of medical indications, patient preferences, quality of life, and contextual features. Medicolegal considerations were also take-into account based on Indonesian Law number 36 of 2009. CASE REPORT: This case report shows the termination of pregnancy in a 26-year-old patient with 25–26 weeks’ gestational age. Unfortunately, the patients are referred too late, so because of limited facilities in the rural area, the presence of congenital abnormalities in the fetus is not detected early in the 1st week of pregnancy. The results of obstetric ultrasonography showed multiple congenital anomalies. The ethical dilemma faced by obstetricians is whether to terminate the pregnancy now or after the fetus has reached term gestational age? RESULTS: The results of ethical and medicolegal considerations in this case were carried out comprehensively by producing a joint decision between the team of doctors, the patient, and her families. The decision was made after providing adequate information regarding medical indications while taking into account the patient’s viewpoint (patient preference), quality of life, and also contextual features.

Hodgkin Disease and Pregnancy - A Case Report

2014 ◽  
Vol 68 (2) ◽  
pp. 104-106
Author(s):  
Aleksandra Pivkova Veljanovska ◽  
Sonja Genadieva Stavrik ◽  
Zlate Stojanoski ◽  
Lazar Cadievski ◽  
Adela Stefanija ◽  
...  
Keyword(s):  
Case Report ◽  
Pregnant Women ◽  
Hodgkin Disease ◽  
Morbidity And Mortality ◽  
Chemotherapy Treatment ◽  
Related Factors ◽  
Hematological Disorder

Abstract The article presents a case with diagnosed Hodgkin disease (HD) during pregnancy. The aim of this case study was to present diagnostic possibilities in determining HD stage during pregnancy and therapeutic dilemmas. The incidence of HD during pregnancy is 3.2% of all cases with this malignant hematological disorder. The treatment of this disease during pregnancy depends on disease-related factors, pregnancy-related factors, as well as possible implications for fetal morbidity and mortality. The need of analysis of the nature of the disease during pregnancy indicates examination of a larger series of pregnant women with HD and the drawn conclusions affect the decision whether chemotherapy treatment should start immediately or it should be postponed for after delivery.

scholarly journals Severe acute respiratory syndrome coronavirus 2 detected in placentas of 2 coronavirus disease 2019–positive asymptomatic pregnant women—case report

2021 ◽  
Vol 1 (1) ◽  
pp. 100001
Author(s):  
Jaime Sanchez ◽  
Paulino Vigil-De Gracia ◽  
Erika Guerrero ◽  
Melissa Gaitán ◽  
Cindy Fu ◽  
...  
Keyword(s):  
Case Report ◽  
Severe Acute Respiratory Syndrome ◽  
Pregnant Women

scholarly journals Formulating an anesthetic plan using a list of high-risk pregnant women on cloud-based business communication tools: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Junnosuke Kimura ◽  
Kento Kawamura ◽  
Manami Minoura ◽  
Ayako Hiramoto ◽  
Yoshifumi Suga ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Business Communication ◽  
Communication Tools ◽  
Case Presentation ◽  
Emergency Cesarean

Abstract Background We report a case in which a list of high-risk pregnant women on cloud-based business communication tools was useful in formulating an anesthetic plan for unscheduled cesarean section. Case presentation A 37-year-old woman, who had been prescribed icosapentate for hypertriglyceridemia, received an antenatal anesthetic evaluation for possible cesarean delivery, and it was agreed that the anesthetic method for emergency cesarean section was general anesthesia if the surgery would take place within 7 days after the discontinuation of the drug, and regional anesthesia if it would take place any time later. Then this agreement was uploaded on the cloud-based business communication tools, and updated until she delivered her baby via unscheduled cesarean section. Conclusions A cloud-based business communication tools was useful in formulating an anesthesia plan for a patient undergoing a cesarean delivery. However, more discussion would be needed to utilize it in security.

Placental mesenchymal dysplasia- A case report

2021 ◽  
Vol 6 (3) ◽  
pp. 249-252
Author(s):  
Zeba Nisar ◽  
Mahendra A Patil ◽  
Vaishali J Pol ◽  
Jaydeep N Pol
Keyword(s):  
Case Report ◽  
Histopathological Examination ◽  
Clinical Suspicion ◽  
Termination Of Pregnancy ◽  
Rare Disorder ◽  
Molar Pregnancy ◽  
Female Fetus ◽  
Beta Hcg ◽  
Antenatal Visits ◽  
Placental Mesenchymal Dysplasia

Placental mesenchymal dysplasia is a rare disorder mainly characterized by enlarged placenta. Patients on antenatal visits present with normal or slightly raised Beta-HCG, raised Alfa-fetoprotein and cystic structures on USG resembling a molar pregnancy. It has to be differentiated from molar pregnancies to avoid unnecessary termination of pregnancy. This condition is associated with IUGR or IUFD. Mostly the fetus are females. Due to lack of awareness of this condition it remains underreported. Here we present a case report of 20 years old female 37 week pregnant with IUGR with clinical suspicion of molar pregnancy gave birth to alive female fetus and on histopathological examination of placenta was diagnosed with PMD.

Arterial hypertension + past stroke – a case report

2021 ◽  
Vol 14 (3) ◽  
pp. 324-326
Author(s):  
Maria Łukasiewicz ◽  
Marta Swarowska-Skuza
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Chronic Disease ◽  
Side Effects ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Systolic Hypertension ◽  
The Elderly ◽  
Isolated Systolic Hypertension ◽  
Special Group

Arterial hypertension, as a very widespread chronic disease, and thus differing in both pathomechanism and course in patients, requires a significant individualization of pharmacotherapy. One such special group is the elderly. Both the low-renin pathomechanism of arterial hypertension and its phenotype (isolated systolic hypertension) imply the choice of a specific pharmacotherapy. Additionally, in this group, side effects should be observed much more vigilantly, while target blood pressure values should be treated more liberally. An example of antihypertensive therapy in a patient belonging to the group described is presented in the following case.

Sedação Paliativa, Perspetiva de Um Clínico

2018 ◽  
Vol 26 (52) ◽  
pp. 127-138
Author(s):  
Madalena Feio ◽  
Keyword(s):  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Principles ◽  
First Line ◽  
Scientific Societies ◽  
Refractory Symptoms ◽  
Medical Associations ◽  
Line Drug

Palliative sedation does not have a universally accepted definition. It is used as a measure of last resort for the control of refractory symptoms in the last days of life. The ethical principles invoked in its use are those of double effect and proportionality. Its prevalence varies according to the place of care, type of study and country. The most frequent indications for its use are the control of dyspnea, delirium and pain. The recommended first line drug is midazolam. The studies performed do not diminish the survival of the patient. It is important that fami­ly support is maintained throughout the process. Several scientific societies and medical associations have defined guidelines that regulate their implementation.

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