CLINICAL CASE FOR DISCUSSION
Mrs. M.
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu


Some Issues Raised:

Mrs. M., a 35-year-old secretary, is found after her routine pap smear to have a carcinoma of the cervix. The cancer is in an early stage, confined to the cervix, with minor invasion (microinvasion) of the tissue of the cervix (stage 1A). The tumor is still easily treatable by means of a simple hysterectomy. Even though the physician informs Mrs. M. that there is a 90 percent chance of a complete cure, she is very distraught and apprehensive. When the physician raises the issue of scheduling a time for surgery, Mrs. M. is evasive and says she wants to think things over. The physician makes another appointment to speak with her a week later. Mrs. M. still is very reluctant to discuss the matter of surgery but agrees that "most likely, it is something I will have to face." She then asks what risks would be involved in a hysterectomy. The physician is concerned that if he describes all of the risks in full detail (e.g., injury to the bladder, to the ureter, injury to the bowel and/or intestinal obstruction, and urinary incontinence, not to mention possible death due to anesthesia), the patient will postpone the surgery even further. He wonders whether he should instead inform the patient's husband of the usual risks and indicate to the patient more globally that things will likely go well and that people are able to return home from the hospital after only a few days.

Some Discussion Questions:

1. What virtues does the physician need to practice in this case?
2. Is a parentalistic intervention by the physician appropriate in this case?
3. How does the issue of Mrs. M.'s dignity arise in this case?
4. Does self-determination as a special value underlying informed consent need special attention in this case?
5. How could the process model of informed consent help in this case?
6. What strategies would you implement to bring this case to a resolution which maximizes the well-being of the patient?