Ethical approach to a case presented to my practice.

case presentation on medical dilemma.

1. Ethics

2. A 62-year-old woman, Mrs. Roberts, a known case of DM, Anxiety with depression and CFS presents with persistent
symptoms of a sensation "coming up from her gut" and feeling giddy since 2020. Despite multiple psychiatric
evaluations and treatments, her symptoms persist. She strongly believes her symptoms are neurological, similar to
her husband's post-surgical experience, and desires a neurology referral.
All her symptoms began after she had COVID and Shingles in 2020. It’s constant and has not got any better.
Her current symptoms are taking a toll on her life in regards to her mood, and her daily activity, which was
recognised by all the doctors whom she visited She was referred to Psychiatry and has undertaken CBT, skycloud
exercises and EMRD all of which were not beneficial for her. She cried almost 20 minutes saying she feels no one is
listening to her.
She had a history of VS which was resected in 2015 and a recent MRI suggested a positive outcome and no size
change and she is happy about that. She had an endoscopy done in 2023 that came out to be negative for CLO.
Her husband had abdominal surgery which was operated on. Still, a few days later he started symptoms like
palpitation, gastric irritation and sweating, which were investigated early on, all results suggesting no pathology.
But a few years later they found that all these symptoms were due to his vagal nerve damage that occurred during
his previous surgery.
This incident makes her feel that her symptoms are probably neurological rather than psychiatric despite all the
examinations and investigation results suggesting the contrary.

3. whats your thought
on this?

4. Autonomy Beneficence
Non-
maleficenceJustice
Principles
DILEMMA?DILEMMA?DILEMMA?
Conflicts!Conflicts!

5. Patients are entitled to good
standards of practice and care
from their doctors. Essential
elements of this are professional
competence, good relationships
with patients and colleagues and
observance of professional ethical
obligations.
Good Medical Practice, GMC

6. Why are we studying this?

7. Where did it begin?
Hippocrates ( BC 5th century )

8. Physicians have moral responsibility to listen to
patient wishes (if autonomous)
or to the patient’s surrogates(if non-autonomous)
but they also have the reponsibility to do what is
“good” for the patient
Autonomy
Beneficence

9. It is the role of
Physician to find a
balance between
autonomy and
beneficence in case
and take right decision

10. Harm the doctor patient
relation ship
Decrease confidence for
medical service
Less willingness to seek help.
Why choose autonomy?
All in-turn affects the beneficience

11. Pros and cons and risks and
benefits should be weighed
against to get to the best
possible solution which would
be in favour of the patient.

12. What I did here?

14. Ann Radcliffe (1795). “The Mysteries of Udolfo: A Romance Interspersed with Some
Pieces of Poetry”, p.214