Chapter 11: Professional Boundaries

Withholding Life-Sustaining Treatment Case Description: A 70-year-old with terminal cancer requests no ventilator support, but his family insists on it, fearing he’ll die sooner. Ethical Question: Should his request be honored?

A. Yes, it’s his autonomy.
B. No, family knows best.
C. Yes, if documented.
D. No, unless futile.

Physician-Assisted Death Case Description: A 50-year-old with ALS, in a state where it’s legal, asks her doctor for a lethal prescription to end her suffering. Ethical Question: Is assisting her ethical?

A. Yes, if legal and consented.
B. No, it violates life’s sanctity.
C. Yes, if suffering is unbearable.
D. No, unless all options fail.

Futile Treatment Demand Case Description: A 60-year-old in a coma has no recovery chance. His family demands continued ICU care, draining resources. Ethical Question: Should care continue?

A. Yes, family decides.
B. No, it’s medically futile.
C. Yes, if funded privately.
D. No, unless hope remains.

DNR Order Conflict Case Description: An 80-year-old with dementia has a DNR order, but his daughter, unaware, demands CPR during a cardiac arrest. Ethical Question: Should CPR be performed?

A. Yes, to appease family.
B. No, honoring the DNR.
C. Yes, if DNR is unclear.
D. No, unless revoked.

Palliative Sedation Case Description: A 45-year-old with terminal pain requests sedation until death, knowing it may hasten dying. Ethical Question: Is this sedation ethical?

A. Yes, to relieve suffering.
B. No, it’s euthanasia.
C. Yes, if not intended to kill.
D. No, unless he’s unconscious.

Family Override of Advance Directive Case Description: A 75-year-old’s directive refuses feeding tubes, but his children insist on one as he declines. Ethical Question: Should the directive be followed?

A. Yes, it’s his prior wish.
B. No, family sees his state.
C. Yes, if legally binding.
D. No, unless confirmed.

Withdrawal of Ventilator Case Description: A 65-year-old on a ventilator after a stroke has no brain activity. His spouse agrees to withdraw, but a sibling objects. Ethical Question: Should withdrawal proceed?

A. Yes, with spouse’s consent.
B. No, due to family conflict.
C. Yes, if futile.
D. No, unless all agree.

Hospice vs. Aggressive Care Case Description: A 55-year-old with metastatic cancer wants hospice, but her doctor pushes chemo with slim odds. Ethical Question: Should her choice be respected?

A. Yes, it’s her right.
B. No, chemo offers hope.
C. Yes, if informed.
D. No, unless futile.

Pain Management vs. Risk Case Description: A 70-year-old in hospice needs high-dose opioids for pain, risking respiratory depression and death. Ethical Question: Is this dosing ethical?

A. Yes, to ease suffering.
B. No, it hastens death.
C. Yes, if unintended.
D. No, unless minimal.

Cultural Beliefs on Death Case Description: A 60-year-old’s family believes withdrawing care is murder, despite his terminal state and wish to stop. Ethical Question: Should his wish be honored?

A. Yes, it’s his autonomy.
B. No, culture matters.
C. Yes, if explained.
D. No, unless family agrees.

Proxy Decision Conflict Case Description: A 90-year-old unconscious patient’s son wants life support, while her daughter, the legal proxy, wants it stopped. Ethical Question: Whose decision prevails?

A. The son, he’s insistent.
B. The daughter, she’s proxy.
C. Neither, seek court.
D. Both, compromise.

Resource Allocation in Palliative Care Case Description: A hospital has one palliative bed, needed by a 40-year-old with weeks to live and an 80-year-old with days. Ethical Question: Who should get the bed?

A. The younger, more time.
B. The older, more urgent.
C. Use a triage score.
D. Flip a coin.

Truth-Telling at End of Life Case Description: A 50-year-old with days to live asks if he’ll recover. His family begs the doctor to lie for hope. Ethical Question: Should the doctor lie?

A. Yes, to comfort him.
B. No, honesty is best.
C. Yes, if family insists.
D. No, unless he suspects.

Euthanasia Request Case Description: A 35-year-old with terminal illness begs for euthanasia in a country where it’s illegal, citing unbearable pain. Ethical Question: Should the doctor comply?

A. Yes, to end suffering.
B. No, it’s illegal.
C. Yes, if secret.
D. No, unless legal.

Feeding Tube Refusal Case Description: A 85-year-old with advanced Alzheimer’s refuses a feeding tube via directive, but staff feel it’s neglect. Ethical Question: Should the tube be placed?

A. Yes, to sustain life.
B. No, per directive.
C. Yes, if family agrees.
D. No, unless revoked.

Spiritual Care Conflict Case Description: A 60-year-old dying atheist rejects a chaplain, but his religious family insists on prayers. Ethical Question: Should the chaplain visit?

A. Yes, family needs it.
B. No, it’s his wish.
C. Yes, if non-intrusive.
D. No, unless he consents.

Terminal Sedation Disclosure Case Description: A 45-year-old is offered terminal sedation but not told it may shorten life. He consents. Ethical Question: Is this consent valid?

A. Yes, he agreed.
B. No, without full disclosure.
C. Yes, if minimal risk.
D. No, unless explained.

Organ Donation Pressure Case Description: A 30-year-old brain-dead patient’s family is pressured to donate organs, against his unknown wishes. Ethical Question: Is this pressure ethical?

A. Yes, it saves lives.
B. No, without his consent.
C. Yes, if gentle.
D. No, unless documented.

CPR in Frail Patients Case Description: An 90-year-old with terminal illness codes. Her DNR is missing, and CPR would likely break ribs. Ethical Question: Should CPR be attempted?

A. Yes, to try saving her.
B. No, it’s futile.
C. Yes, if family wants.
D. No, unless DNR found.

Hospice Denial Case Description: A 55-year-old with cancer is denied hospice due to limited spots, forcing aggressive care he doesn’t want. Ethical Question: Is this denial ethical?

A. Yes, resources are scarce.
B. No, it denies his choice.
C. Yes, if others need it.
D. No, unless equitable.

Family Grief vs. Patient Wishes Case Description: A 70-year-old wants to die at home, but his family begs for hospital care to prolong life. Ethical Question: Should his wish be honored?

A. Yes, it’s his decision.
B. No, family suffers less.
C. Yes, if feasible.
D. No, unless they agree.

Withdrawal Timing Case Description: A 65-year-old on life support has no hope. His family delays withdrawal for a holiday visit. Ethical Question: Is this delay ethical?

A. Yes, for family closure.
B. No, it prolongs suffering.
C. Yes, if brief.
D. No, unless he benefits.

Experimental Treatment at End Case Description: A 40-year-old with weeks to live is offered an untested drug with risks, per family’s push. Ethical Question: Is offering it ethical?

A. Yes, if consented.
B. No, it’s unproven.
C. Yes, if hope exists.
D. No, unless safe.

Pain vs. Alertness Case Description: A 75-year-old in hospice can have pain relief or stay alert for family, not both. Ethical Question: Should pain relief be prioritized?

A. Yes, comfort matters.
B. No, family time does.
C. Yes, if he chooses.
D. No, unless severe.

Proxy Refusal of Care Case Description: A 80-year-old’s proxy refuses palliative care, wanting aggressive treatment despite futility. Ethical Question: Should the proxy decide?

A. Yes, it’s their role.
B. No, it’s futile.
C. Yes, if aligned with wishes.
D. No, unless reasonable.

Child’s End-of-Life Decision Case Description: A 10-year-old with terminal cancer wants to stop treatment, but parents push for more. Ethical Question: Should the child’s wish be honored?

A. Yes, with assent.
B. No, parents decide.
C. Yes, if mature.
D. No, unless futile.

Religious Objection to Withdrawal Case Description: A 60-year-old’s family cites faith against withdrawing a ventilator, though he’s brain-dead. Ethical Question: Should withdrawal proceed?

A. Yes, he’s gone.
B. No, faith matters.
C. Yes, if futile.
D. No, unless they consent.

Cost of End-of-Life Care Case Description: A 70-year-old’s family demands costly ICU care with no benefit, straining public funds. Ethical Question: Is this demand ethical?

A. Yes, their right.
B. No, it wastes resources.
C. Yes, if affordable.
D. No, unless effective.

Grief Counseling Pressure Case Description: A 50-year-old dying patient refuses counseling, but staff push it for his family’s sake. Ethical Question: Is this pressure ethical?

A. Yes, for family benefit.
B. No, it’s his choice.
C. Yes, if gentle.
D. No, unless he agrees.

Living Will Ambiguity Case Description: A 85-year-old’s living will says “no heroic measures,” but family interprets it differently during a crisis. Ethical Question: Should the will guide care?

A. Yes, it’s his intent.
B. No, family clarifies.
C. Yes, if clear.
D. No, unless specific.