The hospitalized prisoner with a life-threatening illness: criminal first and patient second?

It is generally accepted that the Patient's Bill of Rights applies to all patients including prisoners. Yet, a prisoners' incarcerated status generally prohibits inmates from making any decision that may shorten his/her life, and as such, the de facto medical decision maker becomes the medical director of the state correctional facility. This case study highlights the challenges that arise when the ethically appropriate response to a hospitalized prisoner's terminal medical condition warrants decisions that are in conflict with that advocated by the correctional facility.

Cancer therapy and the preservation of adolescent fertility.

The increasing survival of adolescents with cancer, achieved through intensive therapy, is often associated with sterility. For most teenagers, the ability to have biological children is psychologically and socially important. Methods of preserving fertility, some standard and other experimental, have proliferated, but their use raises ethical issues.

Respecting patient autonomy versus protecting the patient's health: a dilemma for healthcare providers.

A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement.

Deciding for neonates: whose authority, whose interests?

Two principles are commonly perceived as being central to decision-making for critically ill newborns: the patient's best interest standard, and the authority of the parents to speak for the newborn as the surrogate decision-makers. In this essay, these 2 principles are examined in the context of a particular setting, that of a critically ill newborn with a mother in early adolescence. Alternatives to the patient's best interest standard are explored, including consideration of other interests in addition to those of the patient, such as the interests of the young mother and other family members.