SUBSTITUTE CONSENT: FOLLOWING THE RULES DOESN'T ALWAYS
MEAN THE BEST RESULT FOR THE PATIENT
Dr. Christine Castle, a prominent medical ethicist and chief of internal medicine at
the University of Chicago Medical Center, believes that the application of ethical
principles to health care in the last 10 years has helped resolve moral problems
more equitably. At the same time, however, there are cases in which following the
ethical rule hasn't always meant the best results for the patient. Dr. Castle cites a
substitute consent case encountered by her own staff. The patient, a 78-year-old
woman, was brought to the clinic for deteriorating mental function. Until that time,
the woman had been relatively active, participating in senior center activities. She
lived with her second husband, a man with failing health who was relatively
housebound. Surprisingly, the woman was diagnosed as having syphilis. The
mental symptoms associated with late syphilis had to be treated with penicillin.
Following correct substitute consent procedure; the patient's daughter was advised
of her mother's condition. The daughter, horrified to learn that her mother had a
sexually transmitted disease, kept trying to imagine how she might have gotten it.
Ultimately, she decided to place her mother in a nursing home rather than care for
her in her own home, as she'd originally intended. Despite the best efforts of the
health care team, the estrangement among daughter, patient, and spouse could not
be resolved. And, in the end, the patient showed only slight improvement. The
staff's concern as to how they might have better handled the case led to an article in
a professional journal. The article generated 25 letters from physicians who, in
confronting similar cases, had opted to give the elderly patient the medication
without advising the family. Dr. Castle believes that these physicians transgressed
the ethical principle because they were looking for the optimum results for their
patients. And, she concludes that we may have to rearticulate some of the ethical
principles or find new ways of solving problems, in some cases.1
1-25. CONSENT FOR/BY MINORS
a. When the Parent's or the Guardian's Consent Is Needed. State law
governs local definitions as to who is a minor. Generally, consent of the parent or the
guardian consent should be obtained before treatment is given to a minor. (Depending
on the state, a minor may be someone under the age of 16, 17, or 18.) The consent of
the parent or guardian is not needed in: 1) an emergency; 2) situations in which the
consent of the minor is sufficient (some states allow minors to consent to receive birth
control counseling and prescriptions or treatment for sexually transmitted diseases
without parental knowledge); or 3) when a court order or other legal authorization is
obtained (where the parents' personal beliefs stand in the way of treating a child for a
life-threatening condition).
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