Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. –PalMD
A 35 year old man was brought to the Emergency Department(ED) after being found unconscious on a sidewalk. On initial evaluation by emergency personnel, he was otherwise medically stable, with normal vital signs, a clear airway which he was guarding well, and no obvious evidence of trauma. On arrival at the ED, a CT of the brain and X-rays of the neck were normal.
On exam, the patient was initially lethargic, but eventually perked up. He was able to state his name, but did not know the date or location. His physical exam was essentially normal except for occasional low-grade fevers. His neurologic function was intact except for his memory, and some speech difficulties which included difficulty naming objects. The content of his speech was sparse and vague. Further laboratory results revealed some liver and kidney abnormalities, and low blood counts (trilineage).
A close relative was found who noted that the patient did not have any significant medical or substance abuse problems. As the patient’s condition did not improve, permission was sought from the relative to perform a bone marrow biopsy to aid in diagnosis and treatment. Permission was refused. When questioned why, the relative noted his own previous bad experiences with “doctors and tests”.
What are the ethical issues here, and how might they be resolved?