Scoliosis repair in a teenager with Duchenne's muscular dystrophy: who calls the shots?
In this exchange, a clinician (the first author) presents a case scenario for comment by an ethicist (the second author). The case concerns a 15-year-old boy with Duchenne's muscular dystrophy requested palliative surgical correction of a 60 degree thoraco-lumbar scoliosis. The surgical team were initially reluctant to offer surgery given their assessment of the perioperative and postoperative risks (anesthetic review suggested an 80% chance of surviving the surgery and 50% likelihood of returning home), but the operation proceeded. The case raises issues of the rights of patients to insist on nonfutile but high risk surgery, risk perception, resource allocation, autonomy, and the integrity of clinicians.
Miles
Fiona
F
Paediatric Intensive Care Unit, Starship Hospital, Auckland, New Zealand.
Dare
Tim
T
D000293:Adolescent; D000758:Anesthesia / Q000941:ethics; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D019637:Orthopedic Procedures / Q000941:ethics*; D011027:Pneumoperitoneum / Q000209:etiology / Q000601:surgery; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000601:surgery; D012121:Respiration, Artificial; D012600:Scoliosis / Q000209:etiology* / Q000601:surgery*; D014139:Tracheostomy