Adequately identify specific applicable principles (Autonomy, Beneficence, Justice & Non-Maleficence) that are associated with the case.
Properly integrate such principles with the bioethical issues that are related to or indicated in the case.
The discussion of the above (identification and integration) should be written according to sections following the module topics:
3.1 Pediatrics
3.2 Surgery
3.3 Justice
3.4 Social Media
3.5 Relationship of Doctors and Biopharmaceutical Sector
CASE
A 39-year-old primigravida with underlying advanced adenocarcinoma of the colon was admitted to our state hospital for a planned premature Caesarean section and tumor resection at 29 weeks gestation due to impending rupture of the tumor. Antenatal steroids were administered for fetal pulmonary maturation. The mother unexpectedly developed fever and cough on the fourth day of hospitalization with progressive lymphopenia on serial blood counts. A chest radiograph revealed signs of pneumonia. Her nasopharyngeal swab was positive for SARS-CoV-2 gene targets via multiplex real-time reverse transcription PCR (RT-PCR) testing. The elective operation was postponed on the diagnosis of COVID-19 infection. However, the mother developed premature contractions and preterm labor rapidly ensued. The mother wore a surgical mask during delivery and was attended by healthcare staff who wore personal protective equipment in line with airborne and contact precautions. A male infant was born via spontaneous vaginal delivery at 29 weeks plus 5 days gestation with a birth weight of 1100 g (50th centile) and length 41 cm (50th centile). Apgar scores were 9 at 1 min and 9 at 5 min. Delayed cord clamping was not performed. The infant had an incomplete congenital cleft lip. No cleft palate or other congenital anomaly was noted. The infant was directly handed over to the neonatal team without skin-to-skin contact with the mother. Stabilization of the neonate was performed in a separate negative pressure room and was uneventful.
The infant was transferred to the neonatal intensive care unit (NICU) and placed in a closed incubator in a negative pressure isolation room with strict airborne and contact precautions. There were no other cases of COVID-19 in the unit, no visitors allowed and all healthcare workers who attended to the child remained asymptomatic in the 2 weeks following delivery. The infant required non-invasive continuous positive airway pressure ventilation. His fractional concentrations of oxygen in inspired air requirements remained at 21% until 12 hours of life when he developed worsening respiratory distress. He required intubation and a dose of surfactant therapy.
A referral was immediately sent to the Hospital Bioethics Committee as all but one of the hospital ventilators are being utilized by patients. There are two other patients who need it: one with neonatal pneumonia currently at the Emergency Department who was brought by a prominent community leader and one with neonatal sepsis with VACTERL-H whose parents are seeking help by crowdfunding via social media.
Chest radiograph findings were consistent with hyaline membrane disease. A nasopharyngeal swab for RT-PCR obtained at 2 hours of life was positive for all 3 SARS-CoV-2 target genes. The repeated respiratory sample with a tracheal aspirate remained positive 24 hours later. The neonate was treated accordingly and was started by the attending physician (AP) with potent higher generation or higher class of antibiotics. The antibiotic prescription was influenced by a tentative verbal personal agreement between the AP and pharmaceutical company for a partial sponsorship for continuing professional education for the hospital and personal participation in an international conference directly related to the AP’s expertise.
EXAMPLE:
Social Media
Bioethical Principles:
The bioethical principles that are associated with this case are beneficence and autonomy, specifically confidentiality.
Discussion:
The case displayed the use of social media with the following statement: “one with neonatal sepsis with VACTERL-H whose parents are seeking help by crowdfunding via social media”.
In the case, beneficence is seen in the instance where the parents of the patient who has neonatal sepsis with VACTERL-H turned to social media to gain financial support from the community. The people within the community were willing to help the family by giving donations to pay off the medical expenses; in this case the people were beneficiaries because the people did good. Autonomy: confidentiality is implied because when the parents turned to social media to ask for support, they had to reveal the gravity of the condition of their child to the public to gain support, thus violating their confidentiality, though it was on their own accord to reveal their situation.
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