Setting: An urban hospital in Central Africa
Scenario: An expatriate nursing student is undertaking an international obstetrics and gynecology elective at a large urban teaching hospital in Central Africa. The student is troubled by the many women who present to the hospital each day with serious medical complications resulting from unsafe clandestine abortions. Since most instances of abortion are illegal in this country, women desiring to terminate a pregnancy often turn to untrained practitioners who may employ unsafe techniques and work in unsanitary conditions. The nursing student has encountered a number of women suffering from life-threatening hemorrhage, infection, or mutilation resulting from illegal abortions.
One day, a young woman from a distant town is brought to the hospital in obvious distress and with signs of sepsis. The nursing student learns that the patient is 20 weeks pregnant and had come to the city to undergo an abortion in a clandestine “clinic” earlier that day. The young woman tells the student that she had tried to have an abortion because her family threatened to disown her if she gave birth to a baby outside of wedlock. However, the patient sustained significant cervical trauma and hemorrhage during the initial steps of the procedure, and the practitioner was unable to terminate the pregnancy. The patient is now in need of emergency surgery, but hospital staff inform her that they are required by law to perform a fetal ultrasound to determine the viability of the fetus before carrying out a dilation and curettage. The patient is a young student, has no family nearby, and cannot afford the $10 fee for the ultrasound.
The expatriate nursing student feels a strong sense of compassion for the patient given their similarity in age and the patient’s significant emotional distress. It is clear that the patient’s condition will continue to deteriorate unless she receives an ultrasound and a potentially life-saving surgical intervention. The student is unsure how she should respond and considers paying the ultrasound fee out of her own pocket.
Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions. The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.
Disclaimer: Case studies in the Student Case Study Series are based on the reflections of healthcare students on ethical challenges experienced in humanitarian health care contexts. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.
While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many students engaged in humanitarian healthcare learning experiences. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.
How to cite: Humanitarian Healthcare Ethics. 2014. Student Case Study Series: Responding to the Suffering of Patients. www.humanitarianhealthethics.net.