Ethical analysis of two cases: Anorexia Nervosa and Incidental finding in Endocrine gland

2 cases to be analyzed, each of max. 10 pages (titlepage and reference list excluded) in Arial.11
Both cases should be analyzed separately on 10 pages each following the steps;
Step 1: Case description
Step 2: Description of relevant facts
Step 3: Moral intuitions of participants in the case/ own intuitive reaction
Step 4: Relevant values and norms
Step 5: Elaboration of normative position
Reference list (include all consulted sources at the end of each case)
NB. The medical, ethical and psychosocial aspects are very important and should be greatly discussed
Case 1
A15-Year-old girl with anorexia nervosa (BMI 15.2 kg/m²) and depression since many months. Ambulatory
psychiatric treatment since 6 months. However, recent refusal to drink and extremely restrictive in eating,
necessitated tube feeding and admission.
She now refuses all treatment, including tube feeding, but does not eat nor drink herself. Without tube feeding,
she will die shortly. What ethical problems, as well as ethical considerations?
Case 2
Incidental finding (Endocrinology)
• Marc, 60 years old, was referred by his GP, because of a lesion that was seen by
incidence in his left adrenal gland, on a CT scan that was performed for his lungs. The
report of the radiologist reads as follows: “nodule in left adrenal gland, maximal
diameter 2 cm, stable in comparison with the CT scan that was performed 12 months
earlier. Endocrine exploration is indicated”.
• Since 10 years Marc has been yearly followed-up by the pneumologist, after he was
treated for lung cancer, from which he was cured.
• He is now very anxious as well as angry, because the pneumologist and the radiologist
that looked at his scan last year, “missed the diagnosis”. He is on the other hand
grateful to the other radiologist that thoroughly looked at his scan of this year and
observed and described the abnormality in the adrenal gland in his report, which Marc
could read himself in his medical file. “O doctor, what a progress that patients can
now follow their own results via the computer”.
• As endocrinologist you know that the risk for cancer is low, and after some extra
testing “following the clinical guidelines” you conclude that the tumor is most
probably non-cancerous and not hormonally active, and you propose active
surveillance for 2 more years, “following the clinical guidelines”.
• However….
• Marc asks you to be in contact with the pneumologist and the radiologist to give them
feedback of their “mistake”,
• Marc repeats that he wants to be 100% sure that the adrenal nodule is not a cancer.
Ethical dilemmas/considerations are for example:
• Communication
• What is the best interest
• Medical error
• Patient access to medical files
• Over-diagnosis and over-treatment
• Impact of active surveillance versus intervention when there are no symptoms

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