Table 1 Case Chart
Fields | No | Ethical focus of presented problem(s) | Wishes of patient / parents | Wishes supported |
|---|---|---|---|---|
Reproductive Medicine | R1 | Infertile husband, diagnosed with cystic fibrosis, wishing treatment with assisted reproduction | ICSI despite uncertain life expectancy of the father-to-be | Yes |
R2 | Infertile multimorbid husband with severe Diabetes mellitus Type 2 | ICSI despite uncertain life expectancy of the father-to-be | Yes | |
R3 | After termination of pregnancy of healthy twin pregnancy after ICSI using donated semen | Wish for another treatment with ICSI | No | |
R4 | Infertile husband and failed testicular biopsy | Sperm donation of husband’s father | No by EC changed into Yes by head physician. | |
R5 | Infertile husband with osteogenesis imperfecta | ICSI despite possible risk of giving on the disease | Yes | |
R6 | Multimorbid wife with kidney failure and extremely rare blood type | ICSI despite possible deadly complications during pregnancy and delivery | Yes by EC changed into No by head physician. | |
R7 | Wife with multiple sclerosis and unfulfilled desire to have children | ICSI despite progressive disabling sickness | No | |
R8 | Wife with several miscarriages after ICSI and borderline personality disorder which worsened after miscarriage causing conflict with the team | Repetition of ICSI | Yes | |
Obstetrics | S1 | Twin pregnancy with impending delivery, need for lung-maturation-treatment after reproductive treatment abroad | Refusal of lung maturation; only “healthy” children to survive | No |
S2 | Request for abortion in the 16th week because of gastroschisis | Abortion after 12th week in case of a treatable disease | No | |
S3 | Triplet pregnancy after ICSI and risk for preeclampsia | Selective feticide | Yes | |
S4 | PPROM in 21st week, lack of compliance (fundamental evangelical church) | Refusal of treatment insisting on God’s direct support | No | |
S5 | Healthy twin pregnancy after ICSI and denial of selective feticide | Abortion of both unborn children | No | |
S6 | Diagnosis of trisomy 18 in 25th week | Comfort care and refusal of life-sustaining measurements | Yes | |
S7 | Request for termination of pregnancy in the 14th week because of minor hand malformation, no impact on child’s QoL | Termination of pregnancy after 12th week in case of minor malformation | No | |
S8 | Incompetent patient (low IQ), life-threatening pregnancy | Patient’s father requests abortion | Yes | |
Patient’s father requests for sterilisation | No | |||
S9 | Request for termination of pregnancy in the 21st week by the 15yo pregnant woman | Abortion after 12th week | No | |
S10 | Request for termination of pregnancy in 22nd week because of cleft lip and palate | Abortion after 12th week in case of treatable disease | No | |
S11.1 | Unborn child with a complex of multiple diseases not compatible with life in the 26th week of pregnancy | Carrying out pregnancy but no medical intervention | Yes | |
S11.2 | Unborn child with a complex of multiple diseases not compatible with life in the 33rd week of pregnancy | Giving birth to a living child by caesarean section | Yes | |
S12 | Request for abortion in 22nd week because of distal forearm malformation | Abortion after 12th week in case of treatable disease | No | |
S13 | Single mother with a strict Muslim background requests termination of pregnancy in the 22nd week | Abortion after 12th week in case of psychosocial distress | Yes | |
S14 | Premature rupture of membranes in 20th week of pregnancy | Request for determined advice for further procedure | No | |
Neonatology | N1 | Limitation vs. intensification of treatment in preterm new-born with brain haemorrhage | Drug-addicted mother requests maximum treatment | No |
N2 | Parents of full term new-born with asphyxia request EC to discuss further treatment limitation | Treatment limitation of life-sustaining measurements incl. Fluid supply | No | |
N3 | Full term new-born with apallic syndrome after intracranial haemorrhage. Planning of further steps | Father requested treatment limitation incl. food & fluid supply referring to outdated guideline | No | |
N4 | Full term new-born with VACTERL association. Planning of further steps | Wish for “perfect child”, vote in favour of surgery | No | |
N5 | Treatment limitation in preterm-born infant with extended brain damage | Limitation of food supply | No | |
N6 | Preterm new-born with trisomy 18 in mosaic. Planning of further steps | Parents (Muslims) designate the child “a gift from God” and wish maximum treatment | No | |
N7 | Treatment limitation in case of severe asphyxia + maternal postpartum death | Widowed father initially requested DNR | No | |
Neurosurgery | NC1 | Pregnant women with intracerebral bleeding in 21st week of pregnancy and unborn child with multiple diseases. Termination vs. continuation of pregnancy regarding prognosis of both mother and child | Continuation of pregnancy | Yes |
Family Planning | F1 | Patient with severe depression with unfulfilled desire to have children after having two abortions because of her mental condition | Wish for removal of IUD | (Yes) |