Please provide lengthy and detailed answers to the questions The Johnson’s have

Question

Please provide lengthy and detailed answers to the questions

The Johnson’s have 2 children. Both young boys. Adam is 6 and John is 3. Adam was diagnosed with Acute Leukemia 7 months ago. Thankfully he was able to respond well to treatment and went into remission much quicker than expected. Unfortunately, in recent testing the oncologist has detected signs of a relapse. Secondary therapy is an option but comes with greater risks. There is significantly higher toxicity with these drugs and a second remission is not certain. This leads the oncologist to recommend an experimental drug that requires bone marrow transplant but helps reduce rejection.

For this to work, a histocombatible donor must be found. Adam’s brother is not a matching donor. This leads to Adam’s parents consulting an endocrinologist about in vitro fertilization as they consider having another child. They get information about pre-implantation genetic testing and in vitro procedures. Neither of them show any concerns or doubts about what they are considering. This solely about the process.

Mr. Johnson’s sperm is used to impregnate his wife’s harvested eggs. Histocompatability tests begin. A family friend asks Mrs. Johnson, “Are you two having a new only in hope that Josh will survive and hopefully have a second chance?” After an uncomfortable silence Mrs. Johnson replies, “Of course not. We will love this new baby, just like Adam and John. There is just the added benefit of helping their sibling.” Later that afternoon, when she goes to the clinic to meet her husband, she begins to cry uncontrollably.

Using critical thought, research and respond to the question below with a minimum of 3-5 sentences.

1) What if Adam doesn’t take well to the transplant and dies anyway? What will they tell their new child one day if the questions asked about the circumstances of their birth and what mental effects could this have on the child, especially if Adam doesn’t survive.

2)What is the role of the physician in this situation? Is this a case where an ethics consult was necessary? Why or why not?

3)What is the goal of medicine? Is it to prolong life for as long as possible, regardless what methods and means are being considered? Prolonging life at all costs is considered “over-treatment” in geriatrics. Is that the same here?

Explanation / Answer

Answer:

1) Inspite of patient and doctors' best effeort sometimes transplant does not work. Adam is a kid only 6 year old, his body many not accept the donated cells or the disease may return. But it is not the fault of the patient or the physiscian, it is due to body's immune response the rejection happens. Graft-versus-host disease (GVHD) is a complication that can occur after certain stem cell or bone marrow transplants. An allogenic transplant was planned for Adam's case. GVHD may occur after a bone marrow, or stem cell, transplant in which someone receives bone marrow tissue or cells from a donor. This type of transplant is called allogeneic. The new, transplanted cells regard the recipient's body as foreign. When this happens, the cells attack the recipient's body.

Mr.Johnson and his wife were tryiong to give new life to Adam. Adam is their elder son and it is obvious that they will try their level best to give him life. Since Adam's Acute leukemia relapsed they had to take this decision of having another baby. This gives them some hope about Adam's survival. Bone marrow stem cells are a good option for Leukemia therapy, but there is no guarantee that 100% it will be successful. There is huge chance of rejection. If Adam does not survive the child should not think that he/she is responsible for their brother's death. Parents should convince him that it is a part of life and nothing was in their hand. His brother could not respond to the tretment well and that was the reason of his death. The new child actually wasa bless to there family who helped his brother for survival.

2) There is a huge of physician in this situation , he has to convice the patient about the therapy. Physiscian should talk about acceptance of the bone marrow transplantation and positive side of the tratment. Ehitically there is a chance of rejection, but if he talks about the rejection too often then the couple might not think about the new child and transplatation of the bone marrow. So the doctor should be very very positive about the success of the treatment.

3) The goals of medicine encompass the relief of pain and suffering, the promotion of health and the prevention of disease, the forestalling of death and the promoting of a peaceful death, and the cure of disease when possible and the care of those who can not be cured. For completeness, we must also
mention broader categories, though they have no role in my analysis below.   
>Medicine 1' is medical care; to this
>medicine 2' adds medical disease prevention;
>medicine 3' adds nursing care and rehabilitation; and
>medicine 4' adds psychological care and health education.

Treatments fall into four categories, based on their potential outcomes:
Preventive
Curative
Disease Management (including pain management)
Palliative
There are pros and cons of each treatment approach, so the doctor and health care personnel has to deal with these.

Modern medicine's increasing ability to stave off temporarily the inevitable outcome of degenerative disease is raising moral problems that require difficult decisions by doctors and by patients and their families. Among the most poignant of the questions that often have to be answered is whether a patient on the brink of death should be allowed to die then and there, or whether measures should be taken to keep him alive a little longer even when there is no hope of recovery. Ultimately, society itself may be forced to make equally difficult decisions regarding prolongation of life in general, and for periods that may be counted in years rather than merely days or hours.
For family and friends keeping a death watch, the borrowed time can be a torment. For the doctor, the decision of when to terminate life-sustaining measures may have legal as well as humanitarian implications. The doctor must protect himself against later charges of patient neglect or even euthanasia, which is proscribed by law in most countries and by all major religions of the West. Large doses of pain-killing drugs, however, may hasten the inevitable without intent to shorten life.

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