The pediatric emergency

Regarding the ethical theory that has to be used, it has to be either: Mill’s utilitarianism, Kant’s deontology, Aristotle’s virtue ethics, or Noddings’s care ethics. You can only use 1 theory and explain how his solution to this problem would be effective or not.

In mid-summer, a 14-year-old youth was brought to the pediatric emergency department by his mother for evaluation for altered mental status. The mother returned from work to find her son acting strangely. She had last seen him the previous evening, and there were no problems or complaints at that time. Earlier in the week the child had sustained several mosquito bites. The child was now at times lethargic and at other times agitated. There were two episodes of vomiting. There was no history of fever trauma, medications, or known ingestions. The medical history was negative. The social history was significant for a high-achieving honor student who came from a very financially successful household. Physical examination revealed a drowsy and disoriented athletic male. The vital signs were temperature of 37.8° Celsius, heart rate of 107 beats per minute, respiratory rate of 20 per minute, and blood pressure of 123/87 mm Hg. The general physical examination was unremarkable. The neurologic examination revealed a disoriented teenager with ataxia, brisk reflexes throughout, reactive pupils, and intact cranial nerves II through XII. A bedside glucose test and pulse oximetry were both normal. Given the ongoing epidemic of West Nile virus at the time of presentation, the mother was convinced that the child had contracted the insect-borne disease because of the combination of mosquito bites and altered mental status. The mother was absolutely insistent that a spinal tap (lumbar puncture) be performed immediately, to evaluate for the possibility of West Nile virus.

The patient’s pediatrician was also concerned and requested a full and thorough evaluation. An intravenous line was started and routine blood evaluations were ordered. The patient seemed at times to be more lucid, but at other times was again disoriented. When interviewed alone, he denied having West Nile virus, but he agreed to tell the physician why he believed this to be the case, but only if his parents were not told. The physician explained that all information given by the patient would be kept in strict confidence. Because of the assurance of confidentiality, the patient disclosed that he had bought a large amount of dextromethorphan on the Internet and had taken it with his friends after school.

Dextromethorphan ingestion, even in large quantities, generally does not require anything but supportive care. The mother, not knowing about the ingestion of this drug, continued to be insistent that further tests be performed, including a spinal tap.*

Who, if anyone, in this scenario should be allowed to give informed consent to treatment (or no treatment)? Why? Should the physician regard the 14-year-old as a mature minor? What actions should the physician take if she regarded him as a mature minor? What actions would the physician likely take if she decided to set aside the issue of informed consent and act only in the patient’s best interests?

Sample Solution