Topics: Informed consent, Autonomy, Decision making Pages: 9 (2986 words) Published: March 1, 2013
A Case Study in Coercion

Manuel Villanueva

Oakland University, Michigan

    A case study of a 70-year-old patient finds his doctor responsible in coercing him into having a pacemaker inserted in his body. The doctor threatens to have the patient’s truck driver license revoked if he refuses treatment. Although the patient does not want the pacemaker put in his body, he does not want to lose his truck driver job which is how he supports himself. Ultimately, the patient submits to his doctor’s threats and has the pacemaker inserted into his body. The case is examined finding legal and moral faults with the doctor in his relationship with his patient.  

A Case Study in Coercion
    The exact medication and dosage is uncertain in this case but an assumption will be made regarding both. Mr. Jones, a 70-year-old man, had been to his doctor’s office complaining of dizziness and lightheadedness for several days after taking his new prescription of diltiazem hydrochloride, 180-mg once a day. Mr. Jones told his doctor, Dr. Smith, that his lightheadedness had become so severe that he collapsed hitting his head in the process. After this incident Mr. Jones discontinued taking his new prescription thinking it was responsible for his lightheadedness. Dr. Smith ordered a twelve-lead electrocardiogram (EKG) and diagnosed Mr. Jones as having third-degree atrioventricular (AV) block, a potentially life-threatening bradycardia. Third-degree AV block “is not a stable pacemaker, and episodes of ventricular asystole are common” (American Heart Association, 1994, p. 3-15). Mr. Jones was admitted to the telemetry unit of a metropolitan teaching hospital for monitoring and tests. One day later Tracy, the night shift nurse, received report that Mr. Jones was diagnosed with third-degree AV block. However, Tracy did not recognize Mr. Jones’ cardiac rhythm as being third-degree AV block. A subsequent twelve-lead EKG revealed Mr. Jones as having a right bundle branch block (RBBB), a condition that does not indicate treatment. At that time, Mr. Jones’ heart rate was seventy to eighty beats per minute with an underlying sinus rhythm: not third-degree AV block. Curiously, Tracy asked Mr. Jones why he had been admitted and diagnosed with third-degree AV block; so, Mr. Jones told his story leading up to his doctor’s appointment. Because Mr. Jones was hemodynamically stable, Tracy told Mr. Jones that his heart was working fine other than some minor abnormalities in his heart rhythm. Later, Dr. Brown, the cardiologist on call, sat down with Tracy and explained that Mr. Jones’ third-degree AV block was temporarily induced by his medication. Dr. Brown also said Mr. Jones’ RBBB, although benign in itself, made him extremely susceptible to the medication’s adverse effects. That morning Mr. Jones, feeling well and no longer in third-degree heart block, told his doctor he wanted to go home. On the contrary, Dr. Smith insisted he must stay to have a permanent pace maker inserted in his chest to counter the effects of diltiazem. Upon hearing Dr. Smith’s plans, Mr. Jones refused to have the pacemaker. But Dr. Smith threatened to inform the State License Bureau that Mr. Jones was unfit to drive if he did not agree to have the pacemaker. Dr. Smith stated that Mr. Jones would be a danger to others if he were to pass out and loose control of his truck due to the diltiazem; he gave no reason why Mr. Jones must continue to take diltiazem. 

    The following night, Mr. Jones explained to Tracy what had happened. Tracy suggested to Mr. Jones that he could retire from work to avoid having a pacemaker but Mr. Jones said that he needed to work to support himself. Then Tracy commented to Mr. Jones, “I really don’t know why you need that medication. Without it your heart rate and your blood pressure are normal. There are risks involved with having a pacemaker put in. You don’t have to get it if you don’t want to.” Mr. Jones agreed but said he did not want to...
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