Bioethics Mediation: A Guide to Shaping Shared Solutions, Revised and Expanded Edition

11. An At-Risk Pregnancy: A Role-Play

173 11 An At-Risk Pregnancy: A Role-Play General Instructions All players should read the general instructions. Before beginning, teachers should review “Using the Role-Plays” in the introduction to Part V. Parties Hans Olsen, patient’s husband Dr. Leah Prince, obstetrician Dr. Ron Walker, obstetrics chief resident Bioethics mediator Background Southend General is a busy urban hospital. Its ambulatory care center serves the many low-income residents in the area who have no other resource. Thanks to a generous long-term grant from the federal government, it has a busy maternal and child health clinic (MCHC) that provides a comprehensive set of services for women through pregnancy and into motherhood. A problem has arisen in the care of one of the regular patients of the MCHC. A thirty-two-year-old woman, Cindy Olsen, is in her eighteenth week of pregnancy . She and her husband, Hans, have one child, a six-year-old girl. Mrs. Olsen has had three recent miscarriages. She has been extremely apprehensive about her pregnancy, worrying and constantly asking questions about her diet, her husband ’s work environment, and her medical care. The medical team working with Mrs. Olsen agrees that her anxieties are excessive, even for a woman with so many miscarriages. On an ultrasound of the fetus, Mrs. Olsen’s obstetrician, Dr. Leah Prince, notes that the structure of the fetus’s heart does not seem quite right. She has her suspicions , but she is not sure whether there is really a problem or whether the anomalous appearance of the heart is the result of the angle at which the ultrasound was taken. Dr. Prince wants to repeat the ultrasound and do a fetal echocardiogram to rule out a heart defect. A confirmed defect in the structure of the heart could indicate not only a serious heart problem but also a chromosomal abnormality. 174 Bioethics Mediation: A Guide to Shaping Shared Solutions Dr. Prince has been seeing Mrs. Olsen and her husband for the past seven years, from the birth of their first child through all the miscarriages. They have developed a very warm professional relationship. Dr. Prince, a doctor for thirty-one years and a mother, believes that sharing her findings and their possible implications with Mrs. Olsen at this point would cause Mrs. Olsen extreme distress. If Dr. Prince’s suspicions are not confirmed, she reasons, she will have spared Mrs. Olsen needless suffering. If her suspicions are confirmed, she will have time later on to discuss the implications of her findings with Mrs. Olsen and her husband. The obstetrics chief resident, Dr. Ron Walker, has been involved with Mrs. Olsen from the start of this pregnancy. Dr. Walker is upset because he finds it inconceivable that a doctor would withhold information about the first ultrasound from the parents. Such a move would deny Mrs. Olsen the right to full information about her baby and the right to decide about her own health and that of her child. The Request for Mediation Dr. Prince has decided to call for a clinical ethics consult to help resolve the question of whether to tell Mrs. Olsen about the doctors’ concerns. (The patient, Mrs. Olsen, is not an active role player in this exercise. This simulation ends when a decision is made about whether to tell her, how to tell her, and what to tell her.) An At-Risk Pregnancy: A Role-Play 175 An At-Risk Pregnancy: Bioethics Simulation Confidential instructions for HANS OLSEN, patient’s husband (Please do not show these instructions to the other participants.) Your wife’s intense anxiety weighs heavily on you. Indeed, you worry that all her tension cannot be good for her health or that of the baby. Still, Cindy has come through three miscarriages pretty well psychologically, and you believe that deep down she is a strong woman. You are reinforced in this belief after talking with Cindy’s close friend Carol. Carol and Cindy have had long talks about the pregnancy , and Carol—a very levelheaded person—continues to reassure you. The real cost of all the tension around the pregnancy is the strain on your marriage . Cindy never misses a chance to worry about the microwave you bought, your halogen lamp, your computer screen, the carbon monoxide from your car, and even—once—the garlic on your breath from lunch. You have tried to humor her. But you have exploded with...