Anorexia Nervosa/Endocrinology Case Analysis

There are two cases to be ethically analysed. Each of which should be maximum 12 pages (titlepage and reference list included) in Arial.11

Paper should follow the steps below

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Step 1: Case description

Step 2: Description of relevant facts

Step 3: Moral intuitions of participants in the case/ own intuitive reaction

Step 4: Relevant values and norms

Step 5: Elaboration of normative position

Reference list

NB. The moral, psychosocial values or aspects of the case are very important and should be taken into account.

Case 1

A15-Year-old girl with anorexia nervosa (BMI 15.2 kg/m²) and depression since many months. Ambulatory psychiatric treatment since 6 months. However, recent refusal to drink and extremely restrictive in eating, necessitated tube feeding and admission.
She now refuses all treatment, including tube feeding, but does not eat nor drink herself. Without tube feeding, she will die shortly.

Case 2

• Marc, 60 years old, was referred by his GP, because of a lesion that was seen by
incidence in his left adrenal gland, on a CT scan that was performed for his lungs. The
report of the radiologist reads as follows: “nodule in left adrenal gland, maximal
diameter 2 cm, stable in comparison with the CT scan that was performed 12 months
earlier. Endocrine exploration is indicated”.
• Since 10 years Marc has been yearly followed-up by the pneumologist, after he was
treated for lung cancer, from which he was cured.
• He is now very anxious as well as angry, because the pneumologist and the radiologist
that looked at his scan last year, “missed the diagnosis”. He is on the other hand
grateful to the other radiologist that thoroughly looked at his scan of this year and
observed and described the abnormality in the adrenal gland in his report, which Marc
could read himself in his medical file. “O doctor, what a progress that patients can
now follow their own results via the computer”.
• As endocrinologist you know that the risk for cancer is low, and after some extra
testing “following the clinical guidelines” you conclude that the tumor is most
probably non-cancerous and not hormonally active, and you propose active
surveillance for 2 more years, “following the clinical guidelines”.
• However….
• Marc asks you to be in contact with the pneumologist and the radiologist to give them
feedback of their “mistake”,
• Marc repeats that he wants to be 100% sure that the adrenal nodule is not a cancer.
Ethical dilemmas/considerations are for example:
• Communication
• What is the best interest
• Medical error
• Patient access to medical files
• Over-diagnosis and over-treatment
• Impact of active surveillance versus intervention when there are no symptoms

Some background for case 2
Pubmed PMID 33148242, 31498374, 23250632, 21333776

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