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The Journal of Bone and Joint Surgery (American) 82:748 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

The Orthopaedic Forum

Ethics in Practice

James D. Capozzi, M.D and Rosamond Rhodes, Ph.D.

H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a nursing home, where she transfers from bed to chair with maximal assistance. She presents to our emergency department with a painful right hip. Physical examination demonstrates a confused, elderly patient with significant right hip pain and shortening and external rotation of the lower extremity. Radiographs demonstrate a displaced intertrochanteric hip fracture. The patient lacks the capacity for informed consent. Her family is contacted to obtain consent for insertion of a compression screw. The family refuses to give consent, stating that the patient is too old and the surgery is too dangerous.

The most significant ethical issues in this case relate to surrogacy. Three related questions will have to be explored to help us to understand how the orthopaedist in this case should respond to the family's decision: Who is an appropriate surrogate? What are . . . [Full Text of this Article]


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