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The Journal of Bone and Joint Surgery 82:1050 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Ethics in Practice

Ethics in Practice

Paternalism

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

Department of Orthopaedics Mount Sinai Medical Center 1065 Park Avenue New York, N.Y. 10128
Director of Bioethics Education Mount Sinai Medical Center One Gustave Levy Place New York, N.Y. 10029

J. S. is a sixty-five-year-old man who was treated at another hospital with arthroscopic débridement of an infection at the site of a right total knee replacement and was placed on long-term intravenous antibiotics. He signed out of that hospital against medical advice. One month later, he presented at our hospital with recurrent sepsis of his knee.

Knee aspiration yielded frank pus with a white blood-cell count of 80,000 cells per cubic millimeter. Gram-staining demonstrated gram-positive cocci. The patient was placed on intravenous antibiotics.

The patient appeared cachectic, reporting a sixty-pound (27.2-kilogram) weight loss over the past year. A metastatic workup, including a chest radiograph, an abdominal sonogram, prostate-specific antigen, a complete blood-cell count, erythrocyte sedimentation rate, and a purified-protein-derivative skin test, was negative; however, an occult neoplasm could not be excluded.

The patient displayed episodes of confusion, disorientation, and argumentative behavior. Medical and psychiatric consults did not determine whether . . . [Full Text of this Article]


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