Case study of bioethics: a case of improper treatment of bladder exstrophy

Background: The principles of bioethics proposed by Beechamp and Childress are difficult to apply to the specific ethical dilemmas that arise in clinical practice. The scientific literature has suggested other ways of analyzing them.

Methods: We use the Moscop's case study method to analyze a case of inappropriate treatment of bladder exstrophy, a rare congenital condition associated with a high chance of medical error during treatment.

Results: The analysis of the present case of a medical mistake considers ethical aspects such as the doctor-patient relationship, the reaction of physician-colleagues and the patient to the medical mistake, and the disclosure of the medical mistake. As a result of the bioethical analysis of the case, the following recommendations have been formed: 1) Despite the objective difficulties of treatment in a low-profile regional center and bureaucratic mechanisms of referral of the patient to another institution, the doctor should respect the autonomy of the patient and his relatives, for which full information about possible risks and treatment alternatives should be provided; 2) Disclosure of the true causes of medical error and apology can help to build trusting relationships with the patient and reduce subsequent conflicts. Short-term psychological discomfort of disclosure will be compensated by long-term positive results of interaction with patients; 3) Criticism of previous treatment should take into account possible difficulties of diagnostics at regional level and lack of experience in treatment of rare pathologies. Achieving an advantage over one's colleagues through pointing out their medical error without knowing the real reasons for the prior treatment is ethically unjustified.

Conclusion: An important function of disclosing medical errors is to warn colleagues against such errors. Most authors are of the opinion that it is the professional duty of a doctor who witnesses an adverse event to assist in the disclosure of an error and help in minimizing its consequences, however, in a medical environment with strong corporate ties and cultivating a spirit of solidarity, this principle has not become widespread in practice.