Alcohol abuse: Analysis of a case study

Previously, you reviewed Henry’s case. Now, we will analyze the case together. Read the analysis and reflect on your own, initial thoughts about the case. Do they align? Did you consider other ethical dilemmas not discussed here?

Review of Henry’s Case

The patient was admitted to the hospital Orthopedic Surgery service after a MVC (motor vehicle collision ), as the passenger, with a right femur fracture for surgical reduction.

Henry drinks beer daily and has done so for the past 15 years. He drinks 5-6 cans on weekdays and 8-12 cans on the weekends, as well as liquor. Henry also smokes half a pack per day of cigarettes. He smoked marijuana as a teen, but took no other drugs.

Henry’s father “drank himself to death.” He has had no previous addiction treatment.

Henry is currently not interested in quitting drinking right now. There is an order on his chart for one can of beer, three times daily with meals. The Psychiatry Consult-Liaison service has been contacted to address smoking cessation (to improve post-operative healing).

The psychiatrist recommends that the hospital:

• Discontinue beer service
• Medically manage the patient’s alcohol withdrawal syndrome
• Utilize motivational interviewing to address his alcohol use disorder

Meanwhile, the orthopedic team argues for the need to respect patient autonomy.

Analysis of Henry’s Case

There are conflicting interpretations of patient autonomy and physician beneficence:

• Beneficence (physician responsibility to provide the greatest benefit for the patient) is, initially, more important than autonomy.
• Drinking beer in the hospital poses short- and long-term health risks.
• Monitoring and medication for alcohol withdrawal is required by the principle of beneficence.
• After stabilization, autonomy becomes more important.
• The patient can decide whether to resume drinking after discharge.

There are additional ethical principles to consider:

• Nonmaleficence (do no harm).
• Beer is an intoxicant and a GI irritant, which can increase post-op complications.
• There are safer and more effective alternatives for alcohol withdrawal.
• Harm can be avoided by not providing beer.
• Fidelity (truthfully inform about all available options.
• Treatment is available for the patient’s alcohol use disorder.
• To fulfill the ethical responsibility to the patient, the clinician should address the patient’s drinking and provide appropriate information to engage the patient in a discussion of options.