Case Study: Astrocytoma

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George Washington University
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This case study involves a male, 59 years of age, diagnosed with astrocytoma. The patient required immediate surgery without which he would be deceased within the next six months. The life of the male patient could be extended through surgery, using chemotherapy, and radiation to kill the malignant tissues in his brain which would increase his chance of living the next five years to between 10- 60 % (Sokol, 2008).

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Medical Indications

Medical indications form the starting quadrant of any case analysis that follows the Four Topic Approach in nursing (Schumann & Alfandre, 2008). The most effective diagnosis for the patient would be benign meningioma which would give him 60 % chance of surviving the next ten years. The risk of death or other complications during surgery is also high while a decision to forego surgery may lead to death. The goals of the treatment are confirming the diagnosis, alleviating the symptoms, and prolonging the patient's life by slowing the effects of the tumor. The treatment has a high chance of making the patient survive after surgery. Medical indications benefit the patient in that, facts about his condition are gathered, and treatment can easily be applied to the right information (Hoffmann et al, 2014).

Patient Preferences

This quadrant concentrates on the wishes of the patient. In this case, the patient could not communicate his preferences on the surgery for the suspected brain tumor. The patient had expressed his preferences, but his condition had to be aligned concerning the medical situation (Mallari, Grace, & Joseph, 2016). The patient had declined operational processes, but his medical circumstances indicated the need for surgery. The refusal by the patient could have been the result of being a witness to the suffering of his sister-in-law after brain surgery. The relatives of the patient were most appropriate to decide on whether the patient should undergo surgery if the patient was incapacitated otherwise the medical team should illustrate their care plan and request for permission (Sokol, 2008).

Quality of Life

Statistically from previous similar procedures, the patient has a good chance of life extension that would improve his quality of life. Additionally, the patient will not experience preoperative nervousness. The surgery will provide better prospects for the patient to go back to his previous life enjoyed before the illness unlike when he chooses not to undergo any treatment (Sokol, 2008).

Contextual Features

This final quadrant involves the clinicians considering the contextual features and how relevant the elements are in ethical analysis. In this case, there are no contextual factors that affect the analysis of the case. Factors such as cultural, confidentiality, religious, and economical do not have any influence. If the wife and the son had said refused the surgery for the patient even after the medical advice, contextual features might have been noted (Sokol, 2008).


In summary, the four quadrant approach was very helpful in deciding on the way forward to treating the patient. We followed the principles in advising the patient and his relatives while making important decisions. The approach is appropriate in determining medical procedures for sick patients without infringing their legal rights and those of their families. The framework is designed for facilitating methodical recognition and analysis ethical problems in medical procedures. The approach increases the ability of clinicians to recognize what are morally relevant and making judgments that are within the codes of ethics (Sokol, 2008).


Hoffmann, T. C., Legare, F., Simmons, M. B., McNamara, K., McCaffery, K., Trevena, L. J., & Del Mar, C. B. (2014). Shared decision making: what do clinicians need to know and why should they bother. Med J Aust, 201(1), 35-9.

Mallari, M. S. N., Grace, M., & Joseph, D. (2016). Ethical Frameworks for Decision-Making in Nursing Practice and Research: An Integrative Review.

Schumann, J. & Alfandre, D. (2008). clinical ethical decision making: the Four Topics Approach. Seminars In Medical Practice.

Sokol, D. K. (2008). The four quadrants approach to clinical ethics case analysis; an application and review. Journal of Medical Ethics, 34(7), 513-516.

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