A 19-year-old undergraduate with a passion for skateboarding fell off a ramp at a local skate park, hitting his head and sustaining traumatic injuries to his brain and spinal cord. Two years later, he still requires round-the-clock care, and he is now hospitalized for an infection that may be resistant to antibiotics. Should antibiotic treatment be stopped?  Adding further complexity to this case are uncertainties about the patient’s decision-making capacity, whether it is possible to communicate with him to understand his preferences, and his parents’ role as decision-makers.

This case is one of a dozen reality-based fictional cases presented in Making Difficult Decisions with Patients and Families, a web-based casebook created by a team from The Hastings Center in collaboration with The Centre for Biomedical Ethics at the National University of Singapore (NUS) and the Ethox Centre at University of Oxford. It is a resource for physicians and other health care professionals designed to support self-reflective practice and clinical education on circumstances with ethical uncertainty. Ethical challenges in decision-making about treatment and care are often associated with the end of life, but they also arise in the management of chronic conditions and in working with multiple decision-makers.

Hastings Center research scholars Nancy Berlinger and Michael Gusmano led the Center’s role in developing and editing the casebook, which was designed by the Center’s former new media director, Jacob Moses. This 18-month collaboration is an example of the international scope of the Center’s work.