Clinical Conflict Between the Principle of Benevolence and Respect for Autonomy

Introduction We present the case of the 25-year-old woman A.V. brought to the Emergency Primary Unit after a cardio-respiratory arrest by resuscitated ventricular tachycardia. Material and Method We mention from the personal pathological history that the patient is known with obstructive hypertrophic cardiomyopathy for which she has performed ablation of the septal artery 2 years ago. Clinical and anamnestic Congenital hip dysplasia of the operative (with familial aggregation-mother with the same affection), facials dismorphic-hyperteism, pterygium coli, short neck, pectus carinatum and cubitus valgus). Corroborating clinical, anamnestic and pre-admission events advocates a diagnosis suspicion: Noonan syndrome (manifested by obstructive hypertrophic cardiomyopathy and cardio-respiratory arrest by ventricular tachycardia). During hospitalization, the patient refuses antiarrhythmic drug therapy and is reluctant to accept the implantation of an automatic cardiac defibrillator (the absolute approach for secondary prophylaxis of sudden death), despite the repeated presentation of the risks to which she is subjected. Results So we are facing a situation where two of the principles of medical ethics, the principle of respect for autonomy and the principle of beneficence are in contradiction, referring to respecting the person's ability to choose (patient's concern not to be stigmatized by others and care for the physical appearance after implantation of the cardiac defibrillator) and care for the patient's well-being (patient status after medication administration and implantation of the automatic cardiac defibrillator). Conclusions It is decided to inform the family about the patient's state of health in order to obtain maximum benefit from all points of view. Finally, the automatic defibrillator assembly is agreed.